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

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  • Deirdre K. Tobias
  • Abrar Ahmad
  • Catherine Aiken
  • Jamie L. Benham
  • Dhanasekaran Bodhini
  • Amy L. Clark
  • Kevin Colclough
  • Rosa Corcoy
  • Sara J. Cromer
  • Daisy Duan
  • Jamie L. Felton
  • Ellen C. Francis
  • Pieter Gillard
  • Véronique Gingras
  • Romy Gaillard
  • Eram Haider
  • Alice Hughes
  • Jennifer M. Ikle
  • Laura M. Jacobsen
  • Anna R. Kahkoska
  • Jarno L.T. Kettunen
  • Raymond J. Kreienkamp
  • Lee Ling Lim
  • Jonna M.E. Männistö
  • Robert Massey
  • Niamh Maire Mclennan
  • Rachel G. Miller
  • Mario Luca Morieri
  • Jasper Most
  • Rochelle N. Naylor
  • Bige Ozkan
  • Kashyap Amratlal Patel
  • Scott J. Pilla
  • Katsiaryna Prystupa
  • Sridharan Raghavan
  • Mary R. Rooney
  • Martin Schön
  • Zhila Semnani-Azad
  • Magdalena Sevilla-Gonzalez
  • Pernille Svalastoga
  • Wubet Worku Takele
  • Claudia Ha ting Tam
  • Mustafa Tosur
  • Amelia S. Wallace
  • Caroline C. Wang
  • Jessie J. Wong
  • Jennifer M. Yamamoto
  • Katherine Young
  • Chloé Amouyal
  • Maxine P. Bonham
  • Mingling Chen
  • Feifei Cheng
  • Tinashe Chikowore
  • Sian C. Chivers
  • Dana Dabelea
  • Adem Y. Dawed
  • Aaron J. Deutsch
  • Laura T. Dickens
  • Linda A. DiMeglio
  • Monika Dudenhöffer-Pfeifer
  • Carmella Evans-Molina
  • María Mercè Fernández-Balsells
  • Hugo Fitipaldi
  • Stephanie L. Fitzpatrick
  • Stephen E. Gitelman
  • Mark O. Goodarzi
  • Jessica A. Grieger
  • Nahal Habibi
  • Chuiguo Huang
  • Arianna Harris-Kawano
  • Heba M. Ismail
  • Benjamin Hoag
  • Randi K. Johnson
  • Angus G. Jones
  • Robert W. Koivula
  • Aaron Leong
  • Gloria K.W. Leung
  • Ingrid M. Libman
  • Kai Liu
  • S. Alice Long
  • William L. Lowe
  • Robert W. Morton
  • Ayesha A. Motala
  • Suna Onengut-Gumuscu
  • James S. Pankow
  • Maleesa Pathirana
  • Sofia Pazmino
  • Dianna Perez
  • John R. Petrie
  • Camille E. Powe
  • Alejandra Quinteros
  • Rashmi Jain
  • Debashree Ray
  • Mathias Ried-Larsen
  • Zeb Saeed
  • Vanessa Santhakumar
  • Sarah Kanbour
  • Sudipa Sarkar
  • Gabriela S.F. Monaco
  • Denise M. Scholtens
  • Elizabeth Selvin
  • Wayne Huey Herng Sheu
  • Cate Speake
  • Maggie A. Stanislawski
  • Nele Steenackers
  • Andrea K. Steck
  • Norbert Stefan
  • Julie Støy
  • Rachael Taylor
  • Sok Cin Tye
  • Gebresilasea Gendisha Ukke
  • Marzhan Urazbayeva
  • Bart Van der Schueren
  • Camille Vatier
  • John M. Wentworth
  • Wesley Hannah
  • Sara L. White
  • Gechang Yu
  • Yingchai Zhang
  • Shao J. Zhou
  • Jacques Beltrand
  • Michel Polak
  • Ingvild Aukrust
  • Elisa de Franco
  • Sarah E. Flanagan
  • Kristin A. Maloney
  • Andrew McGovern
  • Janne Molnes
  • Pål Rasmus Njølstad
  • Hugo Pomares-Millan
  • Michele Provenzano
  • Cécile Saint-Martin
  • Cuilin Zhang
  • Yeyi Zhu
  • Sungyoung Auh
  • Russell de Souza
  • Andrea J. Fawcett
  • Chandra Gruber
  • Eskedar Getie Mekonnen
  • Emily Mixter
  • Diana Sherifali
  • Robert H. Eckel
  • John J. Nolan
  • Louis H. Philipson
  • Rebecca J. Brown
  • Liana K. Billings
  • Kristen Boyle
  • Tina Costacou
  • John M. Dennis
  • Jose C. Florez
  • Anna L. Gloyn
  • Maria F. Gomez
  • Peter A. Gottlieb
  • Siri Atma W. Greeley
  • Kurt Griffin
  • Andrew T. Hattersley
  • Irl B. Hirsch
  • Marie France Hivert
  • Korey K. Hood
  • Jami L. Josefson
  • Soo Heon Kwak
  • Lori M. Laffel
  • Siew S. Lim
  • Ronald C.W. Ma
  • Chantal Mathieu
  • Nestoras Mathioudakis
  • James B. Meigs
  • Shivani Misra
  • Viswanathan Mohan
  • Rinki Murphy
  • Richard Oram
  • Katharine R. Owen
  • Susan E. Ozanne
  • Ewan R. Pearson
  • Wei Perng
  • Toni I. Pollin
  • Rodica Pop-Busui
  • Richard E. Pratley
  • Leanne M. Redman
  • Maria J. Redondo
  • Rebecca M. Reynolds
  • Robert K. Semple
  • Jennifer L. Sherr
  • Emily K. Sims
  • Arianne Sweeting
  • Tiinamaija Tuomi
  • Miriam S. Udler
  • Kimberly K. Vesco
  • Robert Wagner
  • Stephen S. Rich
  • Paul W. Franks

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.

OriginalsprogEngelsk
TidsskriftNature Medicine
Vol/bind29
Udgave nummer10
Sider (fra-til)2438-2457
Antal sider20
ISSN1078-8956
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
We thank P. Siming (Department of Clinical Sciences, Lund University, Malmö, Sweden) for administrative support and M. Björklund and K. Aronsson (Faculty of Medicine Library, Lund University, Sweden) for Covidence support. We thank L. Schwingshackl (University of Freiburg, Germany) for advice on systematic review methods and ADA for administrative support. Funding: The ADA/EASD Precision Diabetes Medicine Initiative, within which this work was conducted, has received the following support: The Covidence license was funded by Lund University, Sweden (PI: P.W. Franks) for which technical support was provided by M. Björklund and K. Aronsson (Faculty of Medicine Library, Lund University, Sweden). Administrative support was provided by Lund University (Malmö, Sweden), University of Chicago (IL, USA) and the American Diabetes Association (Washington DC, USA). The Novo Nordisk Foundation (Hellerup, Denmark) provided grant support for in-person consensus meetings (PI: L. Phillipson, University of Chicago, IL, USA). The opinions expressed herein do not necessarily reflect those of the American Diabetes Association, the European Association for the Study of Diabetes, Novo Nordisk Foundation, National Institutes of Health (NIH), or any other society, institute, or foundation. J. Merino was partially supported by funding from the American Diabetes Association (award no. 7-21-JDFM-005) and the NIH (grant nos. P30 DK40561 and UG1 HD107691); S.J.C. is supported by a Junior Faculty Development Award from the American Diabetes Association (award no. 7-21-JDFM-005); D. Duan is supported by NIH grant no. K23DK133690; E.C.F. received grant support from NIH/NICHD grant no. K99108272-02 and NIH/NHLBI grant no. R25HL146166-05; J.M.I. was supported by NIH (grant no. K08 DK133676-01); A.R.K. is supported by the National Center for Advancing Translational Sciences, NIH, through grant no. KL2TR002490. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. 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; R.J.K. is supported by NIGMS grant no. T32GM774844 and Pediatric Endocrine Society Rising Star Award; N.-M.M. is supported by grants from the NIDDK (grant nos. R01DK125780 and R01DK134955); M.L.M. is supported by the Italian Ministry of Health grant no. GR-2019-12369702; R.N.N. was supported by ADA grant nos. 7-22-ICTSPM-17, R01DK104942 and U54DK118612; B.O. is supported by American Heart Association (grant no. 20SFRN35120152); K.A.P. is funded by the Wellcome Trust (grant no. 219606/Z/19/Z) and the National Institute for Health Research (NIHR) Exeter Biomedical Research Centre, Exeter, UK; S.J.P. was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant no. K23DK128572); S.R. is funded by US Department of Veterans Affairs Award no. IK2-CX001907 and a Webb-Waring Biomedical Research Award from the Boettcher Foundation; M.S.-G. is supported by the American Diabetes Association (grant no. 9-22-PDFPM-04) and NIH (grant no. 5UM1DK078616-14); W.W.T. has received funding from the Monash Graduate and International Tuition Scholarship and the Australian Government Research Training Program Scholarship; M.T. is supported by grant no. K23-DK129821 from NIH/NIDDK; A.S.W. is supported by NIH/NHLBI grant no. T32HL007024; M.C. has received funding from the Monash Graduate and International Tuition Scholarship and the Australian Government Research Training Program Scholarship; T.C. is an international training fellow supported by the Wellcome Trust (grant no. 214205/Z/18/Z); S.C.C. is funded by Diabetes UK Sir George Alberti fellowship (grant no. 21/0006277); A.J.D. is supported by NIH/NIDDK grant no. T32DK007028; S.E.G. currently receives research funding from the NIH: NIDDK (TrialNet, grant no. 2U01DK106993-02) and NIAID (Immune Tolerance Network, grant no. FY20ITN372), and from Provention Bio; M.O.G. is supported by the Eris M. Field Chair in Diabetes Research and NIH grant no. P30-DK063491; J.A.G. is supported by a NHMRC Ideas Grant (APP: 2000905); H.M.I. was supported by NIH/NIDDK grant no. K23DK129799; Pilot and Feasibility Award, CDMD, NIH/NIDDK grant no. P30 DK097512; grant no. 2021258 from the Doris Duke Charitable Foundation through the COVID-19 Fund to Retain Clinical Scientists collaborative grant program and grant no. 62288 from the John Templeton Foundation; R.K.J. is funded by NIH grant no. R03-DK127472 and The Leona M. and Harry B. Helmsley Charitable Trust (grant no. 2103-05094); A.L. is supported by grant no. 2020096 from the Doris Duke Foundation and the American Diabetes Association grant no. 7-22-ICTSPM-23; D.R. is supported by NIH/NIDDK grant no. R21DK125888 and other grants from the NIH; E.S. is supported by NIH/NHLBI grant no. K24 HL152440 and other grants from the NIH; W.H.-H.S. obtained funding from NHRI, Taiwan (grant nos. MG-112-PP-18 and MG-112-PP-19); M.A.S. is supported by NIH grant no. K01/NHLBI HL157658; G.G.U. is funded by the Monash Graduate Scholarship and Monash International Tuition Scholarship; J.M.W is funded by NHMRC Ideas Grant; S.L.W. is supported by a research grant no. MR/W003740/1 from the Medical Research Council; J.B. is funded by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases; E.D.F. is a Diabetes UK RD Lawrence Fellow (19/005971); S.E.F. has a Wellcome Trust Senior Research Fellowship (grant no. 223187/Z/21/Z); K.A.M. was supported by NIH grant no. U54DK118612 and NIH/NICHD grant no. U24HD093486; J. Molnes is funded by the Norwegian Diabetes Association; P.R.N. was supported by grants from the European Research Council (grant no. 293574), the Trond Mohn Foundation (Mohn Center for Diabetes Precision Medicine, grant no. TMS2022TMT01), the Research Council of Norway (grant no. 240413) and the Novo Nordisk Foundation (grant no. 54741); T.C. was supported by grant nos. R01HL130153 and R01DK034818; J.M.D. is supported by Research England’s Expanding Excellence in England (E3) fund; J.C.F. is supported by NIH grant no. K24 HL157960; A.L.G. is a Wellcome Trust Senior Fellow (200837/Z/16/Z) and is also supported by NIDDK (award no. UM-1DK126185); M.F.G. is supported by the Swedish Heart-Lung Foundation (grant no. 20190470), Swedish Research Council (EXODIAB, grant nos. 2009-1039 and 2018-02837), Swedish Foundation for Strategic Research (LUDC-IRC, grant no. 15-0067) and EU H2020-JTI-lMl2-2015-05 (grant agreement no. 115974 - BEAt-DKD); M.-F.H. was supported by the American Diabetes Association Pathways Award no. 1-15-ACE-26; J.L.J. is funded by the NIH (grant no. 5R01DK118403); L.M.L. is supported by National Institute of Healths grant no. P30DK036836; S.S.L. is funded by the Australian National Health and Medical Research Council (NHMRC) Fellowship; C.C., J. Merino, A.C.B.T., M.K.A., M.G.-F., T.H. and R.J.F.L. acknowledge that The Novo Nordisk Foundation Center for Basic Metabolic Research is supported by and unrestricted grant from the Novo Nordisk Foundation (grant no. NNF18CC0034900); R.C.W.M. acknowledges support from the Research Grants Council of the Hong Kong Special Administrative Region (grant no. CU R4012-18), the Croucher Foundation Senior Medical Research Fellowship and University Grants Committee Research Grants Matching Scheme and Research Committee Postdoctoral Fellowship Scheme of the Chinese University of Hong Kong; J.B.M. reports funding from NIH grant nos. U01 DK078616 and R01 HL151855; S.M. has a personal award from Wellcome Trust Career Development scheme (grant no. 223024/Z/21/Z) and is supported by the NIHR Imperial Biomedical Research Centre; K.R.O. is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health; S.E.O. is funded by the British Heart Foundation (grant no. RG/17/12/33167) and the Medical Research Council (grant no. MC_UU_00014/4); T.I.P. was supported by NIH grant nos. U54DK118612, NIH/NICHD U24HD093486 and NIH/NHGRI U01HG007775; L.M.R. is funded by the National Institute of Health (grant no. 5R01DK124806); relevant funding for M.J.R. includes NIH grant no. R01 DK124395 and NIH grant no. 1 R01 DK121843-01; R.M.R. acknowledges the support of the British Heart Foundation (grant no. RE/18/5/34216); T.T. is supported by The Folkhalsan Research Foundation and The Academy of Finland/University of Helsinki (grant nos. 312072 and 336826); M.S.U. is supported by an NIH grant no. K23DK114551 and the Doris Duke Foundation Clinical Scientist Development Award; S.S.R. is supported by NIH/NIDDK grant no. R01DK122586 and other grants from the NIH; P.W.F. is supported by research grants from the European Commission (grant no. ERC-CoG_NASCENT-681742) and the Swedish Research Council (grant nos. 2014-03529 and 2019-01348).

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