Rapid advances in technology and data science have the potential to improve the precision of preventive and therapeutic interventions, and enable the right treatment to be recommended, at the right time, to the right person. There are well-described examples of successful precision medicine approaches for monogenic conditions such as specific diets for phenylketonuria, and sulfonylurea treatments for certain types of MODY. However, the majority of chronic diseases are polygenic, and it is unlikely that the research strategies used for monogenic diseases will deliver similar changes to practice for polygenic traits. Type 2 diabetes, for example, is a multifactorial, heterogeneous, polygenic palette of metabolic disorders. In this non-systematic review I highlight limitations of the evidence, and the challenges that need to be overcome prior to implementation of precision medicine in the prevention and management of type 2 diabetes. Most precision medicine approaches are spuriously precise, overly complex and too narrowly focused on predicting blood glucose levels with a limited set of characteristics of individuals rather than the whole person and their context. Overall, the evidence to date is insufficient to justify widespread implementation of precision medicine approaches into routine clinical practice for type 2 diabetes. We need to retain a degree of humility and healthy scepticism when evaluating novel strategies, and to demand that existing evidence thresholds are exceeded prior to implementation.

Graphical abstract

中文翻译：

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糖尿病精准医疗：潜力、陷阱和危险，但尚未准备好迎接黄金时段

技术和数据科学的快速进步有可能提高预防和治疗干预的精确度，并能够在正确的时间向正确的人推荐正确的治疗方法。对于单基因疾病，例如针对苯丙酮尿症的特定饮食和针对某些类型 MODY 的磺脲类药物治疗，有很多成功的精准医学方法的例子。然而，大多数慢性病是多基因的，用于单基因疾病的研究策略不太可能对多基因性状的实践产生类似的改变。例如，2 型糖尿病是一种多因素、异质、多基因的代谢疾病。在这篇非系统性综述中，我强调了证据的局限性，以及在实施精准医学预防和管理 2 型糖尿病之前需要克服的挑战。大多数精准医学方法都是虚假精确的、过于复杂的，并且过于狭隘地专注于预测血糖水平，其具有有限的个体特征，而不是整个人及其背景。总体而言，迄今为止的证据不足以证明将精准医学方法广泛应用于 2 型糖尿病的常规临床实践。在评估新策略时，我们需要保持一定程度的谦逊和健康的怀疑态度，并要求在实施之前超过现有的证据阈值。大多数精准医学方法都是虚假精确的、过于复杂的，并且过于狭隘地专注于预测血糖水平，其具有有限的个体特征，而不是整个人及其背景。总体而言，迄今为止的证据不足以证明将精准医学方法广泛应用于 2 型糖尿病的常规临床实践。在评估新策略时，我们需要保持一定程度的谦逊和健康的怀疑态度，并要求在实施之前超过现有的证据阈值。大多数精准医学方法都是虚假精确的、过于复杂的，并且过于狭隘地专注于预测血糖水平，其具有有限的个体特征，而不是整个人及其背景。总体而言，迄今为止的证据不足以证明将精准医学方法广泛应用于 2 型糖尿病的常规临床实践。在评估新策略时，我们需要保持一定程度的谦逊和健康的怀疑态度，并要求在实施之前超过现有的证据阈值。迄今为止的证据不足以证明将精准医学方法广泛应用于 2 型糖尿病的常规临床实践。在评估新策略时，我们需要保持一定程度的谦逊和健康的怀疑态度，并要求在实施之前超过现有的证据阈值。迄今为止的证据不足以证明将精准医学方法广泛应用于 2 型糖尿病的常规临床实践。在评估新策略时，我们需要保持一定程度的谦逊和健康的怀疑态度，并要求在实施之前超过现有的证据阈值。

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