Diabetes specialists well-positioned to advance precision medicine goals
Click Here to Manage Email Alerts
Precision medicine will soon become a key component of diabetes management, and diabetes care and education specialists will be at the forefront of providing personalized care, according to a speaker.
“Regardless of the technological advances, individual patient preferences will still need to be considered, and patients will remain at the center of care,” William Cefalu, MD, director of the division of diabetes, endocrinology and metabolic diseases at the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH, said during a virtual presentation at the Association of Diabetes Care & Education Specialists annual conference. “This is where you, as diabetes educators, will play a major role. You will assist the patient with the preferences. You will provide the information. You are the patient’s best advocate, and the patient will still remain at the center of care.”
The NIH defines precision medicine as an emerging approach for disease prevention and treatment that takes into account people’s individual variations in genes, environment and lifestyle, Cefalu said. The interaction between the exposome, or non-genetic elements, and the physiome, or quantifiable elements like the epigenome and metabolome, must be better understood before true precision medicine becomes a reality, he said.
“We are clearly not there yet as a medical community, but with the advances being made, we will be there in a few years,” Cefalu said. “What better time to celebrate the 100-year anniversary of the discovery of insulin. It has been a century of diabetes innovation and translational advances ... these advances are now coming sooner and sooner.”
Cefalu highlighted two ongoing NIH research programs created to advance precision medicine goals specific to diabetes:
- The All of Us research program, an NIH precision medicine initiative, allows volunteers to sign up via a participant portal to share data from their electronic medical records and provide samples for a biobank, with all data returned to the participants. The goal is to allow researchers to use the database to discover genetic and environmental correlates with diseases, improve predictions of therapeutic safety and efficacy, discover disease biomarkers, and potentially develop new disease classifications.
- The Rare and Atypical Diabetes Network, or RADIANT, is an NIH program designed to identify patients and families with novel or rare, atypical forms of diabetes and characterize the underlying molecular mechanisms. Researchers will perform genetic and phenotypic characterizations of participants, construct an access-controlled biorepository and database, and make data and biosamples available to the scientific community to advance research in this area, Cefalu said.
“We are truly at the modern era of diabetes management,” Cefalu said. “We have a number of agents, a number of insulin formulations that we can use for our patients; technology is now available. We can use technology to adjust medications and insulin. We are at the point now where we have evidence that we can delay the onset of type 1 diabetes. We are well set with our ‘omics’ analysis and what needs to be done in medicine. Precision medicine is the next frontier. I don’t think it will take us another 100 years to get there, but we are well-suited at this point to take the next steps.”
The future will be one where the promise of personalized medicine will be realized, Cefalu said. Key steps revolve around more precise diagnostic classifications of diabetes, identification of diabetes subtypes and addressing heterogeneity of treatment patterns that remain widespread.
“Recognize that medicine is an art, not a science,” Cefalu said. “Success will depend on the provider understanding of the precision medicine approach and patient interaction.”
References:
All of Us research program. Available at: www.allofus.nih.gov. Accessed: Aug. 14, 2021
Rare and Atypical Diabetes Network. Available at: www.atypicaldiabetesnetwork.org. Accessed: Aug. 14, 2021.
Collapse
Cefalu W. GS03. Presented at: ADCES21; Aug. 12-15, 2021 (virtual meeting).
Click Here to Manage Email Alerts