Stefano Del Prato: Advancing precision diabetes medicine – the role of data, technology, and JACARDI’s contribution through pragmatic and practical actions

The collection, analysis, and the insights we gain from data are critical for monitoring improvements in healthcare, and helping us to standardize treatment across Europe. JACARDI is a critical asset in this regard, says Stefano Del Prato, President of the European Diabetes Forum (EUDF) and member of JACARDI’s Stakeholder Advisory Board. With decades of expertise in diabetes research and clinical practice, he offers a deep dive into the four most critical steps – early diagnosis, empowering people, equitable care, and embracing science and technology – for combating the burden of NCDs, the avenues for making innovations of diabetes care more accessible, and how advancements in monitoring technology can support personalized treatment.

What significance does JACARDI hold for you and your organization in terms of its mission and values?

The EUDF brings together all the key stakeholders working and advocating in the field of diabetes across Europe. To me, JACARDI is a natural complement to our efforts to standardize diabetes treatment throughout Europe. Standardizing treatment can reduce diabetes-related complications including cardiovascular disease, and mortality. I believe JACARDI is an outstanding tool for uniting the expertise of more than 20 European countries. We are proud to serve as advisors because, at the European Diabetes Forum, we share a goal similar to that of JACARDI. I see this as a partnership and a significant opportunity to improve outcomes for many people at risk of cardiovascular complications across Europe.

What are the most critical next steps for Europe in addressing the dual burden of cardiovascular disease and diabetes?

I believe there are many actions we can take. At the European Diabetes Forum, which I currently preside over, we have been collaborating to identify key initiatives to propose to the new European Parliament’s political agenda – a process that took place during the election campaign. We developed four main messages, primarily focused on diabetes but applicable to many conditions that increase cardiovascular risk.

The first is early detection. This approach works for identifying individuals at risk of diabetes, those showing signs of obesity or overweight to prevent further progression, and those at cardiovascular risk.

The second is empowering people. In diabetes care, this means educating individuals to manage their condition effectively, while also raising general awareness about how proper health education and a healthy lifestyle can prevent non-communicable diseases and their cardiovascular consequences.

The third is providing equitable care. Although Europe is a powerful and dynamic region, significant differences exist from country to country. We must ensure that effective management strategies, procedures, and the latest medications are implemented as swiftly and fairly as possible across Europe to reach all those who need them.

Finally, the fourth is embracing science and technology. We believe Europe should lead in research and clinical development. We have brilliant minds here, and we need systems that enable collaboration to develop new science and technology, as well as to implement effective innovations in clinical practice. In summary, our four priorities are early diagnosis, empowering people, equitable care, and embracing science and technology – each of which can greatly improve care for more people.

In your recent article for Euractive, you highlighted that European health systems are not ready to fully utilize the emerging innovations in diabetes care. You mentioned local policy barriers across Europe, including bureaucratic hurdles and lengthy approval processes for modern treatments. Given that diabetes cases in the EU are projected to nearly double by 2050, with significant implications for cardiovascular diseases and other complications, how do you see JACARDI contributing to the transformation of national health systems to overcome these barriers and implement more effective diabetes care strategies across Member States?

JACARDI is a complex program with great value because it brings together many European countries. By enhancing networking, discussions, and the sharing of experiences and new ideas, it offers a tremendous opportunity for progress. In addition to these networking benefits, JACARDI includes pragmatic and practical actions. One critical aspect is the proper collection of data through registries. Such registries allow us to monitor improvements in healthcare for reducing the burden of diabetes and cardiovascular risk within each country and compare differences between countries, thereby helping us to standardize treatment approaches.

I hold a simple principle: the free circulation of people in Europe means that individuals who move from one country to another—and who may have diabetes or cardiovascular disease—should receive similar and optimal treatment regardless of where they are. To achieve this, we must harmonize healthcare processes as much as possible. With 21 countries participating, JACARDI unites local expertise and experiences, leading to actions that can be translated into effective clinical processes. I am convinced it is essential to teach our new medical professionals the importance of data—its collection, analysis, and the insights we can gain from it. In my view, JACARDI is a critical asset in this regard.

Professor Del Prato, in your article you discussed how scientific and technological innovations are transforming diabetes care. We are aware of continuous glucose monitoring devices, next-generation insulin pumps, digital applications, and AI-driven solutions. Could you elaborate on the specific technological breakthroughs you believe will have the most significant impact on diabetes care in Europe? Which of these innovations do you see as priorities for implementation across EU healthcare systems?

I believe a key technological advance is improved glucose monitoring. This advancement is significant not only because it helps individuals with diabetes understand how lifestyle modifications or medications affect their blood sugar levels but also because continuous glucose monitoring systems allow for interconnectivity. This connectivity makes telemonitoring possible, which can facilitate both the education and self-empowerment of people with diabetes, as well as the collection of data to alert physicians when a patient is deviating from optimal glycemic control.

It’s not just about measuring glucose continuously; it’s also about processing and transmitting that data. For instance, in my region in Tuscany, Italy, there is a system that sends continuous glucose monitoring data directly to a patient’s electronic health record.

There is also a distinction between technologies for type 1 and type 2 diabetes. You mentioned automatic insulin delivery, which is an incredible and important advancement. I recall when I began my career, we used an early form of an artificial pancreas—a bulky machine that required the patient to remain in bed for a time. Now, after more than 30 years of progress, technology has evolved rapidly to manage glucose control in individuals who lack insulin secretion throughout their daily tasks.

These examples demonstrate how technology can support personalized treatment and foster precision diabetes medicine. By analyzing data from glucose monitoring, a more detailed profile of an individual with diabetes can be generated, which may help determine the optimal treatment at the right time. This concept applies not only to diabetes but also to other conditions, including cardiovascular risk. If we can identify individuals at higher risk, we can focus our efforts and allocate resources more effectively. I believe that technology will significantly advance diabetes care and medicine as a whole.

How do you see the role of GLP-1 receptor agonists in type 2 diabetes management? By 2022, the American Diabetes Association’s standards of care included GLP-1 receptor agonists as a first-line pharmacological therapy for type 2 diabetes in patients with or at high risk for heart failure. How do you see their role in Europe?

I do not see much difference across the pond. I was involved in the consensus on the treatment of type 2 diabetes from the American Diabetes Association and the European Association for the Study of Diabetes, and our recommendations were identical. When managing type 2 diabetes, it is essential to reduce complications in order to improve quality of life. This requires addressing four major aspects in addition to social determinants of health and lifestyle modifications.

First, achieving good glycemic control is crucial in preventing microvascular complications. Many individuals with diabetes still experience eye, kidney, or nerve complications, which also contribute to cardiovascular risk.

Second, we must focus on body weight management. Drugs like GLP-1 receptor agonists—and more recently, dual agonists—have shown great promise in achieving glycemic control and promoting weight loss.

Third, it is important to consider cardiovascular risk from the outset, as many patients with diabetes also have high blood pressure, dyslipidemia, or impaired kidney function.

Finally, for those who already have cardiovascular damage or are at very high cardiovascular risk, we recommend that medications proven to provide cardiovascular benefits are used as early as possible. This includes GLP-1 receptor agonists and SGLT-2 inhibitors. In this respect, our approach is aligned with our colleagues in the United States.

Stefano Del Prato is a retired Professor of Endocrinology and Metabolism at the School of Medicine, University of Pisa and past-Chief of the Section of Diabetes, University Hospital of Pisa, Italy. Currently he is affiliate Professor of Medicine at the Interdisciplinary Research Center “Health Science” of the Sant’Anna School of Advanced Studies in Pisa and affiliate physician at the “Fondazione Toscana Gabriele Monasterio”, Pisa.

Professor Del Prato’s main research interests have always been the physiopathology and therapy of type 2 diabetes and insulin resistance. He acts as referee for numerous journals and has served on the Editorial Boards of major scientific journals in the field of diabetes and metabolism. Professor Del Prato is past Vice-President of the European Association for the Study of Diabetes (EASD), past Chairman of the European Foundation for the Study of Diabetes (EFSD), past President and Honorary President of the Italian Society of Diabetology, and immediate past-President of the EASD.

Currently is the President of the European Diabetes Forum (EUDF). He served as Chairman of the Scientific Committee of the World Diabetes Congress in Dubai, UAE, in 2011. He has authored over 560 articles (PubMed) in peer-reviewed international journals and has been awarded several honors including the Prize of the Italian Society of Diabetology for outstanding scientific activity, the Honorary Professorship at the Universidad Peruana Cayetano Heredya in Lima, the 10th Lifetime Contribution Oration Award from the Madras Diabetes Research Foundation, India. He has been bestowed the honor of Commander of the Order of the Italian Republic for Scientific Merits.

Learn more about Stefano Del Prato and his work here, and connect on LinkedIn here.