糖尿病和精准医疗

        With the improvement of people’s living conditions, there was a dramatic shift in people’s lifestyles. Nowadays, people tend to do less physical exercise, ingest more sugar-rich food, and have lots of stress. Such behaviors have brought people’s attention to the phenotype known as “diabetes.” (An unhealthy lifestyle causes not all types of diabetes.) 

        Diabetes is a chronic health problem that can affect how people absorb glucose into their bodies. People who have diabetes are either not able to produce enough insulin (a signal that can “tell” the body to convert simple sugar into an energy source that can be stored in the liver), or cells do not “listen” to the orders given by the insulin. Suppose the cells do not receive nor react to the signals. In that case, the blood sugar in people’s bloodstream will continue rising, which can cause serious health problems like stroke, blindness, heart attack, kidney failure, and amputation. The three most common types of diabetes are type 1 diabetes, type 2 diabetes, and gestational diabetes. Type 1 diabetes is known as insulin-dependent, which means the body does not make insulin. This type of diabetes is caused by an autoimmune reaction (the body attacks itself by mistake). The most common diabetes is type 2 diabetes, accounting for 90-95% of the total diabetes cases. This type of diabetes is caused by the trait called “insulin resistance”(cells do not respond to insulin), which means that the patient’s pancreas (an organ that produces insulin) produces a large amount of insulin, but people’s bodies do not respond to that signal. Blood glucose will increase in the patient’s bloodstream resulted in serious problems. The exact cause of insulin resistance isn’t clear yet; however, family inheritance, lack of exercise, and overweight can increase the chance of getting type 2 diabetes. The third type of diabetes is known as “gestational diabetes.” Gestational diabetes occurs during the woman’s pregnancy when the body cannot make enough insulin to sustain both the mother and the infant.

        Approximately 422 million people had diabetes in 2014(WHO). About 1.6 million people who lost their lives directly resulted from diabetes. In The US, an increasing trend can be observed regarding the number of people who have diabetes. Increasing from about 1.5%—6.9% of the total US population to approximately 12.2%—33.0% of the total US population within 12 years (from 2004 to 2016). According to the World Health Organization, this trend is still increasing; however, “Diabetes can be treated and its consequences avoided or delayed.”

（摘自：https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf）

        Precision medicine is an advanced idea where we category patients according to their symptoms and their unique biology and environment. In our daily lives, we are usually familiar with traditional medicine to classify patients with their symptoms. For example, suppose the same disease infects a group of different people by applying for traditional medicine. In that case, a kind of medicine is provided. Some people will benefit from this kind of medicine. Some will not get the benefit, and some even would get adverse effects from such medicine. Precision medicine is more advanced than traditional medicine. Instead of using the same medicine, the concept of precision medicine will produce a particular type of treatment for each patient by considering the patient’s health status, lifestyle, etc. Shortly, the application of precision medicine in diabetes treatments will become possible.

        The precision public health cycle. The cycle illustrates the benefits of precision approaches to improving patient care and population health.

References:

1. Precision Medicine in Diabetes: A Consensus Report From the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care; 2020;43:1617–1635.

2. Enabling Technologies for Personalized and Precision Medicine, Trends in Biotechnology, 2020; 38 (5)497-518. 

3. https://www.who.int/news-room/fact-sheets/detail/diabetes