Personalized Medicine for Diabetics: UK's Genomic Initiatives and Their Impact

If you go back 50 years and tell someone that you can predict that they’ll have a specific disease in the future, you’ll find no believers.

What if you tell them that you can also predict how medications will affect their bodies and the individual side effects that they may get from certain drugs? Insanity will probably be your second name.

Fortunately, science can make such miracles a reality, especially when pressured. What pressure is better than 415 million people worldwide with the same disease?

That’s right. Diabetes Mellitus, one of the most challenging diseases to handle, is expected to attack over half a billion people in 2040. That’s why scientists are taking more and more measures to battle it.

The latest treatment modality is the personalized medicine for diabetes or PMFD. In this article, we’ll understand what PMFD is, its steps, pros and cons, and their impact in the UK.

Personalisation involves tailoring a particular item/service to suit a specific person as much as possible. So many medications can treat the same condition, but some do so with a lot better efficiency because they’re more effective in certain people.

For example, if 100 patients go to a physician to treat a cold, it’s doubtful they will receive the same medication. Instead, the physician would tailor the type and the dose of medicines according to each patient.

This personalisation is based on many factors, including:

• The patient’s age
• The patient’s gender
• The severity and onset of the disease
• Predisposing and genetic risk factors that may affect the disease
• The mental condition of the patient
• Environmental factors around the patient
• The patient’s immunity and genes

Remember that a disease like the common cold may not force the doctor to go through all of these factors to personalise treatment for the patient.

If 50 of the patients mentioned above are in the same age group, there’s a good chance they would all be prescribed the same medication.

However, the common cold is acquired by catching a virus. It’s a straightforward process with a known treatment.

The same can’t be said for diseases whose definitive cause is yet to be pinpointed, like type 2 diabetes and its strange insulin resistance. That’s when personalised diabetes therapy can leave a more prominent mark on the treatment procedure.

Science is yet to understand the exact cause of different forms of diabetes. As long as the precise cause is unknown, science will keep tracking the disease and pinpoint the most common predisposing (risk) factors.

The risk factors of diabetes include (but aren’t limited to):

Being overweight is arguably the most common risk factor for the onset of diabetes. When too much fat is stored in vital areas of your body, like the liver and pancreas, their function might get impaired.

For example, the pancreas may fail to produce sufficient insulin, leading to diabetes type 1. On the other hand, having too many fatty cells can affect the body’s ability to utilise insulin, leading to type 2 diabetes. If the weight is consistently unchecked, the patient may need insulin treatment.

A physically active person will always have better health because they utilise their body functions. Any muscle/organ in the body that gets left unused for a while deteriorates in one way or another.

Further, movement allows the body to produce insulin and utilise the glucose in the bloodstream constantly. This keeps the cycle of insulin secretion and cessation going, reducing the disease risk factor.

The more common type of diabetes, type 2, is strongly related to genetics. Scientists have identified several gene mutations that can increase the risk of diabetes.

That doesn’t necessarily mean everyone with these genetic variations will develop diabetes. However, along with other predisposing factors, the patient’s genome can increase the risk.

The genomic aspect of diabetes will be our core discussion.

Personalised Medicine for Diabetes, or PMFD, uses a person's genetic makeup to provide the best possible treatment and personalized therapy to monitor the patient’s condition.

Further, by identifying the diabetic predisposing genes in a healthy person, it’s possible to predict diabetes before it happens for such a person.

As such, the doctors would encourage that person to have a better lifestyle, diet, and weight management. This can lessen the risk of diabetes and sometimes prevent it from occurring to begin with.

Precision medicine in diabetes has four primary processes. Those are:

Genes are the basic units of heredity, and they control all the individual's physical features, as well as their susceptibility to certain diseases.

Scientists began the PMFD by identifying the genes involved in obesity and diabetes development.

Once these genes are identified in a person, they are notified that they are more likely to acquire diabetes and/or obesity in the future.

Once the genes and biomarkers we just discussed are identified, various resources can be allocated to help the patient reduce the chances of becoming diabetic or obese.

In most cases, such strategies are non-invasive, and most patients will gladly accept them, as they include lifestyle modifications, diet improvements, and exercises.

In some cases, preventive medications are prescribed as well.

By constantly identifying those “culprit” genes, scientists have developed genetic tests that can be used to identify susceptible patients and those more likely to respond better to certain medications.

You’ve most likely noticed how a medication a friend has seriously recommended ended up with little to no effect on you (and vice versa). That’s because different bodies do, in fact, respond differently to different medications based on their genetic variation.

By recognising the medications that different individuals may have a better therapeutic response to from the start, the treatment plan for every patient can be much more tailored based on their condition.

Once the treatment begins, doctors start keeping up with their patients to monitor their condition. This is known as prognosis.

Instead of relying on conventional tests and noticing the cessation of symptoms, scientists can now measure the circulating biomarkers in the patient’s body during treatment to closely monitor their response.

That way, the doctor won’t waste any time testing a medication deemed to fail from the start. In other words, monitoring the patient’s biomarkers is the fastest and most accurate method to ensure the patient receives the most effective treatment.

Because of how focused this type of treatment is, it can improve the outcome for various patients.

Imagine that the “unstable effect of medicines on different patients” is taken out of the equation. That means every patient will take a tailored medication guaranteed to make them feel better.

The trial and error of medications is taken out of the formula. With PMFD, the doctor won’t have to wait for the patient’s feedback regarding a certain drug before they can change it.

Further, the patient will be less likely to have any side effects because PMFD helps doctors identify patients prone to those side effects.

Since every patient will be taking only the medications that work, there will be no need to try and dispose of medications in case they don’t work.

This isn’t only better for the environment, but it’s also helpful for the patient to immediately start controlling the diseases with their first medication.

With such precision in identifying the susceptibility towards diabetes and the expected side effects of medications, it’s no surprise that PMFD is expensive.

Further, it requires advanced modalities like genetic testing and continuous glucose monitoring, which can be expensive.

Tools and costs aren’t the only factors hindering PMFD from operating effectively. The treatment modality is complex, requiring doctors to deeply understand genetics, genomics, and other complex medical concepts.

This knowledge is not considered “common” among doctors, especially general practitioners.

Because of the required cost and the limited number of doctors who can effectively utilise PMFD, the treatment will likely be more accessible to wealthy people with access to such high-quality health care.

Corporate greed is also present, as insurance companies may use genetic information to deny coverage to people with a higher risk of developing certain diseases.

Identifying diseases before they even happen is a dream come true for scientists. While we’re yet to get there, identifying genes and biomarkers of diabetes can be used to develop new genetic tests and risk prediction tools, which can help create a diabetes prevention program.

The UK government is investing in various diabetes prevention programs and genome-wide association studies, such as the National Diabetes Prevention Program or NDPP. Such programs are based on predicting diabetes before it happens, hence the “prevention” part in the name.

When the prevention step is missed, early diagnosis can be the next best thing. PMFD and genomic initiatives are helping to develop new diagnostic and monitoring tools for diabetes.

Diabetes is one of the diseases that increase in severity with time. The earlier you discover the disease, the more control you’ll have over it.

PMFD has created genetic tests that made scientists identify the following:

• The probability of developing diabetes in the future
• How effective a medication will be if administered in a particular patient
• The possible side effects that certain individuals may experience

This is nothing short of a breakthrough. Doctors can now prescribe the most effective medication for diabetic patients immediately.

Further, doctors can use the same tests to have accurate data about how the medicines affect the patients.

Because of the great expense, personalised medicine is yet to become a standard procedure. According to the NCBI, the cost of having such an analysis will begin from $1000 or £824.

This is a hefty sum, and it may even seem ludicrous for people who don’t have enough awareness about such tests.

Modern DNA sequencing may have begun in 1977, but most people still need to be made aware of the importance of such research. It’s natural for people to find £824 for a test that “may” predict their susceptibility to a particular disease to be senseless or even ludicrous.

Further, we have the problem of knowledge. Only some doctors can handle DNA testing. Medicine must train enough medical genetics specialists for a proper diagnosis, which isn’t happening.

PMFD is a solid foundation and will be the core of diabetes management in the future. Not only can it detect the probability of diabetes, it also allows for specialised treatment that can diminish the side effects.

Unfortunately, the high costs, lack of awareness, and the need for more qualified personnel hinder the process.

Luckily, the concept is growing gradually and will soon become the primary method in battling diabetes.