Type 2 diabetes subtypes for precision medicine: methodological challenges and alternative prediction-based...

Area of Science:

• Endocrinology
• Metabolic Diseases
• Genetics

Background:

• Precision diagnostics are increasingly important for type 2 diabetes.
• Current research explores four pathophysiology-based subtypes: SIDD, SIRD, MOD, and MARD.

Purpose of the Study:

• To review the methodological challenges and limitations of classifying type 2 diabetes into discrete subtypes.
• To discuss alternative approaches, such as individualized prediction models, for precision diabetes care.

Main Methods:

• Narrative review of existing literature on type 2 diabetes subtyping.
• Analysis of challenges including subtype existence, assignment certainty, and clinical utility.
• Discussion of individualized prediction models as an alternative/complementary approach.

Main Results:

• Uncertainty exists regarding the existence of four discrete type 2 diabetes subtypes.
• Low certainty in assigning patients to specific subtypes.
• Limited evidence for the prognostic and therapeutic value of current subtyping methods.

Conclusions:

• Discrete subtyping of type 2 diabetes faces significant methodological challenges.
• Individualized prediction models offer personalized treatment recommendations but lack pathophysiological insights.
• Both subtyping and prediction models can complement each other in advancing precision diabetes medicine.