Tailoring Individual Diabetic Care a Goal
Type 2 diabetes is a heterogenic disease condition, but existing knowledge of the disease hasn’t progressed to the point of tailoring individual treatment. Currently, all patients tend to be treated similarly.
A consensus conference endorsed by the Endocrine Society and the American Diabetes Association have published their conclusions in the April issue of the Journal of Clinical Endocrinology and Metabolism.
Heterogeneity of type 2 diabetes is recognized in the variety of clinical, genetic, behavioral, and socioeconomic factors which influence diabetes' development, progression, and response to therapy. The multiple pathways that can lead to insulin insufficiency and the abnormalities that precede type 2 diabetes (such as impaired fasting glucose and impaired glucose tolerance) also speak to the heterogeneity of type 2 diabetes.
None of this understanding has yet led to tailored individual care for type 2 diabetics. The panel recommend development of new basic and clinical research studies, including a greater focus on identifying type 2 diabetes subtypes, their response to different therapies, and quantization of cost-effectiveness. This might then someday lead to tailored individual care.
The panel concluded the statement with recommendations aimed at improving understanding of the heterogeneity of diabetes. The recommendations include:
Analyze existing data to identify associations between phenotypic and genotypic measures and glycemic control
Expand existing diabetes registries and design new ones
Develop clinical trials that specifically address heterogeneity of response to therapy
Develop more accurate and efficient means to measure biomarkers of type 2 diabetes
Expand basic research
Smith RJ et al. "Individualizing therapies in type 2 diabetes mellitus based on patient characteristics: what we know and what we need to know." J Clin Endocrinol Metab. 2010;doi:10.1210/jc.2009-1966.