LAUSR

Recently, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have jointly released an expert opinion-based Consensus Report on precision diabetes medicine deliberating particularly about the precision diagnosis and the precision therapeutics. This Consensus Report functions as the starting point for a series of activities including systematic review of evidence, dissemination of findings, conduct of international research and educational symposia, and development of clinical guidelines—planned in a phased manner from 2018 to 2025 and beyond. These proposed activities are the reflections of the key objectives set forth by the Precision Medicine in Diabetes Initiative (PMDI). The PMDI (2018) was established by the ADA in collaboration with the EASD, and its vision statement is “realizing a future of longer, healthier lives for people with diabetes, achieved by applying the appropriate (right) treatment for the appropriate (right) person at the appropriate (right) time.” The PMDI Task Force encompasses both the Executive Oversight Committee, which functions as the governing body, and the Steering Committee, which functions as the guiding body for PMDI activities. The Report defines precision diabetes medicine as “an approach to optimize the diagnosis, prediction, prevention, or treatment of diabetes by integrating multidimensional data, accounting for individual differences.” Furthermore, the first purpose of this report was to define the different terminologies related to precision diabetes medicine along with reviewing the present status of diagnostics and therapeutics in diabetes; the term therapeutics includes both prevention and treatment. Precision diagnosis is defined as “refining the characterization of diabetes to optimize therapies and/or prognostication using information about a person's unique biology, environment, and/or context”; it is a “probability-based decision” and is not a single-step event but rather a continuous process evolving through different stages. Likewise, precision therapeutics is defined as “tailoring medical approaches using information about a person's unique biology, environment, and/or context for the purposes of preventing or treating disease”; the success of precision therapeutics depends on optimal application of precision diagnostics. Precision prevention is defined as “using information about a person's unique biology, environment, and/or context to determine their likely responses to health interventions and risk factors and/or to monitor progression toward disease”; it incorporates risk factor avoidance and lifestyle interventions. Precision treatment is defined as “using information about a person's unique biology, environment, and/or context to guide the choice of an efficacious therapy to achieve the desired therapeutic goal or outcome, while reducing unnecessary side effects”; it involves enhancing treatment efficacy and minimizing side effects. Precision prognostics is defined as “improving the precision and accuracy with which a patient's disease-related outcomes are predicted using information about their unique biology, environment, and/or context”; the clinical and environmental characteristics are extrapolated to predictive algorithms in estimating the frequency and extent of complications, related patient-centered outcomes, and early deaths. Precision monitoring is defined as “detailed assessment of biological markers (e.g., continuous glucose monitoring), behaviors (e.g., physical activity), diet, sleep, and psychophysiological stress”; this precision monitoring is vital for the execution of precision diagnostics, precision prevention, and precision prognostics. The demarcation between “personalized” (or “individualized”) medicine and “precision” (or “stratified”) medicine is also stressed— “personalized medicine” (for a particular individual) is the science about who will benefit from a particular drug and who will not, whereas “precision medicine” (for a subgroup of individuals) refers to the treatment and preventive approaches that would be effective for patients based on their genetic, environmental, and lifestyle factors. As per the ADA's Standards of Medical Care in Diabetes-2020, diabetes can be classified as type 1 diabetes, type 2 diabetes, Received: 4 September 2020 Revised: 9 November 2020 Accepted: 16 November 2020