Omnihealth Practice

CONFERENCE UPDATE: EASD 2023

Exploring the prospects of patient-oriented management of diabetes: The 2nd consensus report of the ADA/EASD Precision Medicine in Diabetes Initiative

DIABETES & ENDOCRINOLOGY

02 Jan 2024

Despite advancements in contemporary evidence-based medicine and treatment approaches for diabetes mellitus (DM), their clinical efficacy may still be limited by the heterogenicity of DM in its etiology, clinical presentation, and prognosis.¹ Hence, the concept of precision medicine has been established to improve accuracy in DM-related health recommendations and medical decisions, thus providing optimal treatment outcomes for patients with DM.¹ During the EASD Annual Meeting 2023, Professor Paul Franks from the Novo Nordisk Foundation, Denmark, presented the latest consensus report of the ADA/EASD Precision Medicine in Diabetes Initiative, which focused on the areas with the strongest evidence for clinical application of precision medicine, current research gaps, as well as the roadmap and milestones required for facilitating the incorporation of precision medicine into the standard of care for DM.¹

This international consensus report summarized the findings of 16 systematic reviews and investigated the feasibility of implementing the aspects of precision medicine (prevention, diagnosis, treatment, and prognosis) in the clinical practice of treating DM (monogenic, gestational, type 1, and type 2) by 2030.¹ In total, 200 academics and 194 academic institutions from 28 countries were involved in the literature review and evidence grading sessions.¹ Based on the systematic reviews, the consensus report summarized the current evidence for clinical translation of precision medicine (table 1) and offered recommendations across 5 domains for incorporating precision medicine into DM management, which included benchmarking and technology, policy implementation and liabilities, equity and community engagement, commercialization and access, and education.¹ In addition, the consensus report also highlighted research gaps and established future priorities in the development of DM precision medicine (table 2 & 3).¹

In summary, precision medicine involves multiple stakeholders and phases, including research, regulatory engagement and approval, healthy equity assessment, and access to care.¹ Prioritization of stages beyond the research phase is necessary to ensure a comprehensive clinical application of precision medicine in DM.¹

Type of DM	Aspect of precision medicine	Methodology & Applications	Evidence
Monogenic	Diagnostics	Next-generation genome sequencing for diagnostics & selecting treatment decisions	Strong
	Treatment
GDM	Diagnostics	Treatment algorithms utilizing a combination of traditional clinical factors and novel biomarkers for predicting treatment efficacy & risk of complications	Growing
	Treatment (mother)
	Prognostics (mother & offspring)
T1D	Prevention	Genetic risk scores plus Islet autoantibody testing for predicting & preventing disease development	Strong
	Diagnostics
T2D	Diagnostics	Subclassification algorithms for diagnostics	Strong
	Treatment	Simple clinical markers for predicting differential treatment outcomes

Table 1. Current evidence for clinical translation of precision medicine in DM

DM: Diabetes mellitus; GDM: Gestational diabetes; T1D: Type 1 diabetes; T2D: Type 2 diabetes

Research gaps
Diversity, equity & inclusion
1	Additional focus on ethnic, geographic, and cultural diversity should be included in precision medicine research
2	Ongoing assessment of disparity gaps for vulnerable groups to ensure equity
Precision medicine trials
1	Prospective trials for precision medicine should be incorporated early on into drug development pipelines
2	Interventions that target physiological processes characterized by key biomarkers
Special focus on pregnant patients
1	Dynamic biomarker assessments in pregnancy and postpartum settings
2	Interventions that start in early pregnancy or pre-conception in high-risk patient subgroups
Primary and secondary prevention of T1D & T2D
1	Cost-effective disease-modifying interventions for early detection and prevention in high-risk individuals
2	Interventions that focus on microvascular and macrovascular complications of T1D & T2D patients

Table 2: Current research in the development of precision medicine in DM

T1D: type 1 diabetes; T2D: type 2 diabetes

Roadmap for global application of precision medicine in diabetes
1	Securing health equity & mitigating disparities Conduct population-based studies to modify precision medicine solutions to population-specific needs Investigate alternatives to avoid overreliance on certain technologies (e.g. genetics)
2	Meeting standards of care & managing liabilities Explore how precision medicine might enhance healthcare delivery Establishing patient selection criteria for precision DM medicine
3	Ensuring sustainability & accessibility Strike a balance between commercial profit and accessibility for patients with the pharmaceutical industry Examine the ethical, social, and economic implications
4	Priorities in future precision medicine research Standardize the reported data from precision medicine research to align the consistency of clinical evidence Reuse trial data to generate hypotheses for precision DM medicine trials Investigate novel biomarkers for precision DM medicine approaches Examine the application of multimodal AI prediction models for treatment responses
5	Regulatory requirements Advise regulatory bodies in developing guidance for approval and reimbursement of precision DM medicine

Table 3. Roadmap & milestones for global precision medicine in DM

AI: Artificial intelligence; DM: Diabetes mellitus

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