Precision medicine in diabetes: an opportunity for clinical translation

Abstract

Metabolic disorders present a public health challenge of staggering proportions. In diabetes, there is an urgent need to better understand disease heterogeneity, clinical trajectories, and related comorbidities. A pressing and timely question is whether we are ready for precision medicine in diabetes. Some biological insights that have emerged during the last decade have already been used to direct clinical decision making, especially in monogenic forms of diabetes. However, much work is necessary to integrate high-dimensional explorations into complex disease architectures, less penetrant biological alterations, and broader phenotypes, such as type 2 diabetes. In addition, for precision medicine to take hold in diabetes, reproducibility, interpretability, and actionability remain key guiding objectives. In this review, we examine how mounting data sets generated during the last decade to understand biological variability are now inspiring new venues to clarify diabetes nosology and ultimately translate findings into more effective prevention and treatment strategies.

Effectiveness of Yoga as the Public Health Intervention Module in the Management of Diabetes and Diabetes Associated Dementia in South East Asia: A Narrative Review

“…DM, being a major public health challenge and a heterogeneous disease, calls for better understanding of its pathogenesis, clinical manifestation, comorbidities, and future complications particularly dementia. Despite the heterogeneity of pathogenesis, DM is characterized by insulin resistance or relative insulin deficiency in the presence of hyperglycemia and represented with internal glycemic index parameters like HbA1c, fasting blood sugar, and so on [87]. Several observational studies from high-income countries have found environmental effects influencing T2DM.…”

Utility of Precision Medicine in the Management of Diabetes: Expert Opinion from an International Panel

“…The variety of different hybrid forms of DM, including latent autoimmune disease of adults (LADA) and ketosis-prone diabetes (KPD), is suggestive of biological alterations. In diabetes care, the scope of precision diabetes applies both to the more common forms of diabetes, such as T1DM and T2DM, and to the relatively rare subtypes of diabetes, such as monogenic diabetes [4].…”

“…Knowledge of an accepted classification of DM is prudent to a good understanding of the clinical application of precision medicine in diabetes care. With this in mind, according to the American Diabetes Association (ADA) Standards of Medical Care in Diabetes-2019 [4], DM can be classified into the following general categories: [5].…”

“…Precision diabetes also finds practical applications in the context of continuous glucose monitoring. The clinical applications of precision medicine in diabetes care is summarized in Table 1 (adapted from [4]).…”

The Continuing Evolution of Precision Health in Type 2 Diabetes: Achievements and Challenges

“…Collectively, genome-wide-significant and validated SNPs account for 10-15% of overall heritability of T2D susceptibility [10]. This "missing heritability" led to next generation sequencing of whole exomes and genomes to identify rare variants with presumably larger genetic effect sizes [11].…”