Pharmacological interventions

Abstract

Precision medicine in diabetes mellitus (DM) aims to group individuals with DM into phenotypes defined by specific clinical, anthropometric, biochemical, metabolic, immunological, and genetic variables. This allows for the development of personalized pharmacological treatments based on these precise diagnoses. Furthermore, it seeks to correlate these phenotypes with comorbidities and, especially, with chronic complications of DM, both micro- and macroangiopathic. One of the most significant challenges is that patients can shift between phenotypes as the disease progresses. Therefore, efforts are underway to utilize these variations to establish pharmacological treatments without confining patients to rigid phenotypes.

These objectives have been achieved for MODY DM. Identifying the monogenic phenotype, once the genetic diagnosis is established, allows for personalized treatment tailored to each phenotype. Among the most frequent treatments are non-pharmacological management for MODY 2 and low-dose sulfonylurea therapy for MODY 1 and 3. In autoimmune diabetes mellitus (DM), progress has also been made in identifying phenotypes (DM1 being one of these phenotypes), leading to the development of personalized treatments based on insulin therapy, DPP4 inhibitors, and even GLP-1 receptor agonists, depending on the specific phenotype.

In the case of DM2, the application of precision medicine is more complex due to its highly heterogeneous nature. While different phenotypes have been observed, their usefulness in establishing personalized treatments has been limited. In this regard, electronic prediction models have been developed to personalize treatment based on specific variables, such as the one available at www.diabetesgenes.org/t2-treatment/.