Four stages of type 2 diabetes identified by US doctors

Jack Woodfield
Mon, 03 Dec 2018
Four stages of type 2 diabetes identified by US doctors
Two leading US diabetes groups have issued a joint position statement revealing the four stages of type 2 diabetes.

The model emphasises the importance of type 2 diabetes prevention during the first phase, when signs of insulin resistance begin to emerge.

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) combed through clinical evidence and research to come up with the four phases.

They developed a model which they call "dysglycemia-based chronic disease" or DBCD. Dysglycemia is a broad term referring an abnormality in blood glucose levels.

The position statement also includes recommendations to reduce people's risk of developing type 2 diabetes, with a focus on diet and exercise.

The statement’s four stages of type 2 diabetes are insulin resistance, prediabetes, type 2 diabetes and type 2 diabetes and vascular complications, including retinopathy, nephropathy or neuropathy and, or, related microvascular events.

Professor Jeffrey Mechanick from Icahn School of Medicine at Mount Sinai, who has previously been a president of AACE as well as the ACE, said: "We're not getting rid of the term type 2 diabetes. We’re viewing type 2 diabetes, cardiovascular disease and also prediabetes and insulin resistance, all as one framework, which we’re calling dysglycemia-based chronic disease."

Prof Mechanick said the position statement highlighted the importance of prediabetes as part of an "expanding the framework for type 2 diabetes".

He added: "When you view prediabetes in that kind of continuum, then it has a lot of importance. The context for the importance is a preventive care model. Rather than waiting for a patient to evolve through this continuum, all the way to morbid forms of type 2 diabetes where tertiary prevention would be implemented, which is costly, wouldn’t it make sense to intervene earlier?"

The model can be viewed here.

Editor's note: Type 2 diabetes prevention is indeed important in lowering health risks for at-risk people, and our Low Carb Program is helping people with prediabetes lose weight, reduce their HbA1c and avoid developing type 2 diabetes. Earlier this year, the Low Carb Program's one-year health outcomes were published in the Journal of Medical Internet Research.
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