Exploring the Role of Precision Medicine in Diabetes Diagnoses
Feb 23, 2022, 13:55 PM
By Wendy Mobley-Bukstein, PharmD, BCACP, CDCES, CHWC, FAPhA
Precision medicine is characterized by six categories: precision diagnosis, precision therapeutics, precision prevention, precision treatment, precision prognosis and precision monitoring. Precision medicine considers genetic make-up, environment and contextual factors that cause disease presentation. Precision medicine is a component of person-centered care. (Person-centered care is also known as individualized medicine or personalized medicine.)
The writing team that was assembled to explore the significance of this topic as it relates to diabetes wanted to bring together all types of diabetes into one publication. We wanted a comprehensive look at the classification of diabetes, the diagnostic criteria and the education and treatments for each. As we worked through our research, we learned that there were many ways to classify diabetes depending on where you practiced. In the United States, we utilize one classification schematic where outside the US there are several other classification schemas, both actual and conceptual. This led us to think on a deeper level as to how we want clinicians to think about diabetes. Our findings culminated in “Exploring the Role of Precision Medicine in Diabetes Diagnoses,” now available in the January issue of ADCES in Practice. Precision medicine is the present and future of diabetes diagnosis, prevention, treatment and monitoring.
These models assist in a deeper understanding of the pathophysiology of the disease process and thus lead to quicker diagnosis and ultimately more accurate treatment
In the paper we explore the classification systems of diabetes and call your attention not only to the actual systems in use, but also to those conceptual frameworks that have been hypothesized. As we learn more about the components of precision medicine, some of these models assist in a deeper understanding of the pathophysiology of the disease process and thus lead to quicker diagnosis and ultimately more accurate treatment.
The use of genetic markers to classify diabetes can tell us if there are mutations that could mean that the diabetes diagnosis is a monogenic form, if there is a deficiency in insulin production or absolute pancreatic failure. This helps guide not only a diagnosis, but also treatment care plans, education, prognosis and monitoring. Although now, we can utilize genetic information for these more precise diagnoses, it is difficult to consider how the environment and other contextual factors lead to a diabetes diagnosis. This is the future of diabetes research. We need to learn more about how the environment plays a role in the onset of diabetes. In type 2 diabetes, one could postulate that sedentary lifestyle and nutrition choices could play a role, but there are certainly many more possibilities. Does zip code play a role? Are individuals living in urban settings versus rural settings at a higher risk for developing diabetes? Are individuals who have had COVID-19 at a higher risk for developing diabetes? If a person has experienced a life stressor or traumatic event, does that predispose them to diabetes? Does what you eat or drink and how it was produced predispose you to diabetes?
Precision medicine also utilizes big data from biomarkers, bioimaging, wearable technology data, electronic health information and health insurance claims. Predictive analytics uses this data to determine potential risk for disease. It could also assist in identifying appropriate prevention and/or treatment. This is where research in the future will focus on how to utilize this data and make it more transferable to the clinician.
We identified that the use of genetic testing and precision medicine as it exists is underutilized for many reasons. It is not considered mainstream in diagnostics. Additionally, the lack of trust in the healthcare system and under-representation of racial and ethnic populations in research doesn’t give us a homogenous picture of how precision medicine would work in a generalizable manner. Unfortunately, there are many individuals who may benefit from precision medicine who will not receive it due to factors out of their control, including high cost and lack of insurance coverage.
Precision medicine in diabetes has a bright future. But it depends on us as clinicians and researchers moving this idea forward to better assist the people with diabetes who come to us for help.
Access the paper today to start exploring the potential of precision medicine in your practice.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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