Xia Mingfeng, Li Xiaoying
Ministry of Education Key Laboratory of Metabolism and Molecular Medicine, Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, China.
Camb Prism Precis Med. 2023 Apr 14;1:e24. doi: 10.1017/pcm.2023.12. eCollection 2023.
Diabetes mellitus is prevalent worldwide and affects 1 in 10 adults. Despite the successful development of glucose-lowering drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 inhibitors recently, the proportion of patients achieving satisfactory glucose control has not risen as expected. The heterogeneity of diabetes determines that a one-size-fits-all strategy is not suitable for people with diabetes. Diabetes is undoubtedly more heterogeneous than the conventional subclassification, such as type 1, type 2, monogenic and gestational diabetes. The recent progress in genetics and epigenetics of diabetes has gradually unveiled the mechanisms underlying the heterogeneity of diabetes, and cluster analysis has shown promising results in the substratification of type 2 diabetes, which accounts for 95% of diabetic patients. More recently, the rapid development of sophisticated glucose monitoring and artificial intelligence technologies further enabled comprehensive consideration of the complex individual genetic and clinical information and might ultimately realize a precision diagnosis and treatment in diabetics.
糖尿病在全球范围内普遍存在，每10名成年人中就有1人受其影响。尽管近年来成功开发了降糖药物，如胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂，但血糖控制达到满意水平的患者比例并未如预期那样上升。糖尿病的异质性决定了一刀切的策略并不适用于糖尿病患者。糖尿病无疑比传统的亚分类（如1型、2型、单基因和妊娠糖尿病）更加异质。糖尿病遗传学和表观遗传学的最新进展逐渐揭示了糖尿病异质性的潜在机制，聚类分析在占糖尿病患者95%的2型糖尿病分层方面显示出了有前景的结果。最近，先进的血糖监测和人工智能技术的快速发展进一步使得能够综合考虑复杂的个体遗传和临床信息，并最终可能实现糖尿病的精准诊断和治疗。
