Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM): A Randomized Controlled Trial in Chinese Patients With Young-Onset Diabetes

OBJECTIVE: Young-onset type 2 diabetes (YOD) results from complex causes, calling for precision management. RESEARCH DESIGN AND METHODS: The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM) study was a single-center, two-arm, 3-year randomized controlled trial in which Chinese individuals aged 18 to 50 years with non-type 1 diabetes diagnosed at age ≤40 years were randomly assigned to intervention (Joint Asia Diabetes Evaluation [JADE]-PRISM) or usual clinic-based care (JADE only). The intervention included technologically guided assessment and use of biogenetic markers (autoantibodies, C-peptide, and common and rare genetic variants) to classify diabetes for 1-year intensified, algorithm-based treatment followed by two annual reviews by an endocrinologist-led multidisciplinary team. The primary end point was a composite of incident or progression of all diabetes-related complications. Secondary end points included attainment of three or more treatment targets (HbA1c