Can Precision Medicine Reduce the Burden of Diabetes?

Abstract

Precision medicine is a new health care concept intended to hasten progress toward individualized treatment and, in so doing, to improve everyone’s opportunity to enjoy good health. Yet, this concept pays scant attention to opportunities for change in the social determinants that are the major driv­ers of health. Precision medicine research is likely to generate improvements in medical care but may have the unintended conse­quence of worsening existing disparities in health care access. For prevention, precision medicine emphasizes comprehensive risk prediction and individual efforts to accom­plish risk reduction. The application of the precision medicine vision to type 2 diabe­tes, a growing threat to population health, fails to acknowledge collective responsibility for a health-promoting society.Ethn Dis. 2019;29(Suppl 3):669-674;doi:10.18865/ed.29.S3.669

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“…This result is consistent with other data suggesting that genetic risk information does not motivate behavioral change (68) and is not surprising, given the powerful effect of the social environment on behavior (54). Furthermore, an elevated risk for diabetes is common, affecting a third of Americans and half of individuals over age 65 (34); it seems reasonable to hypothesize that community-based approaches to address this problem, rather than interventions based on stratified risk, will be the most effective (34,54). Conversely, polygenic risk assessment may identify a small proportion of individuals whose risk is markedly elevated and who might therefore benefit from personalized case management (86), although testing this strategy against a community-based approach would be reasonable.…”

“…This process might also help to refine hypotheses for benefits from genomic medicine and clarify elements of study design. As an example, some have speculated that polygenic risk prediction could improve diabetes prevention; however, three clinical trials have shown little impact of genetic risk information on preventive behaviors for diabetes (34). This result is consistent with other data suggesting that genetic risk information does not motivate behavioral change (68) and is not surprising, given the powerful effect of the social environment on behavior (54).…”

Toward better governance of human genomic data

“…Finally, there is the potential for genomic data to be used in ways that exacerbate, rather than reduce, health care disparities across or within societies, especially if there are inequities in the underlying data collection and analysis processes 14 . For example, genomic research projects investigating the prevalence of obesity and type 2 diabetes, which disproportionately affect minority populations in the United States, might in fact exacerbate health disparities among a wide segment of a society if genomic explanations are emphasized rather than integrated into broader social models of disease and interdisciplinary research methods 15 . A good governance framework should identify measures to alleviate inequities in access, use, and analysis.…”

Employees’ Views and Ethical, Legal, and Social Implications Assessment of Voluntary Workplace Genomic Testing

“…Thus, wGT as part of wellness programs might be able to inform strategies to mitigate disease risks. However, whether wGT truly influences behavior change and offers long-term benefits remains an open question ( Hollands et al, 2016 ; Burke et al, 2019 ; Yanes et al, 2019 ). Additionally, existing studies on wellness programs that report minimal benefits do not account for wGT, which is an emerging area ( Lieberman, 2019 ; Song and Baicker, 2019 ).…”