Precision medicine in diabetes: a Consensus Report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Abstract

The convergence of advances in medical science, human biology, data science and technology has enabled the generation of new insights into the phenotype known as 'diabetes'. Increased knowledge of this condition has emerged from populations around the world, illuminating the differences in how diabetes presents, its variable prevalence and how best practice in treatment varies between populations. In parallel, focus has been placed on the development of tools for the application of precision medicine to numerous conditions. This Consensus Report presents the American Diabetes Association (ADA) Precision Medicine in Diabetes Initiative in partnership with the European Association for the Study of Diabetes (EASD), including its mission, the current state of the field and prospects for the future. Expert opinions are presented on areas of precision diagnostics and precision therapeutics (including prevention and treatment) and key barriers to and opportunities for implementation of precision diabetes medicine, with better care and outcomes around the globe, are highlighted. Cases where precision diagnosis is already feasible and effective (i.e. monogenic forms of diabetes) are presented, while the major hurdles to the global implementation of precision diagnosis of complex forms of diabetes are discussed. The situation is similar for precision therapeutics, in which the appropriate therapy will often change over time owing to the manner in which diabetes evolves within individual patients. This Consensus Report describes a foundation for precision diabetes medicine, while highlighting what remains to be done to realise its potential. This, combined with a subsequent, detailed evidence-based review (due 2022), will provide a roadmap for precision medicine in diabetes that helps improve the quality of life for all those with diabetes.

Perspectives on Precision Medicine Approaches to NAFLD Diagnosis and Management

“…Similarly, the use of the glucagon-like peptide 1 (GLP-1) receptor agonists such as liraglutide or semaglutide is very promising as there is evidence that these agents impact liver histology and can also improve cardiovascular outcomes in patients with T2D [ 166 – 169 ]. Finally, as T2D itself is heterogeneous in its etiology, pathogenesis, and clinical presentation, precision medicine approaches to treat and prevent the disease are being actively investigated but significant barriers to their implementation and research gaps still exist [ 170 ].…”

SGLT-2i and Risk of Malignancy in Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials

“…Poor blood sugar control in diabetics may cause blindness, kidney failure and lower limb amputations ( 2 ). In recent decades, type 2 diabetes (T2D) has become a global public health crisis with a severe impact on human health ( 3 ), accounting for about 90% of people with diabetes, and the second leading global death reason is cancer, representing one sixth ( 4 ). Diabetes is evidenced to associate with a potential malignancy, risk with diabetics having a 10–20% higher risk of malignancy than non-diabetics ( 5 ).…”

“…10%; not treat with OAD: FPG <13.9 mmol/l; treat with OAD: FPG <13 3. mmol/l; antidiabetic or antihypertensive or antihyperlipidemic regimen must be stable (≥3 month);capillary blood glucose <13.9 mmol/l 96 Bexagliflozin 20 mg Placebo Halvorsen et al (35) Multicenter NCT03115112 MET ≥1,500 mg/day no change at 8 weeks; hypertension or hyperlipidemia medications must be stable (≥1 month) (if applicable5-10.0%; eGFR 30-60 ml/min/1.73 m 2 ; diet and exercise only or treat with 1 or 2 OHAs at a fixed dose >8 weeks 52 Luseogliflozin 2.5 mg Placebo/Luseogliflozin Henry et al (38) Multicenter NCT00643851 drug naive or with AHA for <24 weeks; C-peptide ≥1.0 ng/ml; Scr <1.50 mg/dl for men or <1.Januzzi et al (45) Multicenter NCT01106651 HbA1c 7-10.0%; no AHA or on a stable regimen of monotherapy or combination therapy; FPG <15 mmol/l; eGFR ≥50 ml/min/1.…”

Precision medicine in diabetes—Finally some light at the end of the tunnel?

“…)-yet-economically congenial (like, random plasma show prompt and sustained glucose-lowering response to sulfonylureas. 1,2 Similar to T2D, gestational diabetes mellitus (GDM) is also a heterogeneous disorder and hence not easily tenable to precision medicine. 1,2…”

“…3 The PMDI Task Force encompasses both the Executive Oversight Committee, which functions as the governing body, and the Steering Committee, which functions as the guiding body for PMDI activities. [1][2][3] The Report defines precision diabetes medicine as "an approach to optimize the diagnosis, prediction, prevention, or treatment of diabetes by integrating multidimensional data, accounting for individual differences." Furthermore, the first purpose of this report 1,2 was to define the different terminologies related to precision diabetes medicine along with reviewing the present status of diagnostics and therapeutics in diabetes; the term therapeutics includes both prevention and treatment.…”