Precision Medicine in Type 1 Diabetes

Abstract

Type 1 diabetes is a complex, chronic disease in which the insulin-producing beta cells in the pancreas are sufficiently altered or impaired to result in requirement of exogenous insulin for survival. The development of type 1 diabetes is thought to be an autoimmune process, in which an environmental (unknown) trigger initiates a T cell-mediated immune response in genetically susceptible individuals. The presence of islet autoantibodies in the blood are signs of type 1 diabetes development, and risk of progressing to clinical type 1 diabetes is correlated with the presence of multiple islet autoantibodies. Currently, a “staging” model of type 1 diabetes proposes discrete components consisting of normal blood glucose but at least two islet autoantibodies (Stage 1), abnormal blood glucose with at least two islet autoantibodies (Stage 2), and clinical diagnosis (Stage 3). While these stages may, in fact, not be discrete and vary by individual, the format suggests important applications of precision medicine to diagnosis, prevention, prognosis, treatment and monitoring. In this paper, applications of precision medicine in type 1 diabetes are discussed, with both opportunities and barriers to global implementation highlighted. Several groups have implemented components of precision medicine, yet the integration of the necessary steps to achieve both short- and long-term solutions will need to involve researchers, patients, families, and healthcare providers to fully impact and reduce the burden of type 1 diabetes.

Navigating Cardiovascular Risk in Type 1 Diabetes: A Comprehensive Review of Strategies for Prevention and Management

“…The concept of precision medicine in T1DM represents a paradigm shift towards personalized treatment strategies tailored to individual characteristics, with the overarching goal of achieving curative outcomes while minimizing adverse effects [ 47 ]. Precision medicine encompasses a multifaceted approach that involves early identification of at-risk individuals, classification into subgroups based on unique characteristics, and optimization of treatment regimens to mitigate the risk of complications in those with T1DM [ 47 ]. Central to this approach is the recognition of individual variability in disease progression and treatment response, highlighting the need for tailored interventions that address each patient's specific needs and risk factors [ 47 ].…”

“…Precision medicine encompasses a multifaceted approach that involves early identification of at-risk individuals, classification into subgroups based on unique characteristics, and optimization of treatment regimens to mitigate the risk of complications in those with T1DM [ 47 ]. Central to this approach is the recognition of individual variability in disease progression and treatment response, highlighting the need for tailored interventions that address each patient's specific needs and risk factors [ 47 ]. In the context of cardiovascular risk management in T1DM, precision medicine holds significant promise for enhancing risk prediction and optimizing therapeutic interventions [ 48 ].…”

PPARs at the crossroads of T cell differentiation and type 1 diabetes

“…This misguided immune attack leads to the progressive destruction of insulin-producing bcells, resulting in insulin deficiency and elevated blood sugar levels. Also, the presence of these autoantibodies is a hallmark of T1D and is often utilized in precision diagnosis (28,29). Besides, this autoimmune process occurs when the immune system, primarily coordinated by T cells, initiates an abnormal assault on the insulinproducing b-cells within Langerhans' pancreatic islets (30).…”