Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge Clinical School, Cambridge, UK.
Diabetologia. 2022 Nov;65(11):1796-1803. doi: 10.1007/s00125-022-05774-7. Epub 2022 Aug 2.
It is well established from clinical trials that behavioural interventions can halve the risk of progression from prediabetes to type 2 diabetes but translating this evidence of efficacy into effective real-world interventions at scale is an ongoing challenge. A common suggestion is that future preventive interventions need to be more personalised in order to enhance effectiveness. This review evaluates the degree to which existing interventions are already personalised and outlines how greater personalisation could be achieved through better identification of those at high risk, division of type 2 diabetes into specific subgroups and, above all, more individualisation of the behavioural targets for preventive action. Approaches using more dynamic real-time data are in their scientific infancy. Although these approaches are promising they need longer-term evaluation against clinical outcomes. Whatever personalised preventive approaches for type 2 diabetes are developed in the future, they will need to be complementary to existing individual-level interventions that are being rolled out and that are demonstrably effective. They will also need to ideally synergise with, and at the very least not detract attention from, efforts to develop and implement strategies that impact on type 2 diabetes risk at the societal level.
从临床试验中可以清楚地看出，行为干预可以将前驱糖尿病进展为 2 型糖尿病的风险降低一半，但将这一疗效证据转化为大规模有效的实际干预措施仍然是一个持续存在的挑战。一种常见的建议是，未来的预防干预措施需要更加个性化，以提高效果。本综述评估了现有干预措施已经实现个性化的程度，并概述了如何通过更好地识别高危人群、将 2 型糖尿病分为特定亚组以及最重要的是，通过更个性化的行为目标来实现更大程度的个性化，从而实现更大程度的个性化。使用更动态实时数据的方法仍处于科学的初级阶段。尽管这些方法很有前途，但需要对其进行长期的临床结果评估。无论未来开发哪种 2 型糖尿病的个性化预防方法，都需要与正在实施的现有的个体层面干预措施相辅相成，并且要证明这些干预措施是有效的。它们还需要理想地与在社会层面上影响 2 型糖尿病风险的策略的开发和实施协同作用，至少不能分散注意力。
