Precision Medicine in Diabetes, Current Research and Future Perspectives
R Franceschi, J Per Medicine, July 28, 2022
Recently the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have jointly released an expert opinion-based consensus report on precision medicine. The report defines precision diabetes medicine as “an approach to optimize the diagnosis, prediction, prevention, or treatment of diabetes by integrating multidimensional data, accounting for individual differences”, and it is characterized by six categories; precision diagnosis, precision therapeutics, precision prevention, precision treatment, precision prognosis and precision monitoring. Precision medicine in diabetes utilizes the individual’s unique genetic makeup, environment or context data (that can be collected from clinical records, wearable technology, genomics and other ‘omics data) and allows one to appreciate individual characteristics, differences, circumstances and preferences
Development and validation of a trans-ancestry polygenic risk score for type 2 diabetes in diverse populations
T Ge et al, Genome Medicine, June 29, 2022
We integrated T2D GWAS in European, African, and East Asian populations to construct a trans-ancestry T2D PRS using a newly developed Bayesian polygenic modeling method, and assessed the prediction accuracy of the PRS in the multi-ethnic Electronic Medical Records and Genomics (eMERGE) study (11,945 cases; 57,694 controls), four Black cohorts (5137 cases; 9657 controls), and the Taiwan Biobank (4570 cases; 84,996 controls). We additionally evaluated a post hoc ancestry adjustment method that can express the polygenic risk on the same scale across ancestrally diverse individuals and facilitate the clinical implementation of the PRS in prospective cohorts.
Enhancing self-management in type 1 diabetes with wearables and deep learning
T Zhu et al, NPJ Digital Medicine, June 27, 2022
Continuous glucose monitoring (CGM) is widely used in T1D self-management for real-time glucose measurements, while smartphone apps are adopted as basic electronic diaries, data visualization tools, and simple decision support tools for insulin dosing. Applying a mixed effects logistic regression analysis to the outcomes of a six-week longitudinal study in 12 T1D adults using CGM and a clinically validated wearable sensor wristband, we identified several significant associations between physiological measurements and hypo- and hyperglycemic events measured an hour later.
Extending precision medicine tools to populations at high risk of type 2 diabetes.
Misra Shivani et al. PLoS medicine 2022 5 (5) e1003989
The generation of ethnicity-specific T2D PS for every subethnic group remains aspirational, as the large sample sizes needed to do this robustly are prohibitive (the genetic ancestry of the Indian subcontinent, for example, is more diverse than the whole of Europe. Thus, strategies to utilise existing scores derived from other populations, or leveraging multi-ancestry GWAS, have predominated. Attempts to apply a PS derived in a population of one ancestry to another ethnic group have shown variable performance.
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