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Review
. 2023;103(1):335-351.
doi: 10.1007/s41745-023-00356-x. Epub 2023 Mar 7.

Precision Medicine in Type 1 Diabetes

Dominika A Michalek  1 , Suna Onengut-Gumuscu  1   2 , David R Repaske  3 , Stephen S Rich  1   2
Affiliations
Review

Precision Medicine in Type 1 Diabetes

Dominika A Michalek et al. J Indian Inst Sci. 2023.

Abstract

Type 1 diabetes is a complex, chronic disease in which the insulin-producing beta cells in the pancreas are sufficiently altered or impaired to result in requirement of exogenous insulin for survival. The development of type 1 diabetes is thought to be an autoimmune process, in which an environmental (unknown) trigger initiates a T cell-mediated immune response in genetically susceptible individuals. The presence of islet autoantibodies in the blood are signs of type 1 diabetes development, and risk of progressing to clinical type 1 diabetes is correlated with the presence of multiple islet autoantibodies. Currently, a "staging" model of type 1 diabetes proposes discrete components consisting of normal blood glucose but at least two islet autoantibodies (Stage 1), abnormal blood glucose with at least two islet autoantibodies (Stage 2), and clinical diagnosis (Stage 3). While these stages may, in fact, not be discrete and vary by individual, the format suggests important applications of precision medicine to diagnosis, prevention, prognosis, treatment and monitoring. In this paper, applications of precision medicine in type 1 diabetes are discussed, with both opportunities and barriers to global implementation highlighted. Several groups have implemented components of precision medicine, yet the integration of the necessary steps to achieve both short- and long-term solutions will need to involve researchers, patients, families, and healthcare providers to fully impact and reduce the burden of type 1 diabetes.

Keywords: Precision diagnostics; Precision medicine; Precision monitoring; Precision prevention; Precision prognostics; Precision therapeutics; Type 1 diabetes.

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Conflict of interest statement

Conflict of interestThe authors have no competing interests that are directly or indirectly related to the work submitted for publication. The study funders had no role in the design or conduct of the research: collection, management, analysis, and interpretation of the data; or preparation of the manuscript. All graphics were created with BioRender.com

Figures

Figure 1:
Figure 1:
Contrast between “Classical medicine” and “Precision medicine” in type 1 diabetes (T1D), through prediction, therapeutics, and prevention.
Figure 2:
Figure 2:
Five pillars of precision medicine in type 1 diabetes (T1D)–precision diagnosis, precision prevention, precision therapeutics, precision prognosis, and precision monitoring.
Figure 3:
Figure 3:
Components of precision medicine in type 1 diabetes that are beyond basic, clinical and population sciences, including patient engagement, education, decision support and global regulatory engagement.
See this image and copyright information in PMC

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