Precision medicine in type 2 diabetes

被引：56

作者：

Prasad, R. B. ^{[1
]}

Groop, L. ^{[1
,2
]}

机构：

[1] Lund Univ, Clin Res Ctr, Dept Clin Sci, Genom Diabet & Endocrinol, Jan Waldenstroms Gata 35, S-20502 Malmo, Sweden

[2] Univ Helsinki, FIMM, Helsinki, Finland

来源：

JOURNAL OF INTERNAL MEDICINE | 2019年 / 285卷 / 01期

基金：

欧洲研究理事会; 芬兰科学院; 瑞典研究理事会;

关键词：

diabetes; GENOME-WIDE ASSOCIATION; EARLY METABOLIC MARKERS; LOW-BIRTH-WEIGHT; LONG-TERM RISK; GENETIC-VARIATION; INSULIN; MUTATIONS; ONSET; KIR6.2; VARIANTS;

D O I：

10.1111/joim.12859

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The Precision Medicine Initiative defines precision medicine as 'an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person'. This approach will facilitate more accurate treatment and prevention strategies in contrast to a one-size-fits-all approach, in which disease treatment and prevention strategies are developed for generalized usage. Diabetes is clearly more heterogeneous than the conventional subclassification into type 1 and type 2 diabetes. Monogenic forms of diabetes like MODY and neonatal diabetes have paved the way for precision medicine in diabetes, as carriers of unique mutations require unique treatment. Diagnosis of diabetes in the past has been dependent upon measuring one metabolite, glucose. By instead including six variables in a clustering analysis, we could break down diabetes into five distinct subgroups, with better prediction of disease progression and outcome. The severe insulin-resistant diabetes (SIRD) cluster showed the highest risk of kidney disease and highest prevalence of nonalcoholic fatty liver disease, whereas patients in the insulin-deficient cluster 2 (SIDD) had the highest risk of retinopathy. In the future, this will certainly be improved and expanded by including genetic, epigenetic and other biomarker to allow better prediction of outcome and choice of more precise treatment.

引用

页码：40 / 48

页数：9

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