Precision medicine in diabetes - current trends and future directions. Is the future now?

Abstract

Diabetes mellitus and its complications are a major challenge of modern medicine, affecting more than 10% of the global adult population. There is an urgent need to transition the existing “one-size-fits-all” approach in diabetes care into precision medicine to effectively meet the challenge of this widespread disease. With the recent progress in technology and data science, significant advances in our understanding of the biology of the disease have been made, including heterogeneity in clinical presentation, pathophysiology, and genetic etiology. This provided a framework for precision medicine approaches to diagnosis and treatment. For monogenic forms of diabetes with genetic diagnosis and its direct translation to treatment, precision medicine is already applied in clinical practice; whereas for common polygenic forms of the disease (type 1 and type 2 diabetes) despite significant progress in recent years, the vision of precision medicine in action is still far-distant. In this chapter, we review the current state of precision medicine in diabetes, in the context of diagnosis, management, and prevention. We summarize the current state of diabetes classifications, including new attempts to address the heterogeneity of the disease. We also discuss the implications of genetic findings and new diabetes subgroups in precision treatment and prevention. Finally, we summarize the existing challenges and prospects for the further development of precision medicine in diabetes.