An Expert take on the concept of Precision Diabetes

The popular adage “One size doesn’t fit all” and the practical implications are well known.  For instance, can there be one shirt size which fits people of all sizes or one shoe which fits everyone?.Then, how can we give the same type of treatment to everyone with diabetes?

Dr V. Mohan, Chairman & Chief Diabetologist, DMDSC explains the concept of Precision Diabetes:

We now know that there are at least 20 types of diabetes.  The diagnosis of each one of these types is based on certain tests which will help the diabetologist to clinch the diagnosis.  The advantage of knowing which type of diabetes one has is that the treatment can be tailored accordingly. For eg., patients with type 1 diabetes need life long insulin injections.  On the other hand, in the ‘common garden’ variety of type 2 diabetes, the tablets may work even better than insulin!

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There are however other forms of diabetes.  For eg., Maturity Onset Diabetes of Youth (MODY).  It is now known that there are at least 14 different types of MODY itself.  Several types of MODY like MODY 3, MODY 1, MODY 11 and MODY 12 respond much better to ‘sulphonylurea’ tablets which correct the defect in insulin secretion.  In contrast, metformin is the drug of choice for ‘type 2 diabetes’ as it corrects insulin resistance.

There are many instances where patients are unfortunately wrongly diagnosed to have type1 diabetes. I recall a 16-year-old girl who was lean and had severe diabetes and was therefore diagnosed by her physician to have type 1 diabetes and was told that she has to take four injections of insulin for the risk of her life.   Devasted, the family came for a second opinion. When I reviewed her history I saw that she had a strong family history of diabetes going through four generations.  She also had good pancreatic beta cell function.  On further investigations, we found that the markers for type 1 diabetes like GAD antibody test were negative.

Genetic testing for MODY showed that she had MODY 3, a form of diabetes which responds to the common sulphonylurea tablets.  We, therefore, stopped the insulin and started her on Glibenclamide, one of the cheapest anti-diabetic drugs and she responded beautifully. If the genetic testing had not been done for this patient, she would probably have been continued on life long insulin therapy.  This is one example of ‘Precision Diabetes’.  There are several such miracles which have happened in treating diabetes, thanks to the introduction of Precision Diabetes.

Also read: Essential lifestyle modifications to treat diabetes 

Precision Diabetes @ DMDSC

At Dr. Mohan’s Diabetes Specialities Centre, over the last several years we have developed algorithms by which a precise diagnosis of diabetes can be made.  Applying the principles of ‘Precision Diabetes’, it will be possible in the near future to very accurately classify a patient and determine the type of diabetes he or she has, and then decide the type of treatment that this patient is likely to respond to.  These are indeed exciting times in the field of diabetology.

 Pic courtesy: biosciencetechnology