An international consensus report on diabetes identifies the potential for diabetes screening, better classification of type 2 diabetes, and biomarkers that can predict cardiovascular disease. The report also highlights that more evidence is needed before it is possible to provide individualised treatment to all patients. The report is based on a large collaboration between 28 universities worldwide and has been led by professor Paul Franks at Lund University.
Using precision medicine in diabetes means that treatment of the disease and its complications can become more precise and accurate. In the future, precision medicine can become an important tool for the prevention of diabetes, to improve treatments, and delay common complications such as cardiovascular disease in diabetes. A new international consensus report published in Nature Medicine summarises how far the research community has come. The report is based on a total of 15 systematic evidence reviews that have been carried out by a total of 200 researchers.
“The report is intended to be of use to policy makers, clinicians, researchers, and funders. It highlights opportunities and gaps for the translation of precision diabetes medicine in clinical practice”, says Paul Franks, professor of genetic epidemiology at Lund University, who has led the work with the report.
One important conclusion drawn by the scientists is that more research is needed to develop evidence-based and individualised treatments for patients with type 1 diabetes, type 2 diabetes, monogenic diabetes, and gestational diabetes. The report highlights the ways in which precision medicine is already aiding diagnosis and treatment in monogenic diabetes.
“It’s a form of diabetes that has a strong genetic component, which means that it may be beneficial to implement screening tests for the disease through next-generation sequencing technologies. Early detection may improve the treatment”, says Paul Franks, who is head of the Department of Translational Medicine at Novo Nordisk Foundation in Denmark as well as a researcher at Lund University Diabetes Centre (LUDC).
In type 1 diabetes, the authors have identified opportunities within research that involves identifying individuals with an increased risk of developing the disease. By screening individuals to find those who have both a genetic and autoantibody profile that raises risk of type 1 diabetes, it may be possible to offer treatments that can prevent or delay disease progression in the future.
Better classification of type 2 diabetes
Type 2 diabetes is the most common form of diabetes and people with the disease are often viewed as a single patient group, but recent research supports the theory that type 2 diabetes is more complex. In 2018 researchers at LUDC published a study that received a lot of attention that shows it is possible to divide type 1 diabetes and type 2 diabetes into five subgroups based on how the disease develops and what the risk of developing common complications looks like. Four of these groups consist of people with type 2 diabetes.
“The report highlights that people tend to transition between subgroups as their disease progresses. It’s important that researchers continue to study different ways of classifying the disease so that the method can be useful in a clinical setting”, says Paul Franks.
Biomarkers that can predict complications
Maria F. Gomez, coordinator at LUDC, has led the work relating to one of the articles that the report is based on. Researchers have reviewed the current knowledge base about precision medicine that can predict cardiovascular disease in people with type 2 diabetes. Their analysis of close to 200 biomarkers identified four that were particularly promising.
“Individuals with type 2 diabetes have up to twice as high risk for cardiovascular disease than those without diabetes, but predicting who will experience a cardiac event is challenging with the risk tools and methods currently used in clinical practice. There is a need for personalised risk prediction tools to classify patients more accurately so that cardiovascular disease prevention can be targeted to those who need it most”, says Maria F. Gomez, professor of physiology at Lund University.
The authors of the report establish that precision medicine has the potential to improve health if the solutions are available, cost-effective, and safe for people in all parts of the world. A consistent deficiency in the field is that many studies have been carried out in people of European ancestry and it is not certain that studies in other populations will produce the same results.
“It becomes problematic if we develop solutions that are only applicable to certain populations and cannot be used in, for example, Africa, where the total number of people with diabetes is predicted to increase quite dramatically in the coming years. We also have increased mobility in the world, so it will become more important that countries can offer treatments that can help all individuals, regardless of ancestry”, says Maria F. Gomez.