The four stages of dysglycemia-based chronic disease: A new diabetes chronic disease care model

The American Association of Clinical Endocrinologists (AACE) has introduced a dysglycemia-based diabetes chronic disease care model in a position statement published in the November 2018 issue of the journal Endocrine Practice.

The dysglycemia-based chronic disease (DBCD) care model acknowledges that diabetes exists as a continuum and it is not just a distinct disease characterized by hyperglycemia. At the same time, it recognizes that identifying distinct stages in this continuum helps formulation of an actionable preventive care plan. Hyperinsulinemia begins much before the blood sugar levels become high enough to be diagnosed as type 2 diabetes. Hyperinsulinemia leads to insulin resistance, the hallmark of type 2 diabetes. Hence, it has identified four separate stages as follows:

  1. Stage 1: DBCD insulin resistance
  2. Stage 2: DBCD prediabetes
  3. Stage 3: DBCD type 2 diabetes
  4. Stage 4: DBCD vascular complications (e.g., retinopathy, nephropathy, neuropathy) and/or type 2 diabetes microvascular events

The statement emphasizes on recognition and management of prediabetes as a necessary component for an effective personalized and population-based type 2 diabetes care plan.

The authors say that initiating treatment only at Stage 3 or Stage 4 is not an optimal care approach, introduction of aggressive management of cardiovascular disease as early as possible is important as those with prediabetes have significant cardiovascular disease risk factors. Early intervention with exercise and weight loss increase insulin sensitivity and are effective in preventing progression from prediabetes to type 2 diabetes.

As stated in the position statement, “while not commonly recognized as a disease entity, prediabetes falls within the progressive spectrum of DBCD and that the high incidence of complications in this patient population, such as hypertension and dyslipidemia, demands better and more actionable diagnostic criteria and intervention before the disease progresses to type 2 diabetes”.

 (Source: Endocrine Practice November 2018, AACE)

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