Utilizing Precision Medicine for Diabetes Management
The future of medicine is already here- Personalized, Preventive and Private. The holy grail of disease management has always been- precision medicine.
Personalized – specific to the individual patients. Until now we were only able to treat all patients the same. Recognizing that not all patients are the same with contemporary science, especially the advance of genetics, we are now able To provide personalized medicine. Focusing on diagnosis, treatment, medications and dosages, which can now be tailored specifically for the individual patient.
Preventive – the best way to manage diseases is to prevent them. Today we start having the tools to predict risks and identify the development of medical condition in advance. This allows us to take actions in the hope to prevent the disease from progressing. Early diagnosis followed by repeated testing, as required, monitoring and active actions like lifestyle modifications and/or specific medications to reduce risk parameters. Genetics is one of the upcoming main cornerstones in helping patients to identify their medical risks. Through direct to the consumer advertising and with patients becoming more aware of their need to control their own destiny they are searching the web and becoming aware of the availability of genetic testing.
Private – people are able to order genetic tests, being performed in the privacy of their home, to understand their unique genetic makeup. The results allow them to take active actions to modify their genetic risks. However, in today’s era of open information, it is critical for people to be aware that all their data may be available to all. They should keep their genetic makeup and medical diseases risk, private to prevent insurance companies, employers and other public institution to identify them as high risk patients and be protected from discrimination. Being able to protect the privacy of genetic testing should be key when ordering the tests.
Direct-to-consumer (DTC) genetic testing – tests that could be purchased over-the-counter or online without the requirement of health care provider involvement. Today’s genetic testing is able to provide a risk assessment for a variety of health conditions e.g. cancer and metabolic conditions Often the tests can help in predicting response to certain medications. As such, once getting the results, it is advisable to further consult with a health care professional like a genetic counselor or a physician- especially when addressing response to medications, and/or lifestyle experts like dietitians and exercise experts
The genetic basis for diabetes has been studied intensively. Although Type 2 diabetes has a high familial risk, more is known about the genetics of Type 1 diabetes. Genes contributing 60% to 65% of susceptibility to Type 1 diabetes. Type 2 DM can often be prevented through intensive lifestyle modifications. There are no known ways to prevent Type 1 DM, though lifestyle changes may help, at least, in delaying its progression. Yet, knowing the risk would help in constant monitoring of people at risk helping to diagnose the disease as it develops before it created a lot of damage.
Identifying diseases at early stages in the life course of a person, especially one that is at high risk for developing diabetes has great value- Knowledge is power.
By Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE
Medical Director & Principal Investigator, Metabolic Institute of America