A new international consensus report on precision medicine in diabetes prevention and care highlights opportunities for the immediate or near-term adoption of precision diabetes medicine in clinical practice, while also emphasizing the critical knowledge gaps that are essential to address.
Supported by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) and the Novo Nordisk Foundation, the consensus report was made possible through a huge collaborative effort involving 200 academic experts from 28 countries under the banner of the Precision Medicine in Diabetes Initiative (PMDI).
“It has involved a tremendous amount of work by many of the world’s experts in precision diabetes medicine,” says Paul Franks, who chaired the report. Franks is Head of Translational Medicine and Scientific Director at the Novo Nordisk Foundation and Professor of Genetic Epidemiology at Lund University, Sweden.
The report, which is the second international consensus report on precision diabetes medicine, highlights significant advancements in the adoption of precision medicine in diabetes prevention, diagnosis, treatment, and prognosis while also shedding light on numerous knowledge gaps.
Diabetes is a significant global health concern, impacting hundreds of millions of people. The disease is categorized into several types, with the two most prevalent being type 1 and type 2 diabetes, along with gestational diabetes, monogenic diabetes, and other rare forms of the disease. Diabetes poses a substantial risk of life-threatening complications and premature death. What adds to the complexity is the heterogeneous nature of diabetes, encompassing various causes, clinical manifestations, and prognoses.
The heterogeneity underscores the need for more precise diagnostic, prevention and treatment strategies than exist today.
Paul Franks explains that precision medicine can be broadly defined as “an approach that uses person-level information to help minimise error in medical decisions and health recommendations”. The goal is to improve health outcomes, cost-effectiveness and health equity.
The application of precision medicine in diabetes prevention and care offers hopeful prospects for reducing complications and fatalities. By acknowledging and addressing the inherent variabilities, precision medicine aims to make meaningful strides towards improving the lives of people living with diabetes.
The consensus report shows clear progress in implementing precision diabetes medicine, shedding light on opportunities for its immediate or near-term clinical application. For instance, precision medicine plays an essential role in diagnosing and treating monogenic diabetes, thanks to major advancements in genetic testing.
“In the field of monogenic diabetes, precision medicine holds a lot of promise because one can achieve a very precise diagnosis using genomics, which guides treatment choices,” Franks says.
Furthermore, precision medicine shows potential in managing gestational diabetes. Notably, specific maternal characteristics have been identified as predictive factors for the success or failure of treatment; these include age, BMI, and a family history of diabetes. Moreover, evidence supports the notion that maternal variables such as BMI, insulin sensitivity, insulin secretion, and dyslipidaemia can contribute to more precise diagnostic assessments.
In the context of type 1 diabetes prevention, the consensus report identifies genetic risk classification as one of the most promising areas for immediate clinical implementation. By screening for islet autoantibodies in individuals identified as having an elevated risk of developing type 1 diabetes based on their genetic profile, there is potential to provide immune interventions for those at highest risk of disease progression.
The report also presents evidence that routine clinical features can help predict how well different types of drugs work when treating type 2 diabetes, and how this common form of diabetes can be sub-classified into more precise sub-types.
While the consensus report highlights areas where precision medicine can have an impact in clinical practice, it also draws attention to research gaps and the need for improved research methods.
“There is a big need for better reporting standards, study design standards, and specifically designed precision medicine trials. The consensus report provides a framework for what future research should focus on,” Paul Franks says.
The report summarizes the findings of 15 systematic reviews of published evidence and expert opinions in prioritized areas of precision diabetes medicine, conducted under the umbrella of the PMDI. The PMDI was established in 2018 by the ADA in collaboration with the EASD to confront the unsustainable health and economic challenges associated with diabetes management and prevention.
The consensus report was published in Nature Medicine on 5 October 2023. Paul Franks presented the main findings at the EASD Annual Meeting in Hamburg on the same day. The systematic evidence reviews summarized in the consensus report were published in Communications Medicine, with a parallel series of papers on precision medicine published in The Lancet Diabetes & Endocrinology.