The 2022 special issue of Diabetologia highlights advances in precision medicine in diabetes research and care. It has long been clear that the ability to collect large data sets and to analyse them quickly and stringently would profoundly affect our understanding of metabolic disease and how we treat it. The challenge is how to move from large, complex data sets to the individual in clinical care. How can medicine transition from one-size-fits-all solutions to personalised approaches? In this special issue, prominent thinkers in the field write on prevention, prediction, diagnosis, stratification and therapy by precision medicine.