Reducing the Burden of Type 2 Diabetes With Precision Medicine

During the American Association of Diabetes Educators 2017 Annual Meeting, Erika Gebel Berg, PhD, discussed how precision medicine can be used to curb type 2 diabetes in patients with prediabetes symptoms.

Dr Berg began her presentation by outlining how precision medicine works. According to her presentation, precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”

She stressed that the need for implementation of precision medicine strategies among patients who are about to develop type 2 diabetes is crucial. She cited data showing that 84.1 million Americans currently have symptoms of prediabetes, while every year 1.5 million more people are diagnosed with type 2 diabetes. Additionally, she stated the problem is more urgent among youth, where diabetes cases have increased in prevalence by 30.5% in the last decade.

“Understanding how to prevent or delay type 2 diabetes and when to intervene, with the goal of reducing long-term morbidity and mortality in a cost-effective manner, is perhaps the most important public health question in diabetes,” Dr Berg said during her presentation.

Dr Berg explained that prediabetes is characterized by fasting plasma glucose levels between 100 and 125 mg/dL, 2 hour plasma glucose on OGTT levels between 140 and 199 mg/dL, and hemoglobin A1c levels between 5.7% and 6.4%. Patients with prediabetes experience beta-cell failure, an very early indicator of type 2 diabetes. 

She explained that prediabetes can be detected via diligent screening efforts among at-risk patients. 

Dr Berg cited research in Diabetes that concluded, “If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications.” 

According to the presentation, genetic testing will soon be used to determine the most precise treatment plans for patients with prediabetes. “We are at the dawn of using genetics to guide treatment in diabetes and prediabetes, but more is likely to come,” she said. 

In the interim, Dr Berg recommended lifestyle interventions and use of metformin among these patients to stall or fully prevent the development of type 2 diabetes. She added that “there may be benefits of going beyond these interventions for particular patients,” such as surgical and nonsurgical weight-loss interventions, use of pioglitazone, and use of rosiglitazone. —David Costill