Unmasking heterogeneity in type 2 diabetes: the clinical relevance of phenotyping in the era of precision medicine.

IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Salvatore Corrao, Massimo Federici
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Abstract

Despite its widespread use in clinical practice, the traditional dichotomous classification of diabetes into type 1 and type 2 fails to capture the marked heterogeneity observed in real-world patients, particularly those with type 2 diabetes mellitus (T2DM). The increasing recognition of the complex interplay between insulin resistance, beta-cell dysfunction, autoimmunity, and genetic predisposition has led to the development of phenotypic classification systems that aim to individualize care beyond glycemic targets. Ahlqvist et al. made a major contribution to this field by identifying five clinically meaningful clusters of adult-onset diabetes using routine clinical variables. These clusters differ in their metabolic profiles, complication risks, and therapeutic needs, offering a pragmatic starting point for personalized diabetology. Their clinical relevance has been further explored and validated by follow-up studies that include detailed metabolic phenotyping, cardiac imaging, and genetic analyses. Nevertheless, enthusiasm for cluster-based models must be tempered by critical appraisal. Evidence from large trials suggests that continuous clinical features may better predict disease progression and treatment response than static cluster assignments. Furthermore, these models have yet to be integrated into clinical guidelines or electronic decision-support systems. This Perspective argues for a multidimensional and dynamic approach to diabetes phenotyping, combining clinical, biochemical, imaging, and genetic data to reflect the evolving nature of the disease. Such a framework could enable more precise stratification and intervention, moving toward truly personalized diabetes care. Integrating these models into real-world settings represents the next frontier in precision diabetology.

揭示2型糖尿病的异质性:精准医学时代表型的临床相关性。
尽管在临床实践中广泛使用,但将糖尿病分为1型和2型的传统二分法未能捕捉到现实世界患者,特别是2型糖尿病(T2DM)患者中观察到的显著异质性。人们越来越认识到胰岛素抵抗、β细胞功能障碍、自身免疫和遗传易感性之间复杂的相互作用,这导致了表型分类系统的发展,其目的是针对血糖目标以外的个体化护理。Ahlqvist等人通过使用常规临床变量确定了成人发病糖尿病的五个临床意义集群,对该领域做出了重大贡献。这些集群在代谢特征、并发症风险和治疗需求方面有所不同,为个性化糖尿病学提供了一个实用的起点。通过详细的代谢表型、心脏成像和遗传分析等后续研究,进一步探索和验证了它们的临床相关性。然而,对基于集群的模型的热情必须通过批判性的评估来缓和。来自大型试验的证据表明,与静态聚类分配相比,连续的临床特征可能更好地预测疾病进展和治疗反应。此外,这些模型尚未被整合到临床指南或电子决策支持系统中。该观点主张采用多维和动态的方法来进行糖尿病表型分析,结合临床、生化、影像学和遗传数据来反映疾病的演变性质。这样的框架可以实现更精确的分层和干预,朝着真正个性化的糖尿病治疗迈进。将这些模型整合到现实环境中代表了精确糖尿病学的下一个前沿。
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来源期刊
Acta Diabetologica
Acta Diabetologica 医学-内分泌学与代谢
CiteScore
7.30
自引率
2.60%
发文量
180
审稿时长
2 months
期刊介绍: Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.
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