ADA/EASD Precision Medicine in Diabetes Initiative: An International Perspective and Future Vision for Precision Medicine in Diabetes.

The ADA/EASD Precision Medicine in Diabetes Initiative (PMDI) was launched in 2018 by the American Diabetes Association (ADA), in collaboration with the European Association for the Study of Diabetes (EASD). The PMDI has subsequently partnered with other organizations including the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), the Juvenile Diabetes Research Foundation (JDRF) and the Diabetes Technology Society (DTS). The mandate of the PMDI is to establish consensus on the viability and ultimate clinical implementation of precision medicine for the diagnosis, prevention, treatment, prognosis, and monitoring of diabetes. This process is designed to take place through systematic evaluation of available scientific evidence, expert consultation, and broad stakeholder engagement (Figure 1). The mandate of the PMDI is pursued with the overarching goal of facilitating longer, healthier lives for people living with diabetes, identifying those at risk, and preventing diabetes through multiple interventional approaches. The PMDI held its first international scientific conference in Madrid, Spain, in October 2019. Approximately 100 delegates participated, with attendees from North America, Europe, Middle East, Asia, and Africa, with diverse representation (including academia, industry, funders, and people with diabetes). The conference provided the foundation and framework from which a first consensus paper on precision medicine in diabetes was developed and published in 2020 (1). The consensus paper named five key pillars, or domains, of precision diabetes medicine: Precision Diagnostics, Precision Prevention, Precision Treatment, Precision Prognostics, and Precision Monitoring. Across each domain, the paper also identified critical gaps in knowledge and evidence required for the scientific advancement, implementation, and ongoing evaluation of precision medicine in diabetes. Newly formed PMDI Working Groups (composed of ~175 internationally leading clinicians and researchers in precision diabetes medicine – (see Appendix)) have since initiated multiple, ongoing evidence-based evaluations in diabetes related to the five key domains. The second international scientific conference organised by the PMDI was held in April 2021 (www.pdm2021.org). This meeting, hosted virtually owing to the COVID-19 pandemic, included more than 3,000 participants from 67 countries. Building on the foundation and framework established at the first conference, diverse stakeholders in the development and implementation of precision diabetes medicine exchanged new data, ideas, and opinions. Over three days, the meeting delivered interactive state-of-the-science overviews of all key domains of precision diabetes medicine in research and practice. The PMDI Working Groups undertaking systematic reviews provided progress updates, summaries of existing evidence, and critical gaps in current scientific knowledge. Plenary presentations discussed the interface of precision medicine in diabetes with the social determinants of health and disparities in care, as well as the impact of racial discrimination and other forms of health inequity. Early career investigators showcased novel findings and contributions to the five key domains. Daily keynote lectures, delivered by people living with diabetes from around the globe, highlighted patient perspectives and offered insights into the opportunities for precision diabetes medicine to improve the day-to-day experience of living with diabetes. A moderated poster session, with abstracts selected by reviewers, was a focus of trainees and early-career investigators, while other abstracts were available for viewing online.