A tremendous opportunity exists for “precision medicine” to transform diabetes care worldwide, but will require bold new ways of thinking and significant investments, say a University of Virginia School of Medicine expert and his colleagues.
In a commentary in the scientific journal Nature Medicine, UVA’s Dr. Stephen S. Rich and other leaders in the battle against diabetes detail an international effort to improve diabetes care and outline the challenges the effort must overcome. They note that diabetes – particularly type 2 diabetes – is a far more complex and diverse disease than many people assume, with huge variations in its causes and effects and in patients’ responses to treatment.
Precision medicine aims to account for all variables and more to improve diabetes care and help patients live healthier lives. For example, true precision medicine would incorporate people’s lifestyles, diet, environment, behavior and other factors to determine the best treatment options for each individual.
But, the scientists said, many big-picture obstacles stand in the way of precision medicine reaching its potential for improving diabetes care. Rich and his colleagues argue, there are huge research gaps that must be addressed. Doctors and scientists must develop more nuanced understanding of the subtypes of the disease, as well as identify new biological markers (“biomarkers”) of the subtypes, the researchers said. Other urgent needs include finding ways to implement artificial intelligence in clinical care and ensuring that patients in lower-income countries are not left behind.
“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,” Rich, of UVA’s newly formed Department of Genome Sciences, said. “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.”
Rich is working to find ways to overcome the obstacles to precision medicine as part of a group convened by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases’ Advisory Council. The group is assessing the state of precision medicine and will provide guidance for how to move forward from a global perspective. Rich co-chairs the group with Dr. Paul Franks of Sweden’s Lund University and Dr. William Cefalu of the National Institute of Diabetes and Digestive and Kidney Diseases.
The international group of investigators has already reached some important conclusions in an initial meeting. The conclusions include that a widespread interest and investment exists around the world in better understanding the many variations, or “heterogeneity,” in diabetes. Important opportunities are also possible to leverage existing data about the disease and great need for more data on non-Europeans. Lastly, an urgent need exists to address the many research gaps that stand in the way of improving care for people around the world.
While some of the challenges are daunting, particularly at a global scale, Rich and his colleagues write that they can be overcome “if the global medical and scientific communities embrace this paradigm shift toward a precision medicine approach for people living with diabetes, regardless of who they are or where they live.”
The members of Rich’s group expect their work will take 18 months to two years. But they hope it will ultimately have long-lasting and far-reaching benefits for patients everywhere.
“We have found that each country represented in the group recognizes the importance of heterogeneity in diabetes, and all are undertaking research to implement a precision medicine, and precision health, approach,” Rich said. “At the same time, these are well-resourced countries, and the global burden of diabetes will be in countries with the least support for research and healthcare, so we need to consider low-cost but high-impact measures that can be used by healthcare practitioners to reduce the burden of diabetes globally.”
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Rebecca Barnabi
