New consensus report highlights progress and potential of precision medicine in diabetes

A new international consensus report on precision medicine in diabetes prevention and care highlights the significant advancements in precision medicine in diabetes prevention, diagnosis, treatment, and prognosis while also shedding light on numerous knowledge gaps.

The report, Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine, was published in Nature Medicine on October 5, 2023.

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) including Marie-France Hivert, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute.

Diabetes is a significant global health concern, impacting hundreds of millions of people and posing a substantial risk of life-threatening complications and premature death. 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. The heterogeneous nature of diabetes, encompassing various causes, clinical manifestations, and prognoses adds to the complexity of treating the disease. These issues underscore the need for more precise diagnostic, prevention, and treatment strategies than exist today.

Among the many findings, the consensus report shows that precision medicine plays an essential role in diagnosing and treating monogenic diabetes and shows potential in managing gestational diabetes. The report also presents evidence that routine clinical features can help predict how well different types of drugs work when treating type 2 diabetes.

"Precision medicine could help refine our diagnosis for sub-types of diabetes and predict treatment responses or outcomes, all of which could help us better target our clinical management, treatment recommendations, and reduce diabetes-related complications," says Dr. Hivert. Her research has focused on understanding the determinants of diabetes, including gestational diabetes mellitus (GDM), using genetics and other omics approaches, and their interaction with lifestyle and environmental factors. As part of this report, Dr. Hivert led the efforts of four working groups focused on precision medicine for GDM (prevention, treatment, diagnostic, and prognostic).

While the consensus report highlights areas where precision medicine can have an impact on clinical practice, it also provides a framework for the direction of future research. When asked about the impact of this work, Dr. Hivert states, "Through the effort of the multiple working groups for each type of diabetes, we know that bringing together international diabetes experts from all around the world is already forging new collaborations. We hope that these relationships will flourish to accelerate the field of precision medicine in diabetes and make meaningful strides towards improving the lives of people living with diabetes."

Collaborative effort

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.