Tailoring
type 2 diabetes interventions to individuals’ genetic profiles has proven
successful, showing the effectiveness of precision medicine.
By Jessica
Kent
July
25, 2019 - Interventions that focus on individuals’ genetic profiles
can help reduce the risk of type 2 diabetes in susceptible patients,
demonstrating the promise of precision medicine for this condition, according
to research from a team at Massachusetts
General Hospital (MGH).
The
team found that the quality of dietary fat consumed and the genetic risk of
diabetes work independently of each other, and that a diet rich in polyunsaturated
fats can be safely applied across the spectrum of type 2 diabetes risk.
By
2017, the number of people with type 2 diabetes soared to 8.8 percent of the
population, researchers noted. Recommendations aimed at improving dietary
quality have become a critical part of the worldwide public health effort to
combat diabetes development.
The MGH
team found that regardless of genetic risk, consuming more polyunsaturated fats
in place of refined starch and sugars is associated with a lower risk of type 2
diabetes. Consuming more monounsaturated fats, such as red meat and dairy
products, instead of carbohydrates is associated with higher type 2 diabetes
risk.
“The positive
association between polygenic scores and type 2 diabetes we reported
acknowledges the fact that people at higher genetic risk could benefit from
additional strategies that have nothing to do with dietary fat intake,” said
Jordi Merino, RD, PhD, of the MGH Diabetes Unit and Center for Genomic
Medicine, and corresponding author of the study published online in the BMJ.
The
study examined more than 102,000 participants of European descent who didn’t
have diabetes at baseline. Researchers followed participants for 12
years.
The
findings from the MGH study are consistent with the National Diabetes Prevention Program,
which showed that lifestyle changes are effective regardless of the genetic
burden of type 2 diabetes.
The
results are also consistent with recent evidence around coronary artery
disease, leading to heart-healthy lifestyle and dietary regimens being promoted
across the genetic landscape.
However,
researchers noted that obesity yields different results. Increasing evidence
has shown that unhealthy dietary or certain lifestyle patterns like consuming a
lot of sugar or sweetened drinks or having limited physical activity might
interact with genetic susceptibility to elevate body mass index.
“The
metabolic complexity of type 2 diabetes and coronary heart disease may account
for the lack of interaction between lifestyle factors and genetic background,”
Merino said.
The
results of this study will further contribute to the growing field of precision
medicine and diabetes research.
The
American Diabetes Association has recently launched a Precision Medicine in Diabetes Initiative,
which aims to provide more guidance around diabetes management by weighing
individual variability in genetics, lifestyle, and environment that can help
ensure healthier lives for people with diabetes.
Over
the next five years, the initiative will use data from EHRs, digital imaging
technologies, and wearable devices to improve the management, prediction, and
prevention of diabetes, as well as diagnostic stratification and revised
classification of the disease. The initiative will help to enhance precision
medicine for the condition.
“The
integration of genetic and environmental information represents one of the
greatest challenges facing the implementation of precision medicine in
metabolic disease,” said Jose Florez MD, PhD, chief of the Diabetes Unit
and Center for Genomic Medicine and professor of Medicine, Harvard Medical
School.
The
results of this study demonstrate the potential for precision medicine to
improve diabetes prevention and care.
“Our
meta-analysis shows on a scale never done before that there is no apparent need
to be concerned about the genetic risk to inform sound dietary recommendations
for individuals with type 2 diabetes,” said Merino.
“This
means that lifestyle or dietary interventions for the prevention of type 2
diabetes can be deployed across all gradients of genetic risk since genetic
burden does not seem to impede their effectiveness.”
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