For a considerable amount of time, the majority of people believed that there were only two types of diabetes: type 1 diabetes and type 2 diabetes, with a few instances falling into a fourth category known as "other" diabetes.
Studies conducted over the past several decades have revealed the complexity and multidimensionality of this condition. Numerous genetic mutations, biomarkers, symptoms, and potential consequences can manifest at different stages of life in the hundreds of millions of individuals diagnosed with diabetes worldwide.
The term "precision medicine" refers to the practice of tailoring therapies to the specific genetic and molecular composition of individual patients, as opposed to depending on symptoms or broad categories.
This method, traditionally associated with cancer treatment, is becoming increasingly important for diabetes prevention and treatment.
Both the precise diagnosis and the characterization of the condition have an impact not only on the treatment options available but also on life planning, other health issues, and even family members' well-being. It entails providing the appropriate diagnosis, the highest quality of treatment, and insights into the results for all individuals with diabetes.
"We want to eliminate guesswork from diabetes care," stated Louis Philipson, MD, PhD, who is the Director of the Kovler Diabetes Center at the University of Chicago Medicine and the James C. Tyree Professor of Diabetes Research and Treatment of Medicine. In order to practice precision diabetic care, it is necessary to have a comprehensive understanding of a patient's biology as soon as possible, preferably prior to therapy prescription, taking into account the patient's personal history and the community in which they live.
The best course of action for the right person at the right time
Siri Greeley, MD, PhD, Rochelle Naylor, MD, PhD, and Philipson, who is participating on the steering committee, are among the academic members of the University of Chicago Medicine who have recently contributed to the Second International Consensus Report on Precision Medicine in Diabetes. Over two hundred diabetes specialists, forming a consortium, presented an overview of ongoing and upcoming efforts to integrate precision medicine research into clinical practice.
The authors expressed their satisfaction with the progress made, which includes breakthroughs in detecting certain types of monogenic diabetes via genetic insights that have led to individualized treatment options.
The analysis also suggested that genetic risk categorization could be a potential strategy for preventing type 1 diabetes. Scientists have found particular maternal factors that might help predict treatment effectiveness in the case of gestational diabetes. This has enabled the customization of treatment strategies for each individual patient.
In spite of these potentially fruitful areas, the paper recommends the implementation of enhanced research methodologies and standardized precision medicine trials in order to close the knowledge gaps that now exist.
The study also raised concerns about the idea that precision medicine as a whole shouldn't be exclusive to wealthy countries or individuals.
"It is necessary for these concepts to be adaptable to any nation and any kind of healthcare system," Philipson said. Some therapies are rather pricey; nonetheless, by using straightforward scientific measurements to tailor treatments, we are able to accomplish a great deal more with the resources that we have.
According to him, patients and politicians alike have the ability to participate in the process of making precision medical techniques available via lobbying and financing for research.
Philipson stated that "precision medicine provides us with a framework that assists us in asking the appropriate questions in order to learn what we still need to know." When it comes to diabetes, the next generation of medical professionals and researchers is well prepared to consider the concept of heterogeneity.
Precision medicine is transforming diabetes treatment in both the present and the future
An increasing number of genetic and molecular insights are already making it possible for medical professionals and researchers to include precision medicine in the treatment regimens of diabetic patients.
According to Philipson, "one of the most remarkable interventions that we have is actually an intervention that does not take place at all."
The unusual subtype of diabetes known as glucokinase maturity-onset diabetes of the young (GCK-MODY, commonly referred to as MODY2) typically manifests itself in individuals who are younger than 25 years old. There is a mutation in a crucial enzyme that causes the pancreas to release less insulin than it normally would.
Patients who have the GCK-MODY mutation have blood sugar levels that are slightly high throughout their whole lifetimes. However, they continue to be healthy and stable even without therapy.
Physicians sometimes have a tendency to treat the numbers listed on a patient's chart, according to Philipson. The diagnosis of this kind of diabetes has significant repercussions for both patients and their treating clinicians. The blood sugar level does not necessarily need to be "normal." in order to prevent the problems of diabetes without having to undergo therapy that is onerous.
Like the previous example, a mutation in the HNF1A gene causes a different kind of MODY that responds well to modest dosages of an ancient, well-established, and reasonably priced medication. In many cases, people who are eligible for this medication may use it as their sole therapy rather than insulin or other medications.
According to Philipson, "It is a huge win when genetic tests reveal that a patient with diabetes has mutations that are uniquely treatable." Such a discovery is a significant victory.
Proactive testing of individuals who have a history of diabetes in their family may, in some circumstances, make it possible to provide patients who are at risk for developing type 1 diabetes with preventive and precise therapy. The University of Chicago developed teplizumab more than three decades ago, a medication that can delay the onset of type 1 diabetes in individuals with specific antibodies in their blood. However, we must provide it at an early stage to prevent the condition from developing into diabetes.
During the process of determining the most effective method for precision medicine, early detection may make all the difference. The genetic characterization of diabetes has been a focus of study at the University of Chicago for several generations, with the expectation that it may provide insights that will lead to more targeted treatment strategies.
For instance, the National Institutes of Health is funding a large-scale research project named RADIANT, which includes the University of Chicago, with the goal of better understanding atypical diabetes. According to Philipson, the research is already producing a number of intriguing genetic results and pieces of information.
Research is revealing whole new medicines, in addition to providing more accurate targeting for already existing medications. Recently, Raghu Mirmira, MD, PhD, a researcher at the University of Chicago Medicine, co-authored a study that provides early data supporting a novel tablet-based medication for type 1 diabetes. The drug not only replaces absent insulin, but also protects these cells of the pancreas.
In a project known as TADPOL, researchers from the University of Chicago, including Greeley, have collaborated with their counterparts at Indiana University to conduct an evaluation of the drug.
The University of Chicago Medicine treats diabetes
The Kovler Diabetes Center also provides patients with the opportunity to benefit from the finest methods for holistic therapy. Since the center's establishment in 2006, personalized medicine has driven the development of treatments.
"Having diabetes is a terrible condition; everyone could use some attention in the area of mental health," she said. Philipson said that it has the potential to alter the course of many people's lives.
A group of health and wellness experts, headed by Executive Director Peggy Hasenauer, MS, RN, and Tina Drossos, PhD, Associate Professor of Psychiatry, collaborate with diabetes care teams to ensure that there are no obstacles that hinder them from providing assistance to patients.
The endocrine clinic incorporates diabetes educators, pharmacists, and social workers as crucial resources. This ensures that patients have a thorough understanding of the many diabetes insurance and prescription options available to them. Precision medicine-guided treatment regimens may significantly benefit from these components.
According to Philipson, "everyone, from our educators and researchers to our nurses and directors, has come together to make the Kovler Diabetes Center the one-of-a-kind place that it is today."
