Research Spotlight: The Precision Medicine in Diabetes Initiative: 2nd International Consensus Report on Gaps & Opportunities for the Clinical Translation of Precision Diabetes Medicine

Several Massachusetts General Hospital investigators including Miriam Udler, MD, PhD, James Meigs, MD, Sara Cromer, MD, Magdalena Sevilla-Gonzalez, PhD, Aaron Deutsch, MD, Camille Powe, MD, Marie-France Hivert, MD and Jose Florez, MD, PhD, Chair of the Department of Medicine, are among the authors of a recent report published in Nature Medicine, The Precision Medicine in Diabetes Initiative: 2^nd International Consensus Report on Gaps & Opportunities for the Clinical Translation of Precision Diabetes Medicine.

What was the question you set out to answer with this study?

There are hundreds of millions of people living with diabetes worldwide, many who will develop life-threatening complications and die prematurely.

Precision medicine – a practice designed to optimize efficiency and therapeutic benefit for patients –could help address this critical problem by accounting for the complex causes, clinical presentations, and disease progression of common forms of diabetes, as well as the risk of complications and related conditions.

Through this report and several accompanying methods papers, this international research group sought to study what is currently known and to identify the important gaps of knowledge regarding implementation of precision medicine in the care of people with diabetes.

This 2^nd International Consensus Report from the Precision Medicine in Diabetes Initiative (PMDI) summarizes the comprehensive systematic reviews and resulting consensus among the PMDI consortium for the pillars of precision medicine prevention, diagnosis, treatment, and prognosis across multiple forms of diabetes: type 1, type 2, gestational, and monogenic diabetes.

What Did You Find?

The key findings of this 2^nd Consensus Report were that within the areas examined, several actionable and near-actionable examples of precision diabetes medicine exist. However, the quality of data is generally low, and few studies have been explicitly designed to test precision medicine hypotheses.

There is also a dearth of relevant, high-quality research in people of non-European ancestry, hindering the development and implementation of precision diabetes medicine in many of the most heavily burdened populations worldwide.

What are the Clinical Implications and Future Research Priorities?

The report provides examples of systemic reviews of literature supporting particular clinical approaches. Additionally, the report will help guide areas of need for future research to improve diabetes care.

Key future research priorities include: (i) meta-analyses of existing clinical trials using individual-level data to ensure adequate power and re-analysis of existing trials with attention placed on determining treatment effect heterogeneity; (ii) novel clinical trial designs to test a priori hypotheses regarding treatment heterogeneity, particularly those with two or more active comparators to inform clinically-relevant decisions; (v) discovery and evaluation of novel genetic and non-standard biomarkers, and (vi) integration of combinations of clinically accessible features to enhance prediction of response and selection of optimal therapies.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.