Getting it right first time – precision medicine in diabetes. (10th October 2022)

• Record Type: Journal Article
• Authors: Kilvert, Anne; Fox, Charles
• Is Part Of: Practical diabetes. Volume 39:Number 5(2022)
• Page Start: 36
• Page End: 39
• Publication Date: 2022-10-10
• Subjects: precision medicine -- classification of diabetes -- treatment algorithms -- data clusters; Diabetes -- Treatment -- Periodicals; Medical protocols -- Periodicals; 616.46206
• DOI: 10.1002/pdi.2419
• Languages: English
• ISSNs: 2047-2897

Abstract

Abstract: Precision medicine – 'The right therapy for the right patient at the right time – every time' – has been a hot topic over the past few years. The definition refers not just to treatment but also to diagnosis, prevention and prognosis. The evidence base for precision medicine is drawn from three categories: (i) assessment of the genetic and metabolic state; (ii) interrogation of big data to inform disease categories; (iii) science‐guided preventative and treatment decisions. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) launched the Precision Medicine in Diabetes Initiative (PMDI) in 2018. Their first consensus report was published in 2020, with a four‐phase plan in place to produce guidelines and commence education of clinicians and patients by 2025. The best example of precision medicine in diabetes is monogenic diabetes, for which a genetic test in an individual identifies a specific diabetes type with implications for treatment. At the other extreme, ADA/EASD guidelines for type 2 diabetes identify four broad groups (cardiovascular disease risk; risk of hypoglycaemia; weight; cost) to guide treatment choice. Data analysis has led to identification of clusters within type 2 diabetes, with different clinical and genetic characteristics, but simple clinical factors such as age, weight, and eGFR may be sufficient to predict therapeutic response. For precision medicine to benefit the millions of people with diabetes globally, characteristics used to identify the best treatment for subgroups of populations must be easily measured and inexpensive. Precision medicine is a tool to aid treatment selection but the final choice must lie with the person who will be taking the treatment. Copyright © 2022 John Wiley & Sons.