- Please check and comment entries here.
Precision Health Care for Diabetes
Tailoring integrated care through interdisciplinary collaborative practice among patients, nurses, and physicians based on the patient’s genetics or lifestyle, glycemic target, biodata- or evidence-based practice, patient preferences, and priority for improving patient self-management to achieve glycemic control.
2. Discovery of the Elements and Their Concept Description
|No||Elements||Concept Description||Clinical Strategies|
|1.||Personalized genetic or lifestyle||- Genetic or lifestyle analysis; genomic test screening for diabetes autoantibodies that remain after a drug or insulin dose, gene encoding glucokinase, presence of HNF1A and HNF4A that are associated with forms of diabetes onset; C-peptide is a biomarker that can be used as a guide to treatment choice (insulin deficiency); single-nucleotide polymorphisms provide information regarding drug toxicity||- Assessment of risk of complication by using risk prediction charts, genotype, or electronic health records|
|2.||Biodata-or evidence-based||- Genetic examination to detect various potential health problems, cardiovascular disease, a person’s metabolic ability to a nutrient, and HbA1c target||- Electronic health records and ADA guidelines|
|3.||Glycemic target||- Based on ADA guidelines, target and therapy differ based on the features and responses of each individual (including HbA1c, blood pressure, and cholesterol)||- Shared decision-making assessment tool|
|4.||Patient preferences||- Identification of whether the patient needs additional medication and their concern regarding hyper/hypoglycemia, further expressing their decision||- Shared decision-making assessment tool|
|5.||Glycemic control||- Supporting the use of a potent drug to achieve a reduction in HbA1c to <6.5%.||- HbA1c based on ADA guidelines|
|6.||Interdisciplinary collaboration practice||- Teamwork entails discussion of the most appropriate treatment for patients||- Shared decision-making among patients, nurses, physicians, etc.|
|7.||Self-management||- Individualizing therapy so that patients can effectively self-manage their disease through increasing self-efficacy||- Diabetes SM education, self-efficacy enhancing intervention program|
|8.||Patient priority direct care||- Assess the individual as a whole including the complex interplay of comorbid conditions, psychosocial, functional status, and individual need||- Shared decision-making assessment tool|
2.1. Personalized Genetic or Lifestyle
2.2. Biodata- or Evidence-Based Requirement
2.3. Glycemic Target
2.4. Patient Preferences
2.5. Glycemic Control
2.6. Interdisciplinary Collaboration Practice
2.8. Patient Priority Direct Care
3. Definition of PHC
4. Strategies of PHC for Diabetes in Clinical Practice
The entry is from 10.3390/ijerph18126535
- IDF. International Diabetes Federation Diabetes Atlas, 9th ed.; Innis Communication: Brussels, Belgium, 2019; Available online: (accessed on 11 January 2020).
- WHO. World Health Organization/International Society of Hypertension (WH0/ISH) Risk Prediction Charts; WHO: Geneva, Switzerland, 2014; pp. 1–40. Available online: (accessed on 13 March 2020).
- Parimbelli, E.; Marini, S.; Sacchi, L.; Bellazzi, R. Patient similarity for precision medicine: A systematic review. J. Biomed. Inform. 2018, 83, 87–96.
- Sherifali, D.; Viscardi, V.; Bai, J.W.; Ali, R.M.U. Evaluating the Effect of a Diabetes Health Coach in Individuals with Type 2 Diabetes. Can. J. Diabetes 2016, 40, 84–94.
- Sherifali, D. Diabetes coaching for individuals with type 2 diabetes: A state-of-the-science review and rationale for a coaching model. J. Diabetes 2017, 9, 547–554.
- Weston, A.D.; Hood, L. Systems Biology, Proteomics, and the Future of Health Care: Toward Predictive, Preventative, and Personalized Medicine Introduction: Paradigm Changes in Health Care. J. Prot. Res. 2004, 3, 179–196.
- Hood, L.; Balling, R.; Auffray, C. Revolutionizing medicine in the 21st century through systems approaches. Biotechnol. J. 2012, 7, 992–1001.
- Jameson, J.L.; Longo, D.L. Precision medicine—Personalized, problematic, and promising. N. Engl. J. Med. 2015, 372, 2229–2234.
- Flores, M.; Glusman, G.; Brogaard, K.; Price, N.D.; Hood, L. P4 medicine: How systems medicine will transform the healthcare sector and society. Per. Med. 2013, 10, 565–576.
- Bierman, A.S.; Tinetti, M.E. Precision medicine to precision care: Managing multimorbidity. Lancet 2016, 388, 2721–2723.
- Corwin, E.; Redeker, N.S.; Richmond, T.S.; Docherty, S.L.; Pickler, R.H. Ways of knowing in precision health. Nurs. Outlook 2019, 67, 293–301.
- Davies, A.K.; McGale, N.; Humphries, S.E.; Hirani, S.P.; Beaney, K.E.; Bappa, D.A.S.; McCabe, J.G.; Newman, S.P. Effectiveness of a self-management intervention with personalised genetic and lifestyle-related risk information on coronary heart disease and diabetes-related risk in type 2 diabetes (CoRDia): Study protocol for a randomised controlled trial. Trials 2015, 16, 1–11.
- Tinetti, M.E.; Esterson, J.; Ferris, R.; Posner, P.; Blaum, C.S. Patient Priority-Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions. Clin. Geriatr. Med. 2016, 32, 261–275.
- Spiegel, A.M.; Hawkins, M. “Personalized medicine” to identify genetic risks for type 2 diabetes and focus prevention: Can it fulfill its promise? Health Aff. 2012, 31, 43–49.
- Floyd, J.S.; Psaty, B.M. The application of genomics in diabetes: Barriers to discovery and implementation. Diabetes Care 2016, 39, 1858–1869.
- Pearson, E.R. Personalized medicine in diabetes: The role of “omics” and biomarkers. Diabet. Med. 2016, 33, 712–717.
- Meneghini, L.; Reid, T. Individualizing insulin therapy. J. Fam. Pract. 2012, 61, 13–27.
- Otgontuya, D.; Oum, S.; Buckley, B.S.; Bonita, R. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health 2013, 13, 539.
- Hickey, K.T.; Bakken, S.; Byrne, M.W.; Bailey, D.C.E.; Demiris, G.; Docherty, S.L.; Dorsey, S.G.; Guthrie, B.J.; Heitkemper, M.M.; Jacelon, C.S.; et al. Precision Health: Advancing Symptom and Self-Management Science [Internet]; Nursing Outlook; Elsevier Inc.: Amsterdam, The Netherlands, 2019; Volume 67, pp. 462–475.
- Holt, R.I.G. Personalized medicine for diabetes: A special issue. Diabet. Med. 2016, 33, 711.
- Mayor, S. Individualising treatment and care of patients with diabetes. Prescriber 2017, 28, 23–25.
- Subramanian, S.; Hirsch, I.B. Personalized diabetes management: Moving from algorithmic to individualized therapy. Diabetes Spectr. 2014, 27, 87–91.
- Paschou, S.A.; Leslie, R.D. Personalizing guidelines for diabetes management: Twilight or dawn of the expert? BMC Med. 2013, 11, 161.
- Miñambres, I.; Mediavilla, J.J.; Sarroca, J.; Pérez, A. Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain. BMC Endocr. Disord. 2016, 16, 10.
- Sexton, M.; Baessler, M. Interprofessional Collaborative Practice. J. Contin. Educ. Nurs. 2016, 47, 156–157.
- Fradkin, J.E.; Hanlon, M.C.; Rodgers, G.P. NIH precision medicine initiative: Implications for diabetes research. Diabetes Care 2016, 39, 1080–1084.
- Rich, S.S.; Cefalu, W.T. The impact of precision medicine in diabetes: A multidimensional perspective. Diabetes Care 2016, 39, 1854–1857.
- Wu, S.F.V.; Lee, M.C.; Liang, S.Y.; Lu, Y.Y.; Wang, T.J.; Tung, H.H. Effectiveness of a self-efficacy program for persons with diabetes: A randomized controlled trial. Nurs. Health Sci. 2011, 13, 335–343.
- Sherifali, D. Diabetes Management in Older Adults: Seeing the Forest for the Trees. Can. J. Diabetes 2016, 40, 10–11.
- Agency for Healthcare Research Quality (AHRQ). The SHARE Approach Essential Steps of Shared Decision Making; Agency for Healthcare Research Quality: Rockville, MD, USA, 2016.