Capitalizing on the potential of "precision medicine" to improve diabetes care around the world will require us to change how we think about the disease, our Stephen S. Rich, PhD, and colleagues argue in a new commentary in the journal Nature Medicine.
Precision medicine looks not just at a disease but all the factors that contribute to it at the individual level, such as a person's lifestyle, diet and environment. This holistic view helps determine the best treatment options for each individual.
There are, however, many big-picture obstacles standing in the way of true precision medicine for diabetes, Professor Rich and his colleagues argue. For example, they say, there are huge research gaps that need to be addressed. This includes developing more nuanced understanding of the disease subtypes, as well as identifying biomarkers for these subtypes.
Other needs include ensuring that patients in lower-income countries are not left behind and capitalizing on the potential of artificial intelligence to improve clinical care.
“There is a global epidemic of diabetes, particularly type 2 diabetes, that reflects the interaction of genetic susceptibility with a Westernized lifestyle, including a poor diet and physical inactivity that leads to insulin resistance through apparently multiple biological pathways,” Professor Rich told me. “While there has been some progress on identifying subgroups of people that are based upon simple clinical measures that predict the ‘type’ of diabetes and its prognosis, how to implement change in behavior and treatment specific to the subgroups globally has yet to be resolved.”
Professor Rich is working to find ways to overcome such obstacles in a group convened by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases’ Advisory Council. The group expects its work will take 18 months to two years.
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