Primary care clinicians are sometimes mistakenly described as not caring about the pathophysiology, but rather, more pragmatically interested in “just tell me what to do.” Instead, in my experience, primary care clinicians are very interested in the pertinent pathophysiology: i.e., having insight into the story line that gives clarity about why a particular medication is chosen, why some medications are complementary, and others not, etc.
Recently, microRNAs (miRNA) have been recognized to play an important role in diabetes, cardiovascular disease, and even cancer. Although miRNA literature at this point may seem “alien” to most clinicians, there have been more than 25,000 publications on the topic since their discovery in 2000. miRNA is measurable in plasma, saliva, and urine. Particular subgroups of miRNA have been identified in persons with diabetic retinopathy.
The basic function of miRNA is to regulate the activity of specific target messenger RNA, thereby altering production of individual proteins. A primary action of miRNA appears to be to suppress protein production, such that activation of miRNA results in reduction of specific proteins. A recent study found an association between specific miRNA and glucose perturbations, such that essentially half of abnormal glucose excursions could be explained by abnormalities in miRNA.
At the current time, miRNA is primarily a research tool, but investigators are hopeful that identification of specific miRNA associated with disorders as diverse as obesity, diabetes, and cancer may lead to early identification of pathology, and hopefully even the opportunity for improved disease modification.
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