Precision medicine in diabetes : a multidisciplinary approach to an emerging paradigm

Foreword
Preface
Contents
Contributors
Introduction
Chapter 1: Precision Medicine Approaches for Management of Type 2 Diabetes
	Introduction
		The Metabolic Milieu of Diabetes
		Precision Medicine: Now and Later
	Targeted Screening for Type 2 Diabetes and Diabetes Prevention
	Mnemonic to Guide Diabetes Care
	Benefits of Multiple Risk Factor Control
		Lifestyle
		Glycemia
			Personalizing Glucose Targets
			Rationale for Glucose Targets
			Novel Glucose Control Agents
			Individualizing Glucose-Lowering Medications
		Lipids and Lipid Drugs
			Associations Between Lipids, Diabetes, and Chronic Diabetes Complications
				Statins and Diabetes Complications
			Other LDL-Lowering Drugs
			Triglyceride-Lowering Drugs
			Suggested Lipid Drug Use in People with Type 2 Diabetes
		Obesity
		Blood Pressure
			Individualizing BP Targets
			Selecting BP-Lowering Drugs
		Emotion
		Smoking
		Screening
		TReating to Target
		Inflammation/Infections
		Vaccinations
		Education
		Devices
			Glucose Monitoring
		Antiplatelet Agents
	Management of Type 2 Diabetes Patients with Known CVD
	Management of Arterial Disease and Heart Failure
	Management of Microvascular Complications in Type 2 Diabetes
	Conclusions
	References
Chapter 2: Precision Medicine for Diabetes and Cardiovascular Disease
	Introduction
	Cardiovascular and Metabolic Cross-talk
		Cardiovascular Complications of Diabetes
			Coronary Artery Disease
			Hypertension
			Diabetic Cardiomyopathy
			Heart Failure
	Epidemiology and Burden of Diabetes and Heart Disease
		Coronary Artery Disease
		Heart Failure
		Hypertension
		Hyperlipidemia
	Management of Diabetes and Heart Disease
		Glycemic Control
		Pharmacologic Agents
		SGLT2 Inhibitors
		GLP1 Agonists
		Natriuretic Peptides
	Summary
	References
Chapter 3: Precision Medicine for Diabetes and Dyslipidemia
	Introduction
	Pathogenesis
	Treatment
		Statins
			Secondary Prevention
			Primary Prevention
			Do Statins Increase Newly Incident Diabetes?
		PCSK-9 Inhibitors
		Ezetimibe
		Bempedoic Acid
		Non-LDL Directed Medications
		Fibrates
		Omega-3 Fatty Acids
		Diabetes-Specific Medications
			Metformin
			GLP-1 Receptor Agonists
		Thiazolidinediones
	Summary
	References
Chapter 4: Imaging in Precision Medicine for Diabetes
	Role of Noninvasive Imaging Techniques in Precision Diabetology
	Imaging Tools for Assessing Body Composition and Adipose Tissue Compartments
	Imaging Tools for Assessing Skeletal Muscle Tissue Structure and Metabolism
		Intramyocellular Lipid Content
		Assessment of Mitochondrial Function in Skeletal Muscle
		Assessment of Metabolic Fluxes
	Imaging Tools for Assessing Hepatic Tissue Function and Metabolism
		Hepatocellular Lipid Content
		Progression of NAFLD
		Mitochondrial Function
		Measurement of Metabolic Fluxes
	Imaging Tools for Assessing Cardiovascular Function and Metabolism
		Myocardial Lipid Contents
		Myocardial Mitochondrial Function
		Diabetes-Associated Vascular Disease
	Imaging Tools for Assessing Pancreatic Steatosis in the Context of Diabetes
		Pancreatic Steatosis
	Imaging Tools for Assessing and Monitoring Diabetic Nephropathy
	Imaging Tools for Assessing and Monitoring Diabetic Retinopathy
	Concluding Remarks
	References
Chapter 5: Implementation of Precision Genetic Approaches for Type 1 and 2 Diabetes
	Introduction
	Potential for Precision Medicine in Type 1 Diabetes (T1D)
		Precision Diagnosis in T1D
		Precision Prevention in T1D
		Precision Monitoring in T1D
		Precision Treatment in T1D
		Precision Prognostics in T1D
	Potential for Precision Medicine in Type 2 Diabetes (T2D)
		Precision Diagnosis in T2D
		Precision Prevention in T2D
		Precision Monitoring in T2D
		Precision Treatment in T2D
		Precision Prognostics in T2D
	Implementation of Precision Medicine for Diabetes
	Conclusions
	References
Chapter 6: Precision Genetics for Monogenic Diabetes
	Introduction
	Epidemiology of Monogenic Diabetes
	Classification of Monogenic Diabetes
	Diagnosis of Monogenic Diabetes
	Challenges with Diagnosing Monogenic Diabetes
	Risk Calculator and Screening Algorithm for MODY
	Common Subtypes of MODY: Clinical Phenotypes, Management, and Implications on Pregnancy
		GCK-MODY
		HNF1A-MODY
		HNF4A-MODY
		HNF1B-MODY
		KCNJ11-NDM and ABCC8-NDM
		INS-NDM
	Conclusion
	References
Chapter 7: Diabetic Kidney Disease: Identification, Prevention, and Treatment
	Introduction and Epidemiology
	Pathophysiology
	Screening, Diagnosis and Stages, and Monitoring
	Structural Kidney Lesions in Diabetes
	Relationships Between Kidney Structure and Function
	Risk Factors
	Comorbidities and Associated Complications
	Prevention and Treatment
		Glycemic Control
		Organ Protection
	Monitoring
	Pregnancy in Women with Diabetes and Chronic Kidney Disease
	Organization of Care
	References
Chapter 8: Precision Medicine for Diabetic Neuropathy
	Diabetic Peripheral Neuropathy: Clinical Evaluation and Epidemiology
		Evolution of Understanding
		Type 1 Versus Type 2 Diabetic Peripheral Neuropathy: Towards a More Precise Understanding
		Clinical Approach
		Metabolic Syndrome, Obesity, and Peripheral Neuropathy
		Prediabetes and Peripheral Neuropathy
		Pediatric Diabetic Peripheral Neuropathy
		Genetic Risk Factors
	Diabetic Peripheral Neuropathy: Pathogenesis and Therapeutic Targets
		Animal Models
		Potential Therapeutic Avenues
	Diabetic Peripheral Neuropathy: Pain
		Painful Diabetic Peripheral Neuropathy
		Sensory Profiling
			Quantitative Sensory Profiling
			Two Distinct Pain Phenotypes: The Nonirritable and Irritable Nociceptor
			Phenotype-Driven Therapeutic Experience in Painful DPN
			Sensory Phenotyping to Predict Therapeutic Response
		Brain Imaging in Painful Diabetic Peripheral Neuropathy
	Diabetic Peripheral Neuropathy: Future Directions and Moving Toward Precise Treatments
	References
Chapter 9: Inpatient Precision Medicine for Diabetes
	Introduction
	Patient Heterogeneity and Complexity in Factors Affecting Metabolism
	Hospital Glucose Monitoring and Data Acquisition
	Individualized Management Strategies: Glycemic Targets and Pharmacotherapy
	Conclusions
	References
Chapter 10: Precision Medical Management Strategies for Diabetes Remission
	Definition of Remission in Type 2 DM
	Twin Cycle Hypothesis and Remission Window: Clinical Inertia
	Negative Energy Balance, How It Can Induce Remission, and Clinical Trials Showing Practicality
	Pharmacotherapy with Oral Hypoglycemics, Insulin, and Appetite Suppressants
	References
Chapter 11: Surgical Management for Diabetes Remission
	Introduction
	DM2 Cure Versus Remission
	Bariatric Surgeries Associated with DM2 Remission
	DM2 Remission After Bariatric Surgery
	Mechanisms Driving DM2 Remission
	Important Considerations of Bariatric Surgery in DM2 Remission and Future Directions
	Conclusions
	References
Chapter 12: Precision Nutrition for Type 2 Diabetes
	Introduction
	Determinants of Precision Nutrition in T2DM
		Deep Phenotyping (Omics Technologies)
			Nutrigenetics and Nutrigenomics
			Microbiome
			Metabolomics
		Deep Monitoring
			Mobile Technologies for Nutritional Assessment and Diabetes Management
			Wearable Devices for Metabolic Assessment
	From Science to Practice: Clinical Translation
	Bibliography
Chapter 13: Precision Exercise and Physical Activity for Diabetes
	Definitions and Considerations
		Physical Activity Definitions
		Precision Medicine
	Type 1 Diabetes
		The Right Treatment: Adaptations to Exercise Training and Habitual Physical Activity in People with Type 1 Diabetes
		The Right Treatment: Acute Glycemic Effects of Exercise in Individuals with Type 1 Diabetes
		The Right Patient
			Insulin Management
			Continuous Glucose Monitoring/Intermittently Scanned Continuous Glucose Monitoring (CGM/isCGM)
			Individual Characteristics
		The Right Time
			The “Honeymoon” Phase
			Children and Adolescents with Type 1 Diabetes
			Pregnancy
			Older Adults
			Timing of Exercise: Fasting Versus Fed Exercise
			Timing of Exercise: Late Afternoon/Evening Exercise
			Timing of Exercise Relative to Meals/Snacks
	Type 2 Diabetes
		The Right Treatment
			General Considerations
			Aerobic Training
			Resistance Training
			High-Intensity Interval Exercise (HIIE)
			Breaking Sedentary Time
		The Right Patient
			General Considerations
			Age and/or Duration of Diabetes
			Sex
			Obesity, Body Fat Distribution, and Sarcopenia
			Other Treatments (e.g., Medications or Nutrition)
		The Right Time
			General Considerations
			Speculations on When Delaying Exercise Interventions (or Co-Interventions) Could Be Considered
			Exercise Timing (e.g., Time of Day)
	Summary
	References
Chapter 14: Diabetes Technology for Precision Therapy in Children, Adults, and Pregnancy
	Introduction
	Changing the Precision Medicine Paradigm
	CGM Technology
	CGM Clinical Outcomes
	CGM and the Ambulatory Glucose Profile (AGP)
	Expanding the Role of CGM: Real-Life Applications
	Background and Rationale for Pump Therapy
	Pumps with Integrated CGM
	Hybrid Closed Loop in Clinical Practice: Following the Principles of Precision Medicine
	Expanding the Role of Pumps
	References
Chapter 15: Adaptive and Individualized Artificial Pancreas for Precision Management of Type 1 Diabetes
	Introduction
	Individualization
		CR-Based Models
		Impulse Response (IR) Models
		Constrained Optimization (CO) Models
		Nonparametric (NP) Models
		Neural Network (NN) Models
	Adaptivity
	Conclusions
	References
Chapter 16: Evolving Approaches to Type 1 Diabetes Management
	Automated Insulin Delivery
	Prevention of Immune Destruction to Preserve Beta-Cell Mass or Function
	Replacement of Insulin-Secreting Beta Cells
	Regeneration of Beta Cells
	Conclusions
	References
Index