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US position statement on four stages of type 2 diabetes published

By Editor
6th December 2018
Type 2 diabetes, Type 2 prevention

The four stages of type 2 diabetes have been identified and written into a position statement by two leading diabetes doctor groups in America. 

The document emphasised the importance of prevention during the first phase of diabetes, when signs of insulin resistance had begun to develop.

The other stages include prediabetes, type 2 diabetes and vascular complications, including retinopathy, nephropathy or neuropathy and, or, related microvascular events.

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) teamed up to issue the statement, having combined clinical evidence and research to come up with the four phases.

Together they developed a model they entitled “dysglycaemia-based chronic disease” or DBCD. The authors focused on the characteristic pathophysiologic effects of abnormal fat mass, distribution and function, rather than just increased body weight, and provided standardised protocols for weight loss and complications management.

Professor Jeffrey Mechanick is from Icahn School of Medicine at Mount Sinai, who helped draw up the statement, 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 dysglycaemia-based chronic disease.”

He told Endocrine Today that people who are classed as having prediabetes tend to “leapfrog” over type 2 diabetes without complications and develop type 2 diabetes with cardiovascular disease.

He added: “So, really, it’s not just primary prevention, there is a secondary prevention component.

“It brings into question a lot of the older models just following glycemic status, rather than following a comprehensive approach. The earlier you intervene, the better. Not only from a cost-savings standpoint, but also for the individual patient’s quality of life, welfare and overall health.”

Professor 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?”

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