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

Deirdre K Tobias^#^{1

2}, Jordi Merino^#^{3

4

5}, Abrar Ahmad^#⁶, Catherine Aiken^#^{7

8}, Jamie L Benham^#⁹, Dhanasekaran Bodhini^#¹⁰, Amy L Clark¹¹, Kevin Colclough^#¹², Rosa Corcoy^{13

14

15}, Sara J Cromer^#^{4

16

17}, Daisy Duan^#¹⁸, Jamie L Felton^#^{19

20

21}, Ellen C Francis^#²², Pieter Gillard^#²³, Véronique Gingras^#^{24

25}, Romy Gaillard^#²⁶, Eram Haider^#²⁷, Alice Hughes^#¹², Jennifer M Ikle^#^{28

29}, Laura M Jacobsen^#³⁰, Anna R Kahkoska^#³¹, Jarno L T Kettunen^#^{32

33

34}, Raymond J Kreienkamp^#^{4

5

16

35}, Lee-Ling Lim^#^{36

37

38}, Jonna M E Männistö^#^{39

40}, Robert Massey^#²⁷, Niamh-Maire Mclennan^#⁴¹, Rachel G Miller⁴², Mario Luca Morieri^#^{43

44}, Jasper Most^#⁴⁵, Rochelle N Naylor^#⁴⁶, Bige Ozkan^#^{47

48}, Kashyap Amratlal Patel^#¹², Scott J Pilla^#^{49

50}, Katsiaryna Prystupa^#^{51

52}, Sridharan Raghavan^#^{53

54}, Mary R Rooney^#^{47

55}, Martin Schön^#^{51

52

56

57}, Zhila Semnani-Azad^#², Magdalena Sevilla-Gonzalez^#^{16

17

58}, Pernille Svalastoga^#^{59

60}, Wubet Worku Takele^#⁶¹, Claudia Ha-Ting Tam^#^{38

62

63}, Anne Cathrine B Thuesen^#³, Mustafa Tosur^#^{64

65

66}, Amelia S Wallace^#^{47

55}, Caroline C Wang^#⁵⁵, Jessie J Wong^#⁶⁷, Jennifer M Yamamoto^#⁶⁸, Katherine Young^#¹², Chloé Amouyal^{69

70}, Mette K Andersen³, Maxine P Bonham⁷¹, Mingling Chen⁷², Feifei Cheng⁷³, Tinashe Chikowore^{17

74

75

76}, Sian C Chivers⁷⁷, Christoffer Clemmensen³, Dana Dabelea⁷⁸, Adem Y Dawed²⁷, Aaron J Deutsch^{5

16

17}, Laura T Dickens⁷⁹, Linda A DiMeglio^{19

20

21

80}, Monika Dudenhöffer-Pfeifer⁶, Carmella Evans-Molina^{19

20

21

81}, María Mercè Fernández-Balsells^{82

83}, Hugo Fitipaldi⁶, Stephanie L Fitzpatrick⁸⁴, Stephen E Gitelman⁸⁵, Mark O Goodarzi^{86

87}, Jessica A Grieger^{88

89}, Marta Guasch-Ferré^{2

90}, Nahal Habibi^{88

89}, Torben Hansen³, Chuiguo Huang^{38

62}, Arianna Harris-Kawano^{19

20

21}, Heba M Ismail^{19

20

21}, Benjamin Hoag^{91

92}, Randi K Johnson^{93

94}, Angus G Jones^{12

95}, Robert W Koivula⁹⁶, Aaron Leong^{4

17

97}, Gloria K W Leung⁷¹, Ingrid M Libman⁹⁸, Kai Liu⁸⁸, S Alice Long⁹⁹, William L Lowe Jr¹⁰⁰, Robert W Morton^{101

102

103}, Ayesha A Motala¹⁰⁴, Suna Onengut-Gumuscu¹⁰⁵, James S Pankow¹⁰⁶, Maleesa Pathirana^{88

89}, Sofia Pazmino¹⁰⁷, Dianna Perez^{19

20

21}, John R Petrie¹⁰⁸, Camille E Powe^{4

16

17

109}, Alejandra Quinteros⁸⁸, Rashmi Jain^{110

111}, Debashree Ray^{55

112}, Mathias Ried-Larsen^{113

114}, Zeb Saeed¹¹⁵, Vanessa Santhakumar¹, Sarah Kanbour^{49

116}, Sudipa Sarkar⁴⁹, Gabriela S F Monaco^{19

20

21}, Denise M Scholtens¹¹⁷, Elizabeth Selvin^{47

55}, Wayne Huey-Herng Sheu^{118

119

120}, Cate Speake¹²¹, Maggie A Stanislawski⁹³, Nele Steenackers¹⁰⁷, Andrea K Steck¹²², Norbert Stefan^{52

56

123}, Julie Støy¹²⁴, Rachael Taylor¹²⁵, Sok Cin Tye^{126

127}, Gebresilasea Gendisha Ukke⁶¹, Marzhan Urazbayeva^{65

128}, Bart Van der Schueren^{107

129}, Camille Vatier^{130

131}, John M Wentworth^{132

133

134}, Wesley Hannah^{135

136}, Sara L White^{77

137}, Gechang Yu^{38

62}, Yingchai Zhang^{38

62}, Shao J Zhou^{89

138}, Jacques Beltrand^{139

140}, Michel Polak^{139

140}, Ingvild Aukrust^{59

141}, Elisa de Franco¹², Sarah E Flanagan¹², Kristin A Maloney¹⁴², Andrew McGovern¹², Janne Molnes^{59

141}, Mariam Nakabuye³, Pål Rasmus Njølstad^{59

60}, Hugo Pomares-Millan^{6

143}, Michele Provenzano¹⁴⁴, Cécile Saint-Martin¹⁴⁵, Cuilin Zhang^{146

147}, Yeyi Zhu^{148

149}, Sungyoung Auh¹⁵⁰, Russell de Souza^{102

151}, Andrea J Fawcett^{152

153}, Chandra Gruber¹⁵⁴, Eskedar Getie Mekonnen^{155

156}, Emily Mixter¹⁵⁷, Diana Sherifali^{102

158}, Robert H Eckel¹⁵⁹, John J Nolan^{160

161}, Louis H Philipson¹⁵⁷, Rebecca J Brown^#¹⁵⁰, Liana K Billings^#^{162

163}, Kristen Boyle^#⁷⁸, Tina Costacou⁴², John M Dennis^#¹², Jose C Florez^#^{4

5

16

17}, Anna L Gloyn^#^{28

29

164}, Maria F Gomez^#^{6

165}, Peter A Gottlieb^#¹²², Siri Atma W Greeley^#¹⁶⁶, Kurt Griffin^#^{111

167}, Andrew T Hattersley^#^{12

95}, Irl B Hirsch^#¹⁶⁸, Marie-France Hivert^#^{4

169

170}, Korey K Hood^#⁶⁷, Jami L Josefson^#¹⁵², Soo Heon Kwak^#¹⁷¹, Lori M Laffel^#¹⁷², Siew S Lim^#⁶¹, Ruth J F Loos^#^{3

173}, Ronald C W Ma^#^{38

62

63}, Chantal Mathieu^#²³, Nestoras Mathioudakis^#⁴⁹, James B Meigs^#^{17

97

174}, Shivani Misra^#^{175

176}, Viswanathan Mohan^#¹⁷⁷, Rinki Murphy^#^{178

179

180}, Richard Oram^#^{12

95}, Katharine R Owen^#^{96

181}, Susan E Ozanne^#¹⁸², Ewan R Pearson^#²⁷, Wei Perng^#⁷⁸, Toni I Pollin^#^{142

183}, Rodica Pop-Busui¹⁸⁴, Richard E Pratley^#¹⁸⁵, Leanne M Redman^#¹⁸⁶, Maria J Redondo^#^{64

65}, Rebecca M Reynolds^#⁴¹, Robert K Semple^#^{41

187}, Jennifer L Sherr^#¹⁸⁸, Emily K Sims^#^{19

20

21}, Arianne Sweeting^#^{189

190}, Tiinamaija Tuomi^#^{32

33

34}, Miriam S Udler^#^{4

5

16

17}, Kimberly K Vesco^#¹⁹¹, Tina Vilsbøll^#^{192

193}, Robert Wagner^#^{51

52

194}, Stephen S Rich^#¹⁰⁵, Paul W Franks^#^{195

196

197

198}

Affiliations

¹ Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴ Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA.
⁵ Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
⁷ Department of Obstetrics and Gynaecology, The Rosie Hospital, Cambridge, UK.
⁸ NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK.
⁹ Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India.
¹¹ Division of Pediatric Endocrinology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA.
¹² Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.
¹³ CIBER-BBN, ISCIII, Madrid, Spain.
¹⁴ Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
¹⁵ Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
¹⁶ Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA.
¹⁷ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹⁸ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁹ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁰ Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA.
²¹ Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.
²² Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
²³ University Hospital Leuven, Leuven, Belgium.
²⁴ Department of Nutrition, Université de Montréal, Montreal, Quebec, Quebec, Canada.
²⁵ Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Quebec, Canada.
²⁶ Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands.
²⁷ Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK.
²⁸ Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
²⁹ Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
³⁰ University of Florida, Gainesville, FL, USA.
³¹ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³² Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland.
³³ Folkhalsan Research Center, Helsinki, Finland.
³⁴ Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland.
³⁵ Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
³⁶ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
³⁷ Asia Diabetes Foundation, Hong Kong SAR, China.
³⁸ Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
³⁹ Departments of Pediatrics and Clinical Genetics, Kuopio University Hospital, Kuopio, Finland.
⁴⁰ Department of Medicine, University of Eastern Finland, Kuopio, Finland.
⁴¹ Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁴² Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁴³ Metabolic Disease Unit, University Hospital of Padova, Padova, Italy.
⁴⁴ Department of Medicine, University of Padova, Padova, Italy.
⁴⁵ Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
⁴⁶ Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA.
⁴⁷ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴⁸ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴⁹ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁵⁰ Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁵¹ Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
⁵² German Center for Diabetes Research (DZD), Neuherberg, Germany.
⁵³ Section of Academic Primary Care, US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA.
⁵⁴ Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁵⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵⁶ Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany.
⁵⁷ Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.
⁵⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
⁵⁹ Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.
⁶⁰ Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway.
⁶¹ Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
⁶² Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁶³ Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁶⁴ Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
⁶⁵ Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA.
⁶⁶ Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA.
⁶⁷ Stanford University School of Medicine, Stanford, CA, USA.
⁶⁸ Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶⁹ Department of Diabetology, APHP, Paris, France.
⁷⁰ Sorbonne Université, INSERM, NutriOmic team, Paris, France.
⁷¹ Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.
⁷² Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
⁷³ Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
⁷⁴ MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷⁵ Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁷⁶ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷⁷ Department of Women and Children's Health, King's College London, London, UK.
⁷⁸ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷⁹ Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
⁸⁰ Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
⁸¹ Richard L. Roudebush VAMC, Indianapolis, IN, USA.
⁸² Biomedical Research Institute Girona, IdIBGi, Girona, Spain.
⁸³ Diabetes, Endocrinology and Nutrition Unit Girona, University Hospital Dr Josep Trueta, Girona, Spain.
⁸⁴ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
⁸⁵ University of California at San Francisco, Department of Pediatrics, Diabetes Center, San Francisco, CA, USA.
⁸⁶ Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸⁷ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸⁸ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁸⁹ Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
⁹⁰ Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁹¹ Division of Endocrinology and Diabetes, Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA.
⁹² University of South Dakota School of Medicine, E Clark St, Vermillion, SD, USA.
⁹³ Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁹⁴ Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
⁹⁵ Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
⁹⁶ Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
⁹⁷ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹⁸ UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
⁹⁹ Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, USA.
¹⁰⁰ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁰¹ Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁰² Population Health Research Institute, Hamilton, Ontario, Canada.
¹⁰³ Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark.
¹⁰⁴ Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
¹⁰⁵ Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
¹⁰⁶ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
¹⁰⁷ Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium.
¹⁰⁸ School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹⁰⁹ Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹⁰ Sanford Children's Specialty Clinic, Sioux Falls, SD, USA.
¹¹¹ Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
¹¹² Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹³ Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark.
¹¹⁴ Institute for Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹¹⁵ Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA.
¹¹⁶ AMAN Hospital, Doha, Qatar.
¹¹⁷ Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹¹⁸ Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan.
¹¹⁹ Divsion of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan.
¹²⁰ Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
¹²¹ Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA, USA.
¹²² Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹²³ University Hospital of Tübingen, Tübingen, Germany.
¹²⁴ Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
¹²⁵ University of Newcastle, Newcastle upon Tyne, UK.
¹²⁶ Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
¹²⁷ Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands.
¹²⁸ Gastroenterology, Baylor College of Medicine, Houston, TX, USA.
¹²⁹ Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
¹³⁰ Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.
¹³¹ Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.
¹³² Royal Melbourne Hospital Department of Diabetes and Endocrinology, Parkville, Victoria, Australia.
¹³³ Walter and Eliza Hall Institute, Parkville, Victoria, Australia.
¹³⁴ University of Melbourne Department of Medicine, Parkville, Victoria, Australia.
¹³⁵ Deakin University, Melbourne, Victoria, Australia.
¹³⁶ Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India.
¹³⁷ Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
¹³⁸ School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia.
¹³⁹ Institut Cochin, Inserm U 10116, Paris, France.
¹⁴⁰ Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France.
¹⁴¹ Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
¹⁴² Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁴³ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁴⁴ Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy.
¹⁴⁵ Department of Medical Genetics, AP-HP Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
¹⁴⁶ Global Center for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁴⁷ Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁴⁸ Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
¹⁴⁹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹⁵⁰ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
¹⁵¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁵² Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁵³ Department of Clinical and Organizational Development, Chicago, IL, USA.
¹⁵⁴ American Diabetes Association, Arlington, VA, USA.
¹⁵⁵ College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
¹⁵⁶ Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁵⁷ Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
¹⁵⁸ School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁵⁹ Division of Endocrinology, Metabolism, Diabetes, University of Colorado, Aurora, CO, USA.
¹⁶⁰ Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland.
¹⁶¹ Department of Endocrinology, Wexford General Hospital, Wexford, Ireland.
¹⁶² Division of Endocrinology, NorthShore University HealthSystem, Skokie, IL, USA.
¹⁶³ Department of Medicine, Prtizker School of Medicine, University of Chicago, Chicago, IL, USA.
¹⁶⁴ Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
¹⁶⁵ Faculty of Health, Aarhus University, Aarhus, Denmark.
¹⁶⁶ Departments of Pediatrics and Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
¹⁶⁷ Sanford Research, Sioux Falls, SD, USA.
¹⁶⁸ University of Washington School of Medicine, Seattle, WA, USA.
¹⁶⁹ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
¹⁷⁰ Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada.
¹⁷¹ Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
¹⁷² Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
¹⁷³ Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁷⁴ Broad Institute, Cambridge, MA, USA.
¹⁷⁵ Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹⁷⁶ Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
¹⁷⁷ Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
¹⁷⁸ Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁷⁹ Auckland Diabetes Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand.
¹⁸⁰ Medical Bariatric Service, Te Whatu Ora Counties, Health New Zealand, Auckland, New Zealand.
¹⁸¹ Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁸² University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK.
¹⁸³ Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸⁴ Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA.
¹⁸⁵ AdventHealth Translational Research Institute, Orlando, FL, USA.
¹⁸⁶ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
¹⁸⁷ MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
¹⁸⁸ Yale School of Medicine, New Haven, CT, USA.
¹⁸⁹ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁹⁰ Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹⁹¹ Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹⁹² Clinial Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
¹⁹³ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁹⁴ Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
¹⁹⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. paul.franks@med.lu.se.
¹⁹⁶ Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden. paul.franks@med.lu.se.
¹⁹⁷ Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK. paul.franks@med.lu.se.
¹⁹⁸ Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark. paul.franks@med.lu.se.

^# Contributed equally.

PMID: 37794253
PMCID: PMC10735053
DOI: 10.1038/s41591-023-02502-5

Review

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

Deirdre K Tobias et al. Nat Med. 2023 Oct.

. 2023 Oct;29(10):2438-2457.

doi: 10.1038/s41591-023-02502-5. Epub 2023 Oct 5.

Authors

Affiliations

¹ Division of Preventative Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁴ Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, USA.
⁵ Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
⁷ Department of Obstetrics and Gynaecology, The Rosie Hospital, Cambridge, UK.
⁸ NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK.
⁹ Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai, India.
¹¹ Division of Pediatric Endocrinology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA.
¹² Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK.
¹³ CIBER-BBN, ISCIII, Madrid, Spain.
¹⁴ Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
¹⁵ Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
¹⁶ Programs in Metabolism and Medical & Population Genetics, Broad Institute, Cambridge, MA, USA.
¹⁷ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹⁸ Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁹ Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁰ Herman B Wells Center for Pediatric Research, University School of Medicine, Indianapolis, IN, USA.
²¹ Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.
²² Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
²³ University Hospital Leuven, Leuven, Belgium.
²⁴ Department of Nutrition, Université de Montréal, Montreal, Quebec, Quebec, Canada.
²⁵ Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Quebec, Canada.
²⁶ Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands.
²⁷ Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK.
²⁸ Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
²⁹ Stanford Diabetes Research Center, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
³⁰ University of Florida, Gainesville, FL, USA.
³¹ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³² Helsinki University Hospital, Abdominal Centre/Endocrinology, Helsinki, Finland.
³³ Folkhalsan Research Center, Helsinki, Finland.
³⁴ Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland.
³⁵ Department of Pediatrics, Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
³⁶ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
³⁷ Asia Diabetes Foundation, Hong Kong SAR, China.
³⁸ Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
³⁹ Departments of Pediatrics and Clinical Genetics, Kuopio University Hospital, Kuopio, Finland.
⁴⁰ Department of Medicine, University of Eastern Finland, Kuopio, Finland.
⁴¹ Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
⁴² Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
⁴³ Metabolic Disease Unit, University Hospital of Padova, Padova, Italy.
⁴⁴ Department of Medicine, University of Padova, Padova, Italy.
⁴⁵ Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
⁴⁶ Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA.
⁴⁷ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴⁸ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴⁹ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁵⁰ Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁵¹ Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
⁵² German Center for Diabetes Research (DZD), Neuherberg, Germany.
⁵³ Section of Academic Primary Care, US Department of Veterans Affairs Eastern Colorado Health Care System, Aurora, CO, USA.
⁵⁴ Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁵⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵⁶ Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, Neuherberg, Germany.
⁵⁷ Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.
⁵⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
⁵⁹ Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.
⁶⁰ Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway.
⁶¹ Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
⁶² Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁶³ Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁶⁴ Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
⁶⁵ Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA.
⁶⁶ Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA.
⁶⁷ Stanford University School of Medicine, Stanford, CA, USA.
⁶⁸ Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶⁹ Department of Diabetology, APHP, Paris, France.
⁷⁰ Sorbonne Université, INSERM, NutriOmic team, Paris, France.
⁷¹ Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.
⁷² Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
⁷³ Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
⁷⁴ MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷⁵ Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁷⁶ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷⁷ Department of Women and Children's Health, King's College London, London, UK.
⁷⁸ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷⁹ Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
⁸⁰ Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
⁸¹ Richard L. Roudebush VAMC, Indianapolis, IN, USA.
⁸² Biomedical Research Institute Girona, IdIBGi, Girona, Spain.
⁸³ Diabetes, Endocrinology and Nutrition Unit Girona, University Hospital Dr Josep Trueta, Girona, Spain.
⁸⁴ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
⁸⁵ University of California at San Francisco, Department of Pediatrics, Diabetes Center, San Francisco, CA, USA.
⁸⁶ Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸⁷ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸⁸ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁸⁹ Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
⁹⁰ Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁹¹ Division of Endocrinology and Diabetes, Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA.
⁹² University of South Dakota School of Medicine, E Clark St, Vermillion, SD, USA.
⁹³ Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁹⁴ Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
⁹⁵ Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
⁹⁶ Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
⁹⁷ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹⁸ UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
⁹⁹ Center for Translational Immunology, Benaroya Research Institute, Seattle, WA, USA.
¹⁰⁰ Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁰¹ Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁰² Population Health Research Institute, Hamilton, Ontario, Canada.
¹⁰³ Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark.
¹⁰⁴ Department of Diabetes and Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
¹⁰⁵ Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
¹⁰⁶ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
¹⁰⁷ Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinologyó, KU Leuven, Leuven, Belgium.
¹⁰⁸ School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
¹⁰⁹ Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹⁰ Sanford Children's Specialty Clinic, Sioux Falls, SD, USA.
¹¹¹ Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
¹¹² Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹³ Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark.
¹¹⁴ Institute for Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹¹⁵ Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA.
¹¹⁶ AMAN Hospital, Doha, Qatar.
¹¹⁷ Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹¹⁸ Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan.
¹¹⁹ Divsion of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan.
¹²⁰ Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan.
¹²¹ Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA, USA.
¹²² Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹²³ University Hospital of Tübingen, Tübingen, Germany.
¹²⁴ Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
¹²⁵ University of Newcastle, Newcastle upon Tyne, UK.
¹²⁶ Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
¹²⁷ Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands.
¹²⁸ Gastroenterology, Baylor College of Medicine, Houston, TX, USA.
¹²⁹ Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
¹³⁰ Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France.
¹³¹ Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France.
¹³² Royal Melbourne Hospital Department of Diabetes and Endocrinology, Parkville, Victoria, Australia.
¹³³ Walter and Eliza Hall Institute, Parkville, Victoria, Australia.
¹³⁴ University of Melbourne Department of Medicine, Parkville, Victoria, Australia.
¹³⁵ Deakin University, Melbourne, Victoria, Australia.
¹³⁶ Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India.
¹³⁷ Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
¹³⁸ School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia.
¹³⁹ Institut Cochin, Inserm U 10116, Paris, France.
¹⁴⁰ Pediatric Endocrinology and Diabetes, Hopital Necker Enfants Malades, APHP Centre, Université de Paris, Paris, France.
¹⁴¹ Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
¹⁴² Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁴³ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁴⁴ Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy.
¹⁴⁵ Department of Medical Genetics, AP-HP Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
¹⁴⁶ Global Center for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁴⁷ Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹⁴⁸ Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
¹⁴⁹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹⁵⁰ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
¹⁵¹ Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁵² Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹⁵³ Department of Clinical and Organizational Development, Chicago, IL, USA.
¹⁵⁴ American Diabetes Association, Arlington, VA, USA.
¹⁵⁵ College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
¹⁵⁶ Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁵⁷ Department of Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
¹⁵⁸ School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁵⁹ Division of Endocrinology, Metabolism, Diabetes, University of Colorado, Aurora, CO, USA.
¹⁶⁰ Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland.
¹⁶¹ Department of Endocrinology, Wexford General Hospital, Wexford, Ireland.
¹⁶² Division of Endocrinology, NorthShore University HealthSystem, Skokie, IL, USA.
¹⁶³ Department of Medicine, Prtizker School of Medicine, University of Chicago, Chicago, IL, USA.
¹⁶⁴ Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
¹⁶⁵ Faculty of Health, Aarhus University, Aarhus, Denmark.
¹⁶⁶ Departments of Pediatrics and Medicine and Kovler Diabetes Center, University of Chicago, Chicago, IL, USA.
¹⁶⁷ Sanford Research, Sioux Falls, SD, USA.
¹⁶⁸ University of Washington School of Medicine, Seattle, WA, USA.
¹⁶⁹ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
¹⁷⁰ Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada.
¹⁷¹ Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
¹⁷² Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
¹⁷³ Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁷⁴ Broad Institute, Cambridge, MA, USA.
¹⁷⁵ Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
¹⁷⁶ Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
¹⁷⁷ Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India.
¹⁷⁸ Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁷⁹ Auckland Diabetes Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand.
¹⁸⁰ Medical Bariatric Service, Te Whatu Ora Counties, Health New Zealand, Auckland, New Zealand.
¹⁸¹ Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁸² University of Cambridge, Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK.
¹⁸³ Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸⁴ Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA.
¹⁸⁵ AdventHealth Translational Research Institute, Orlando, FL, USA.
¹⁸⁶ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
¹⁸⁷ MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
¹⁸⁸ Yale School of Medicine, New Haven, CT, USA.
¹⁸⁹ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁹⁰ Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
¹⁹¹ Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹⁹² Clinial Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
¹⁹³ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁹⁴ Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
¹⁹⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. paul.franks@med.lu.se.
¹⁹⁶ Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden. paul.franks@med.lu.se.
¹⁹⁷ Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK. paul.franks@med.lu.se.
¹⁹⁸ Department of Translational Medicine, Medical Science, Novo Nordisk Foundation, Hellerup, Denmark. paul.franks@med.lu.se.

^# Contributed equally.

PMID: 37794253
PMCID: PMC10735053
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.

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Conflict of interest statement

The following authors report unrelated disclosures. J. Merino. is an Associate Editor of Diabetologia; S.J.C. reports a close family member employed by a Johnson & Johnson company; A.R.K. is supported by the National Center for Advancing Translational Sciences, NIH, through grant KL2TR002490. A.R.K. also reports receiving research grants from the Diabetes Research Connection and the American Diabetes Association, and a research prize from the National Academy of Medicine, outside the submitted work; J.L.T.K. declares lecture fees from Novo Nordisk, international conference costs covered by Medtronic, AstraZeneca and Novo Nordisk; L.-L.L. reports receiving research grants via her academic institution and serving on an advisory board for Boehringer Ingelheim, Novartis, Novo Nordisk, Viatris Pharmaceutical and Zuellig Pharma. L.-L.L. has received speaking honoraria from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Roche, Sanofi, Servier, Viatris Pharmaceutical and Zuellig Pharma for scientific talks over which she had full control of the content; R.M. has received consulting or speaker honoraria from Eli Lilly, Novo Nordisk and Boeringer Engelheim; M.L.M. has received lecture, consultancy, or advisory board fees from Amarin, Amgen, Eli Lilly, Merck Sharp & Dohme, Mylan, Novo Nordisk, Novartis, Servier and SlaPharma; C.E.-M. reports serving on advisory boards for Provention Bio, Isla Technologies, MaiCell Technologies, Avotres, DiogenyX and Neurodon; receiving in-kind research support from Bristol Myers Squibb and Nimbus Pharmaceuticals; receiving investigator-initiated grants from Lilly Pharmaceuticals and Astellas Pharmaceuticals; and having patent (16/291,668) Extracellular Vesicle Ribonucleic Acid (RNA) Cargo as a Biomarker of Hyperglycaemia and Type 1 Diabetes and provisional patent (63/285,765) Biomarker for Type 1 Diabetes (PDIA1 as a biomarker of β cell stress); S.E.G. has been on advisory boards for Abata, Avotres, Genentech, GentiBio, Provention Bio, Sana Biotechnology, Sanofi and is a DSMB member for INNODIA (MELD, ATG), Diamyd (DIAGNODE-3, GAD) and JDRF (TADPOL, DFMO); M.O.G. has served on an advisory board for Nestle Health Science; A.L. reports a close family member employed by Merck & Co., Inc.; C.E.P. is an Associate Editor of Diabetes Care, receives payments from Wolters Kluwer for UpToDate chapters on diabetes in pregnancy and has received payments for consulting and speaking from Mediflix Inc; E.S. is a Deputy Editor of Diabetes Care and a member of the editorial board of Diabetologia and receives payments from Wolters Kluwer for chapters and laboratory monographs in UpToDate on measurements of glycemic control and screening tests for type 2 diabetes; W.H.H.S. has been an Advisor and/or Speaker for AstraZeneca, Bayer HealthCare, Boehringer Ingelheim Pharmaceuticals, Daiichi Sankyo, Eli Lilly and Company, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals, Novo Nordisk, Pfizer, Sanofi-Aventis, Takeda Pharmaceutical Company; J.M.W. reports a research collaboration with ENABLE Biosciences; R.J.B. has received research support from Amryt, Third Rock Ventures, Ionis and Regeneron; L.K.B. has received consulting honoraria from Bayer, Novo Nordisk, Sanofi, Lilly and Xeris; J.C.F. has received speaking honoraria from AstraZeneca and Novo Nordisk for scientific talks over which he had full control of content; A.L.G.’s spouse holds stock options in Roche and is an employee of Genentech; M.F.G. has received financial and nonfinancial (in kind) support from Boehringer Ingelheim Pharma GmbH, JDRF International, Eli Lilly, AbbVie, Sanofi-Aventis, Astellas, Novo Nordisk A/S, Bayer AG, within EU grant H2020-JTI-lMl2-2015-05 (grant agreement number 115974 - BEAt-DKD); and also from Novo Nordisk, Pfizer, Follicum, Coegin Pharma, Abcentra, Probi, Johnson & Johnson, within a project funded by the Swedish Foundation for Strategic Research on precision medicine in diabetes (LUDC-IRC no. 15-0067). M.F.G. has received personal consultancy fees from Lilly and Tribune Therapeutics AB. R.dS. has served as an external resource person to the World Health Organization’s Nutrition Guidelines Advisory Group on trans fats, saturated fats, and polyunsaturated fats. The WHO paid for his travel and accommodation to attend meetings from 2012 to 2017 to present and discuss this work. He has presented updates of this work to the WHO in 2022. He has also done contract research for the Canadian Institutes of Health Research’s Institute of Nutrition, Metabolism, and Diabetes, Health Canada, and the World Health Organization for which he received remuneration. He has received speaker’s fees from the University of Toronto, and McMaster Children’s Hospital. He has served as an independent director of the Helderleigh Foundation (Canada). He serves as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada), co-chair of the Method working group of the ADA/EASD Precision Medicine in Diabetes group and is a co-opted member of the Scientific Advisory Committee on Nutrition (SACN) Subgroup on the Framework for the Evaluation of Evidence (Public Health England). He has held grants from the Canadian Institutes of Health Research, Canadian Foundation for Dietetic Research, Population Health Research Institute, and Hamilton Health Sciences Corporation as a principal investigator, and is a co-investigator on several funded team grants from the Canadian Institutes of Health Research. P.A.G. consults or has consulted for Provention Bio and Viacyte. He is the cofounder of IM Therapeutics and serves as CMO on the Board as well as being a shareholder. P.A.G. has also received research support from Helmsley Foundation, Nova Pharmaceuticals, Imcyse, Provention Bio, Intrexon T1D Partners and Novartis. All payments have been made to the University of Colorado; R.C.W.M. has received research grants from AstraZeneca, Bayer, Novo Nordisk, Pfizer, Roche Diagnostics (HK) Ltd, Tricida Inc, and consultancy/speaker honorarium from AstraZeneca, Boehringer Ingelheim, Bayer and Merck. All proceeds have been donated to the Chinese University of Hong Kong to support diabetes research. R.C.W.M. is a cofounder of GemVCare, a technology start-up initiated with support from the Hong Kong Government Innovation and Technology Commission and its Technology Start-up Support Scheme for Universities (TSSSU); C.M. serves or has served on the advisory panel for Novo Nordisk, Sanofi, Merck Sharp and Dohme Ltd., Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Imcyse, Insulet, Zealand Pharma, Avotres, Mannkind, Sandoz and Vertex. Financial compensation for these activities has been received by KU Leuven; KU Leuven has received research support for C.M. from Medtronic, Imcyse, Novo Nordisk, Sanofi and ActoBio Therapeutics; C.M. serves or has served on the speakers’ bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca and Novartis. Financial compensation for these activities has been received by KU Leuven. C.M. has been an Advisor and/or Speaker for Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Sanofi-Aventis. C.M. is president of EASD (all external support of EASD is to be found on www.easd.org); N.S. is Senior Associate Editor of Diabetes and has received speaking honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer and Sanofi for scientific talks over which he had full control of content; J.B.M. is an Academic Associate for Quest Inc. Diagnostics R&D; S.M. has investigator- initiated funding from DexCom, has received speaker fees from Sanofi for a scientific talk over which she had full control of content and serves on the Board of Trustees for the Diabetes Research & Wellness Foundation (UK); V.M. has acted as consultant and speaker, received research or educational grants from Novo Nordisk, MSD, Eli Lilly, Novartis, Boehringer Ingelheim, Lifescan J&J, Sanofi-Aventis, Roche Diagnostics, Abbott and from several Indian pharmaceutical companies including USV, Dr. Reddy’s Laboratories and Sun Pharma. E.R.P. has received speaking honoraria from Lilly, Novo Nordisk and Illumina for scientific talks over which he had full control of content; J.L.S. serves or has served on advisory panels for Bigfoot Biomedical, Cecelia Health, Insulet Corportation, Medtronic Diabetes, StartUp Health Diabetes Moonshot and Vertex. She has served as a consultant to Abott Diabetes, Bigfoot Biomedical, Insulet, Medtronic Diabetes and Zealand. Yale School of Medicine has received research support for JLS from Abott Diabetes, JAEB Center for Health Research, JDRF, Insulet, Medtronic, NIH and Provention Bio; M.S.U. reports an unpaid collaborator with AstraZeneca; K.K.V. reports that her institution received funding from Pfizer Independent Grants for Learning and Change for an unrelated study. R.W. declares lecture fees from Novo Nordisk, Sanofi and Eli Lilly. He served on an advisory board for Akcea Therapeutics, Daiichi Sankyo, Sanofi, Eli Lilly and Novo Nordisk; P.W.F. has received consulting fees from Zoe Ltd and research grants from multiple pharmaceutical companies; R.W.M. and P.W.F. are employees of the Novo Nordisk Foundation, a private philanthropic enterprise foundation based in Denmark supporting research and education in the life sciences. All other authors report no disclosures.

Figures

**Fig. 1 |. Sources of heterogeneity in diabetes.**
The success of precision diabetes medicine will be enhanced by successfully leveraging heterogeneity in diabetes. To do so will require parsing ‘signal’ from ‘noise’; the figure illustrates the key sources of heterogeneity within each of these domains.

**Fig. 2 |. Organogram of the PMDI consortium and workflow.**
Organizational structure of the PMDI consortium during the systematic review and consensus report processes.

**Fig. 3 |. Precision medicine across the life course and the role of precision diabetes medicine.**
The collection of deep phenotypic, environmental and social data through the life course will allow the generation of prediction algorithms to identify individuals with shared characteristics that are more likely to benefit from targeted screening and preventive and treatment strategies for the prevention, diagnosis and management of diabetes.

See this image and copyright information in PMC

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

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

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