Report: Precision medicine has potential to advance diabetes treatment
CHARLOTTESVILLE, Va. (CBS19 NEWS) -- An international report says diabetes patients may be able to get personalized care thanks to “precision medicine.”
According to a release, more than 200 experts from 28 countries put together a consensus report that looks at published scientific literature to assess the state of the field of diabetes diagnosis and treatment around the world.
This report has found that precision medicine has great potential to advance the diagnosis, treatment, and possibly prevention of different forms of diabetes.
It highlights ways in which this kind of care has already has already changed how diabetes is diagnosed, prevented, treated and monitored, but it also helps to identify other areas where research is needed.
Additionally, the report recommends steps to take immediately to help improve current patient care.
“The work by this international consortium has taken over three years, all by volunteer effort, determining where precision diabetes medicine works and, more importantly, what are the knowledge gaps and barriers to implementation,” said the University of Virginia School of Medicine’s Stephen S. Rich, PhD, co-chair of the Precision Medicine in Diabetes Initiative (PMDI) that produced the report. “Diabetes is a heterogeneous disease, and the classical definitions of type 2 diabetes, for example, is overly simple and leads to issues of diagnosis (is it really type 2 diabetes?), treatment (what drug is best to achieve normal blood sugars, or is behavioral change, such as increased exercise and/or improved diet, sufficient?), and prognosis (is there increased risk of heart disease, kidney disease or other complication of diabetes that requires more intensive follow-up and monitoring?). Critically, we need to develop an understanding of the heterogeneity of diabetes that can be applied globally, and not to only the well-resourced countries and groups.”
Through precision medicine, patients receive personalized treatment tailored to their needs instead of getting the same treatment as others.
This approach has been more commonly seen in cancer research where treatments are selected for each person.
Precision medicine identifies groups of people with similar disease characteristics and similar responses to treatment as well as similar risks of complications.
Type 2 diabetes is the most common form of the disease, so the use of precision medicine can help to break cases down into precise sub-types and allow for better treatment options.
For diabetes medicine, this incorporates information about a person’s genes, lifestyle and other factors to make sure the patient gets the best care.
As a result, patients and providers see correct effects and improved outcomes.
The PMDI was convened in 2018 by the American Diabetes Association and the European Association for the Study of Diabetes to assess where diabetes precision medicine stands as well as its future potential.
The release says this report shows important progress in the implementation of this approach, including how precision medicine plays an essential role in diagnosing and treating several forms of monogenetic diabetes, which is caused by a single gene mutation seen in less than three percent of cases.
“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,” said Paul Franks, PhD, chair of the report and scientific director in medical science and head of translational medicine at the Novo Nordisk Foundation.
All forms of diabetes are based on genetics, but most have many variants and non-genetic factors that contribute to the risk, making precise diagnosis more difficult.
Scientists say precision medicine may also help manage gestational diabetes, which can occur in mothers during pregnancy and increase the risk of type 2 diabetes in mother and child.
The release says specific maternal characteristics, including age, body mass index and family history, have been identified as predictive factors for the success or failure of treatment.
Regarding type 1 diabetes, this report shows genetic risk classification is a promising area for immediate clinical implementation.
And UVA researchers have identified 90 percent of the genetic risk of type 1 diabetes, which means doctors can look at a child’s genetic risk to see if they have an increased chance of developing type 1 diabetes.
For children at high risk, doctors can screen for the presence of specific antibodies called islet autoantibodies, which indicate that the immune system is attacking insulin-producing beta cells.
That may allow for immune interventions.
“A series of gaps in knowledge were identified by the experts that cut across all forms of diabetes,” said Rich,of UVA’s Center for Public Health Genomics and the Department of Public Health Sciences. “It became clear that the published findings were predominantly in people of European Caucasian ancestry, from well-resourced countries, and often did not provide strong statistical support for their results. As a result, more work in diverse populations is needed, to include use of multiple data sources, development of scalable and inexpensive assays for biomarkers, understanding both clinical and social/behavioral factors and consideration of diabetes across the lifespan.”
The findings of this report were recently presented at a meeting in Hamburg, Germany, and the report has been published in Nature Medicine.