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The subgroup of diabetes caused by single gene defects thus provides the best example to date of the vision of \u2018precision diabetes\u2019. Monogenic diabetes may be divided into primary pancreatic beta cell failure, and primary insulin resistance. In both groups, clear examples of genotype-selective responses to therapy have been advanced. The benign trajectory of diabetes due to pathogenic\n                    <jats:italic>GCK<\/jats:italic>\n                    mutations, and the sulfonylurea-hyperresponsiveness conferred by activating\n                    <jats:italic>KCNJ11<\/jats:italic>\n                    or\n                    <jats:italic>ABCC8<\/jats:italic>\n                    mutations, or loss-of-function\n                    <jats:italic>HNF1A<\/jats:italic>\n                    or\n                    <jats:italic>HNF4A<\/jats:italic>\n                    mutations, often decisively guide clinical management. In monogenic insulin-resistant diabetes, subcutaneous leptin therapy is beneficial in some severe lipodystrophy. Increasing evidence also supports use of \u2018obesity therapies\u2019 in lipodystrophic people even without obesity. In beta cell diabetes the main challenge is now implementation of the precision diabetes vision at scale. In monogenic insulin-resistant diabetes genotype-specific benefits are proven in far fewer patients to date, although further genotype-targeted therapies are being evaluated. The conceptual paradigm established by the insulin-resistant subgroup with \u2018adipose failure\u2019 may have a wider influence on precision therapy for common type 2 diabetes, however. For all forms of monogenic diabetes, population-wide genome sequencing is currently forcing reappraisal of the importance assigned to pathogenic mutations when gene sequencing is uncoupled from prior suspicion of monogenic diabetes.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s00125-022-05720-7","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T20:22:27Z","timestamp":1653596547000},"page":"1782-1795","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Achievements, prospects and challenges in precision care for monogenic insulin-deficient and insulin-resistant diabetes"],"prefix":"10.1007","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9976-3005","authenticated-orcid":false,"given":"Am\u00e9lie","family":"Bonnefond","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6539-3069","authenticated-orcid":false,"given":"Robert K.","family":"Semple","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"5720_CR1","doi-asserted-by":"publisher","first-page":"107843","DOI":"10.1016\/j.diabres.2019.107843","volume":"157","author":"P Saeedi","year":"2019","unstructured":"Saeedi P, Petersohn I, Salpea P et al (2019) Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. 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