The heterogeneity of diabetes underscores the need for more precise diagnostic, prevention and treatment strategies. The newly published international consensus report in Nature Medicine highlights significant advances in the adoption of precision medicine in diabetes prevention, diagnosis, treatment and prognosis, while also shedding light on numerous knowledge gaps.

The diversity of types of diabetes and its many forms make it difficult to treat. The heterogeneous nature of diabetes encompasses its various causes, clinical manifestations and prognoses.

The report comes from an international collaboration of over 200 academics – including Trinity College Dublin scientists – in 28 countries and highlights opportunities for the immediate or near-term adoption of precision diabetes medicine in clinical practice, while also emphasising the critical knowledge gaps that must be addressed.

The report summarises the findings of 15 systematic reviews of published evidence and expert opinions in prioritised areas of precision diabetes medicine, conducted under the umbrella of the Precision Medicine in Diabetes Initiative (PMDI). Its findings are supported by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) and the Novo Nordisk Foundation.

Prof John Nolan, executive committee member of the PMDI and adjunct professor in TCD’s Department of Clinical Medicine, said: “This is a major step forward in diabetes care. Accurate and precise diagnosis of the sub-type of diabetes is key. Everything around planning for treatment and prognosis relies on this. Misdiagnosis of diabetes is not uncommon.”

Diabetes is categorised into several types: type 1 and type 2 diabetes being most prevalent, along with gestational diabetes, monogenic diabetes and other rare forms of the disease.

Prof Nolan defines precision medicine as: “An approach that uses person-level information to help minimise error in medical decisions and health recommendations”.

He concluded: “The goal is to improve health outcomes, cost-effectiveness and health equity. There is a big need for better reporting standards, study design standards and specifically designed precision medicine trials. This consensus report provides a framework for what future research should focus on.”