Personalized and evidence-based management of type 2 diabetes : the role of clinical-phenotyping for treatment planning and surveillance of complications
Abstract
The thesis narrates the use of clinical-phenotyping based on standard clinical characteristics to deliver effective management of type 2 diabetes and its complications. This thesis uses seven published papers to test out the hypothesis that clinicalphenotyping approach can facilitate a pragmatic and practical approach to deliver evidence-based, cost-effective and individualized diabetes care. The first 4 papers focus on therapeutic management and next 3 on identifying clinical phenotypes at risk of diabetic retinopathy: • i-DREAM demonstrates significant improvement in clinical performance score (31.8 vs 52.3/80, p0.01) when an interactive, clinical-phenotype based platform that provides evidence-based, individual and holistic decision-making is used. • GAIA demonstrates the application of a holistic management framework across economically-diverse healthcare systems (36% improvement on care processes, p0.001). • i-NICE stratifies cardiovascular outcome trials based on trial-phenotypes, aligned to clinical outcomes, to create decision-aids to choose the best evidence-based drug. • YoDa introduces an innovative expenditure estimate for a given clinical-phenotype and desired endpoint, thereby adding a cost-efficiency dimension to drug choice (liraglutide would cost 8 times higher than empagliflozin to reduce all-cause mortality). • UKAD establishes South-Asian ethnicity as a clinical-phenotype, with higher prevalence of retinopathy (44.9% vs 36.6%, p=0.007) despite shorter…
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