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糖尿病预防、分类和管理中的精准医学。

Precision medicine in diabetes prevention, classification and management.

机构信息

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

出版信息

J Diabetes Investig. 2018 Sep;9(5):998-1015. doi: 10.1111/jdi.12830. Epub 2018 Apr 25.

Abstract

Diabetes has become a major burden of healthcare expenditure. Diabetes management following a uniform treatment algorithm is often associated with progressive treatment failure and development of diabetic complications. Recent advances in our understanding of the genomic architecture of diabetes and its complications have provided the framework for development of precision medicine to personalize diabetes prevention and management. In the present review, we summarized recent advances in the understanding of the genetic basis of diabetes and its complications. From a clinician's perspective, we attempted to provide a balanced perspective on the utility of genomic medicine in the field of diabetes. Using genetic information to guide management of monogenic forms of diabetes represents the best-known examples of genomic medicine for diabetes. Although major strides have been made in genetic research for diabetes, its complications and pharmacogenetics, ongoing efforts are required to translate these findings into practice by incorporating genetic information into a risk prediction model for prioritization of treatment strategies, as well as using multi-omic analyses to discover novel drug targets with companion diagnostics. Further research is also required to ensure the appropriate use of this information to empower individuals and healthcare professionals to make personalized decisions for achieving the optimal outcome.

摘要

糖尿病已成为医疗支出的主要负担。遵循统一治疗方案进行糖尿病管理往往与治疗失败的逐渐进展和糖尿病并发症的发生有关。我们对糖尿病及其并发症的基因组结构的理解的最新进展为开发精准医学以实现糖尿病预防和管理的个体化提供了框架。在本次综述中,我们总结了对糖尿病及其并发症遗传基础的最新认识。从临床医生的角度出发,我们试图在糖尿病领域对基因组医学的实用性提供一个平衡的观点。利用遗传信息来指导单基因糖尿病的管理代表了基因组医学在糖尿病领域的最佳应用实例。尽管在糖尿病、其并发症和药物遗传学的遗传研究方面取得了重大进展,但仍需要努力将这些发现转化为实践,即将遗传信息纳入风险预测模型以确定治疗策略的优先级,以及使用多组学分析来发现具有伴随诊断的新型药物靶点。还需要进一步的研究来确保正确使用这些信息,以使个人和医疗保健专业人员能够做出个性化决策,以实现最佳结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0ab/6123056/4035da0392b5/JDI-9-998-g001.jpg

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