Precision Medicine in Diabetes.
Precision Medicine in Diabetes.
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糖尿病精准医学。
DOI：
10.1007/164_2022_590
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发表时间：
2023
影响因子：
--
通讯作者：
Dawed AY
中科院分区：
文献类型：
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作者：
Dawed AY
根据特定的临床、分子和基因组特征为个体群体量身定制治疗或管理是精准医学的概念。糖尿病在临床表现、疾病进展、并发症发生和药物反应方面具有高度异质性。目前的药物治疗实践主要基于报告平均效果的临床试验证据。然而，约一半的2型糖尿病患者尽管有很高的依从性，但没有达到降糖目标，并且不良结局的发生率存在显著差异。因此，需要鉴定可在开处方时告知差异药物反应的预测性标志物。分子遗传学的最新进展以及现实世界和随机试验数据的可用性增加，已经开始增加我们对疾病异质性及其对特定群体潜在治疗的影响的理解。利用简单临床特征（年龄、性别、BMI、种族和共同处方药物）和基因组标记物的信息，有可能识别出可能从给定药物中获益且副作用最小的亚组。在本章中，我们将讨论在发现临床和遗传标记，有可能优化药物治疗2型糖尿病的现有证据的状态。
Tailoring treatment or management to groups of individuals based on specific clinical, molecular, and genomic features is the concept of precision medicine. Diabetes is highly heterogenous with respect to clinical manifestations, disease progression, development of complications, and drug response. The current practice for drug treatment is largely based on evidence from clinical trials that report average effects. However, around half of patients with type 2 diabetes do not achieve glycaemic targets despite having a high level of adherence and there are substantial differences in the incidence of adverse outcomes. Therefore, there is a need to identify predictive markers that can inform differential drug responses at the point of prescribing. Recent advances in molecular genetics and increased availability of real-world and randomised trial data have started to increase our understanding of disease heterogeneity and its impact on potential treatments for specific groups. Leveraging information from simple clinical features (age, sex, BMI, ethnicity, and co-prescribed medications) and genomic markers has a potential to identify sub-groups who are likely to benefit from a given drug with minimal adverse effects. In this chapter, we will discuss the state of current evidence in the discovery of clinical and genetic markers that have the potential to optimise drug treatment in type 2 diabetes.