Precision medicine for diabetic Individuals: a joint Malaysia-UK Effort (PRIME) project

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Malaysia has the highest rate of diabetes in Asia and one of the highest in the world. Adding to this problem is the growing number of obese Malaysian children and adolescents who are now or will be affected by diabetes. The harmful effects of diabetes on the vasculature or blood vessels dominate the complications caused by diabetes. These vascular effects affect the heart (to cause heart attack, stroke and heart failure), feet (leading to amputations), eyes (to cause blindness) and kidneys (to cause kidney failure). This escalating diabetes pandemic with its cardiovascular complications has huge effects both for the affected individual and their society. Despite sugar-lowering diabetic drugs and control of other cardiovascular risk factors, people with diabetes continue to succumb to the cardiovascular-related diseases. While efforts are being made to combat this diabetic epidemic through public health measures, new strategies are clearly needed to address and prevent the cardiovascular complications of diabetes. In the UK, we have pioneered the concept of personalised medicine through the use of genetics to determine who will and will not respond to commonly used drugs in diabetes, as well as for heart protective drugs such as those that lower blood pressure and cholesterol. We have also made substantial inroads in the use of artificial intelligence to analyse digital pictures of patients' retinas to find features that reveal a patient's current disease status and is predictive of future risk of complications such as stroke and heart disease. However, the majority of these studies on how diabetes and the cardiovascular complications arise and how patients respond to medications are from white European ancestry populations despite the fact that diabetes in Europeans is very different to diabetes in Asians. There is therefore an urgent need for detailed research into the specific causes and cardiac consequences of diabetes in Asians including those in Malaysia in order to identify the processes that drive the onset of cardiovascular complications of diabetes that exist in Malaysian ethnicities and use this to understand how best to manage diabetes in Malaysia. In our proposed PRIME partnership, we propose to build upon the precision medicine expertise in Dundee that includes the on-going £7 million NIHR Global Health Research Unit on Global Diabetes Outcomes Research INdia-Scotland Partnership for Precision medicine in Diabetes - INSPIRED (https://inspired-nihr.com/) project that is exploring specific differences in combinations of genomic, retinal and clinical determinants of complications of diabetes and therapeutic response between Scottish and the South Indian population. The plan is to embed insights from the on-going INSPIRED program into the PRIME project that will add value to each project. Using the available precision medicine expertise in Dundee, we will facilitate knowledge transfer to Malaysia for initial establishment of a similar concept using the Malaysian government initiated The Malaysian Cohort (TMC) study, that is the biggest and most comprehensive population-based cohort study in Malaysia. The overarching objective of the PRIME project is to develop an international collaboration between Dundee and Malaysia that will establish the potential for translation of precision medicine to management of diabetes and its associated cardiovascular complications in Malaysia.