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Changhong Li

The management of diabetes has barely improved even as its prevalence has become more widespread, with massive impacts on people and healthcare systems. An alternative approach based on individualised precision medicine is desperately needed.
The International Diabetes Foundation estimates almost 540 million adults had diabetes in 2021. In China, only less than 40 per cent receive adequate treatment and of those only 50 per cent achieve good glucose control, according to a 2018 study. Treatment outcomes are bad more often than they are good despite billions of dollars invested in research and a variety of classes of diabetic drugs on the market.
Patients receive prescriptions for the same drugs with little regard for their genetic background or understanding of why they have diabetes. This one-size-fits-all approach to managing and treating the disease is ineffective because the underlying causes can vary from person to person.
Genetic background, changing lifestyles, inexpensive sugar and processed foods, larger portion sizes and sedentary work have all contributed to the spread of diabetes. We have moved away from physical work and natural foods towards office jobs and sugary energy drinks. This is significant because, at the most basic level, diabetes is driven by a poor relationship between the body and food.
China, which is home to about a fifth of the global diabetic population, has taken a leadership role in dealing with diabetes in terms of drug discovery. It has put in place policies that reward innovation and was the first country to approve the first new class of drug in a decade to treat diabetes, dorzagliatin, developed by my company Hua Medicine. It has also put in place aggressive pricing and distribution strategies to make treatments more widely available.
One common cause of diabetes is a reduction in the function of glucokinase, an enzyme that serves as an internal glucose sensor and plays an important role in regulating blood sugar levels by governing the conversion of glucose into energy. Declines in the function of glucokinase are linked to a genetic variation that can be found in people all over the world.


To be effective, treatments have to take these differences into account. This means we need a new approach which should be driven by precision medicine.
Without a doubt, adopting this approach will require more research, more clinical and real-world studies and, perhaps most importantly, it will require healthcare providers to take the time they need to understand what causes diabetes in each person.
There are at least three hurdles to overcome. The first is a mismatch between what patients need and the level of care that health systems can actually provide. There are many patients and a limited number of healthcare professionals to manage them. The analysis needed to understand the causes of diabetes in every person can be expensive, although the cost is likely much lower than providing dialysis for life when diabetes gets out of control.
A second hurdle is political. Precision medicine is largely based on individual genetic information, and that information is increasingly considered a matter of national security. This can make research and international collaboration challenging. At the same time, diabetes care can have an outsize impact on national or regional economies, while the politics of funding diabetes care can be complicated.

A third hurdle is the market. Pharmaceutical companies want doctors to prescribe their drugs as often as possible rather than use tailored combinations that involve products from several different companies. This fear of losing market share might be overblown given the size of the market, but there is no denying that competition in the market for diabetes drugs and treatments is significant.
Still, increasing the application of precision medicine in diabetes care and treatment would make a significant difference in the future.
The widespread adoption and popularity of GLP-1-related medicines could give this shift momentum. The rising demand for GLP-1 drugs such as Ozempic (semaglutide) or Victoza (liraglutide) has had more to do with obesity than diabetes.
On their own, GLP-1 drugs are powerful, tackling diabetes by amplifying the secretion of insulin. Combining them with other classes of drugs that are able to, for instance, improve glucose-sensing mechanisms and enhance insulin secretion in response to increased glucose levels after meals can make them even more powerful. Such combinations can better balance glucose levels than any single class of drug by taking into account the idiosyncrasies of diabetes in each individual.
This type of personalised approach would pay enormous returns in terms of quality of life for people with diabetes and reduced healthcare spending, with substantial benefits for healthcare systems.
Precision medicine represents the future of diabetes care. The buzz around new drugs, the possibility of combinations, fresh research and the enormous pressure that diabetes continues to put on healthcare systems are powerful catalysts for a transformation that can benefit everyone.


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Why a new approach to diabetes treatment is desperately needed

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Current widely used treatment approaches are not fit for task as they ignore the idiosyncrasies in diabetes that can arise in each patient


Current widely used treatment approaches are not fit for task as they ignore the idiosyncrasies in diabetes that can arise in each patient.


Biomedicine: Science

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Expresses the views, ideas and conclusions of the author. (Eg. Enough of Crazy Rich Asians, think of crazy poor Hongkongers.)


Why a new approach to diabetes treatment is desperately needed

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Current widely used treatment approaches are not fit for task as they ignore the idiosyncrasies in diabetes that can arise in each patient

Current widely used treatment approaches are not fit for task as they ignore the idiosyncrasies in diabetes that can arise in each patient