Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Tobias DK 1 , Merino J 2 , Ahmad A 3 , Aiken C 4 , Benham JL 5 , Bodhini D 6 Show all authors , Clark AL 7 , Colclough K 8 , Corcoy R 9 , Cromer SJ 10 , Duan D 11 , Felton JL 12 , Francis EC 13 , Gillard P 14 , Gingras V 15 , Gaillard R 16 , Haider E 17 , Hughes A 8 , Ikle JM 18 , Jacobsen LM 19 , Kahkoska AR 20 , Kettunen JLT 21 , Kreienkamp RJ 10 , Lim LL 22 , Männistö JME 23 , Massey R 17 , Mclennan NM 24 , Miller RG 25 , Morieri ML 26 , Most J 27 , Naylor RN 28 , Ozkan B 29 , Patel KA 8 , Pilla SJ 30 , Prystupa K 31 , Raghavan S 32 , Rooney MR 29 , Schön M 31 , Semnani-Azad Z 33 , Sevilla-Gonzalez M 34 , Svalastoga P 35 , Takele WW 36 , Tam CH 37 , Thuesen ACB 2 , Tosur M 38 , Wallace AS 29 , Wang CC 39 , Wong JJ 40 , Yamamoto JM 41 , Young K 8 , Amouyal C 42 , Andersen MK 2 , Bonham MP 43 , Chen M 44 , Cheng F 45 , Chikowore T 46 , Chivers SC 47 , Clemmensen C 2 , Dabelea D 48 , Dawed AY 17 , Deutsch AJ 49 , Dickens LT 50 , DiMeglio LA 12 , Dudenhöffer-Pfeifer M 3 , Evans-Molina C 12 , Fernández-Balsells MM 51 , Fitipaldi H 3 , Fitzpatrick SL 52 , Gitelman SE 53 , Goodarzi MO 54 , Grieger JA 55 , Guasch-Ferré M 33 , Habibi N 55 , Hansen T 2 , Huang C 37 , Harris-Kawano A 12 , Ismail HM 12 , Hoag B 56 , Johnson RK 57 , Jones AG 8 , Koivula RW 58 , Leong A 10 , Leung GKW 43 , Libman IM 59 , Liu K 55 , Long SA 60 , Lowe WL 61 , Morton RW 62 , Motala AA 63 , Onengut-Gumuscu S 64 , Pankow JS 65 , Pathirana M 55 , Pazmino S 66 , Perez D 12 , Petrie JR 67 , Powe CE 10 , Quinteros A 55 , Jain R 68 , Ray D 39 , Ried-Larsen M 69 , Saeed Z 70 , Santhakumar V 1 , Kanbour S 30 , Sarkar S 30 , Monaco GSF 12 , Scholtens DM 71 , Selvin E 29 , Sheu WH 72 , Speake C 73 , Stanislawski MA 57 , Steenackers N 66 , Steck AK 74 , Stefan N 75 , Støy J 76 , Taylor R 77 , Tye SC 78 , Ukke GG 36 , Urazbayeva M 79 , Van der Schueren B 66 , Vatier C 80 , Wentworth JM 81 , Hannah W 82 , White SL 47 , Yu G 37 , Zhang Y 37 , Zhou SJ 83 , Beltrand J 84 , Polak M 84 , Aukrust I 35 , de Franco E 8 , Flanagan SE 8 , Maloney KA 85 , McGovern A 8 , Molnes J 35 , Nakabuye M 2 , Njølstad PR 35 , Pomares-Millan H 3 , Provenzano M 86 , Saint-Martin C 87 , Zhang C 88 , Zhu Y 89 , Auh S 90 , de Souza R 91 , Fawcett AJ 92 , Gruber C 93 , Mekonnen EG 94 , Mixter E 95 , Sherifali D 91 , Eckel RH 96 , Nolan JJ 97 , Philipson LH 95 , Brown RJ 90 , Billings LK 98 , Boyle K 48 , Costacou T 25 , Dennis JM 8 , Florez JC 10 , Gloyn AL 18 , Gomez MF 3 , Gottlieb PA 74 , Greeley SAW 99 , Griffin K 100 , Hattersley AT 8 , Hirsch IB 101 , Hivert MF 10 , Hood KK 40 , Josefson JL 92 , Kwak SH 102 , Laffel LM 103 , Lim SS 36 , Loos RJF 2 , Ma RCW 37 , Mathieu C 14 , Mathioudakis N 30 , Meigs JB 46 , Misra S 104 , Mohan V 105 , Murphy R 106 , Oram R 8 , Owen KR 58 , Ozanne SE 107 , Pearson ER 17 , Perng W 48 , Pollin TI 85 , Pop-Busui R 108 , Pratley RE 109 , Redman LM 110 , Redondo MJ 38 , Reynolds RM 24 , Semple RK 24 , Sherr JL 111 , Sims EK 12 , Sweeting A 112 , Tuomi T 21 , Udler MS 10 , Vesco KK 113 , Vilsbøll T 114 , Wagner R 31 , Rich SS 64 , Franks PW 115

Affiliations 

  • 1 Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
  • 2 Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  • 3 Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
  • 4 Department of Obstetrics and Gynaecology, The Rosie Hospital, Cambridge, UK
  • 5 Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 6 Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India
  • 7 Division of Pediatric Endocrinology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
  • 8 Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK
  • 9 CIBER-BBN, ISCIII, Madrid, Spain
  • 10 Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA
  • 11 Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • 12 Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
  • 13 Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
  • 14 University Hospital Leuven, Leuven, Belgium
  • 15 Department of Nutrition, Université de Montréal, Montreal, Quebec, Quebec, Canada
  • 16 Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
  • 17 Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
  • 18 Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
  • 19 University of Florida, Gainesville, FL, USA
  • 20 Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  • 21 Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland
  • 22 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 23 Departments of Pediatrics and Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
  • 24 Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
  • 25 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
  • 26 Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
  • 27 Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
  • 28 Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA
  • 29 Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • 30 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • 31 Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • 32 Section of Academic Primary Care, US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA
  • 33 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • 34 Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA
  • 35 Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
  • 36 Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  • 37 Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
  • 38 Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
  • 39 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • 40 Stanford University School of Medicine, Stanford, CA, USA
  • 41 Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  • 42 Department of Diabetology, APHP, Paris, France
  • 43 Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
  • 44 Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
  • 45 Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
  • 46 Department of Medicine, Harvard Medical School, Boston, MA, USA
  • 47 Department of Women and Children's Health, King's College London, London, UK
  • 48 Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  • 49 Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
  • 50 Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
  • 51 Biomedical Research Institute Girona, IdIBGi, Girona, Spain
  • 52 Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
  • 53 University of California at San Francisco, Department of Pediatrics, Diabetes Center, San Francisco, CA, USA
  • 54 Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
  • 55 Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  • 56 Division of Endocrinology and Diabetes, Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA
  • 57 Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  • 58 Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
  • 59 UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
  • 60 Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, USA
  • 61 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • 62 Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  • 63 Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  • 64 Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
  • 65 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
  • 66 Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium
  • 67 School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  • 68 Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
  • 69 Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
  • 70 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA
  • 71 Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • 72 Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
  • 73 Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA, USA
  • 74 Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  • 75 German Center for Diabetes Research (DZD), Neuherberg, Germany
  • 76 Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
  • 77 University of Newcastle, Newcastle upon Tyne, UK
  • 78 Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
  • 79 Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
  • 80 Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
  • 81 Royal Melbourne Hospital Department of Diabetes and Endocrinology, Parkville, Victoria, Australia
  • 82 Deakin University, Melbourne, Victoria, Australia
  • 83 Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
  • 84 Institut Cochin, Inserm U 10116, Paris, France
  • 85 Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
  • 86 Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
  • 87 Department of Medical Genetics, AP-HP Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
  • 88 Global Center for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 89 Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
  • 90 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
  • 91 Population Health Research Institute, Hamilton, Ontario, Canada
  • 92 Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • 93 American Diabetes Association, Arlington, VA, USA
  • 94 College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
  • 95 Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
  • 96 Division of Endocrinology, Metabolism, Diabetes, University of Colorado, Aurora, CO, USA
  • 97 Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
  • 98 Division of Endocrinology, NorthShore University HealthSystem, Skokie, IL, USA
  • 99 Departments of Pediatrics and Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
  • 100 Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
  • 101 University of Washington School of Medicine, Seattle, WA, USA
  • 102 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  • 103 Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
  • 104 Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
  • 105 Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
  • 106 Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
  • 107 University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
  • 108 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
  • 109 AdventHealth Translational Research Institute, Orlando, FL, USA
  • 110 Pennington Biomedical Research Center, Baton Rouge, LA, USA
  • 111 Yale School of Medicine, New Haven, CT, USA
  • 112 Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  • 113 Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Portland, OR, USA
  • 114 Clinial Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
  • 115 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. paul.franks@med.lu.se
Nat Med, 2023 Oct;29(10):2438-2457.
PMID: 37794253 DOI: 10.1038/s41591-023-02502-5

Abstract

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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