What are the four stages of type 2 diabetes and what do they mean for treatment?
Type 2 diabetes is the most common form of the disease by a long shot, which is why so much attention is paid to it by doctors and researchers. In 2018, two leading diabetes doctor groups, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) teamed up to publish a groundbreaking position statement identifying four “stages” of Type 2 Diabetes.
So what was and continues to be so revolutionary about this statement?
The four-stage approach represents a deeper way of looking at the progression and treatment of Type 2 Diabetes. In fact, the team even gave its new model a name – dysglycemia-based chronic disease or DBCD for short.
Perhaps, Dr. Jeffery Mechanick, Professor at the Icahn School of Medicine at Mount Sinai, and a past president of both the AACE and ACE, stated it best when he 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 are calling dysglycemia-based chronic disease.”
In case you’re still wondering what that means.
In a nutshell, the DBCD model expands the framework for Type 2 diabetes to include insulin resistance and prediabetes conditions. It became the first model to look at treating diabetes beyond examining a person’s current glycemic status. DBCD directly acknowledges that diabetes follows a continuum, building and evolving over time. So, rather than wait for a person to pass through the often undetectable and asymptomatic early stages of the disease, only to begin treating them once they’ve become a full-fledged Type 2 diabetic (possibly even in the morbid stages), the DBCD approach starts the conversation much earlier.
It is at its core a preventative model. Why? Because it takes into account the full spectrum of Type 2 diabetes and includes them all under one umbrella condition - dysglycemia-based chronic disease (DBCD).
What are the four stages of Type 2 Diabetes in the DBCD model?
Stage 1: Insulin Resistance
This is the early stage, when muscle, fat and liver cells become insulin resistant and have difficulty bringing glucose in and effectively processing it. However, the pancreas is able to compensate for the problem by creating more insulin and thereby keeping blood glucose levels within the normal range.
Stage 2: Prediabetes
The disease has already progressed rather dramatically in this stage. The extra insulin being produced by the pancreas is no longer enough to maintain normal blood sugar levels. In some cases, beta cell dysfunction may also be found. Blood sugar has reached higher than normal levels, but not enough for a diabetes diagnosis. The frightening part is that people in this stage will most likely feel no telltale symptoms, which why they often find themselves facing the next stage.
Stage 3: Type 2 Diabetes
At this point, blood sugar has reached a level that can accurately be diagnosed as Type 2 Diabetes. Blood sugar levels remain abnormally high and without treatment will likely cause long-term damage to the body.
Stage 4: Vascular Complications
This is when the most serious consequences of high blood sugar begin to show themselves due to damage to the vascular system. These include nerve damage (neuropathy), chronic kidney disease, retinopathy, and Type 2 diabetes-related microvascular events.
So what does this mean for Type 2 diabetes treatment?
The DBCB model provides a blueprint for preventative Type 2 diabetes care and treatment. According to Dr. Mechanick, “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.”
Dr. Mechanick goes onto explain that what the group did was reframe the problem. Rather than viewing the early stages, insulin resistance and prediabetes, in isolation, they created an expanded perspective for Type 2 Diabetes to include these stages, which, in turn expands the framework for treatment. After all, when you consider prediabetes part of the disease, the context for a preventative care model changes. Rather than waiting for a patient to evolve into full-fledged Type 2 Diabetes and then beginning treatment, it makes far more sense to look at the proverbial big picture and intervene earlier to prevent Type 2 Diabetes from developing in the first place.
In fact, there is some debate as to whether prediabetes should be reclassified from a “pre-disease” condition to a true disease state. The authors hint in their statement that future researchers just might advocate for this change and reclassify prediabetes. Whether this happens or not, widening the lens on how medicine examines Type 2 Diabetes and looks for the best ways to treat it, is sure to bring more preventative methods to the table. After all, the disease is a progressive one, and when we view those early stages as a part of the overall condition, it clearly points to early intervention as the most reasonable solution.
Understanding is the key
According to the experts, understanding the progression of Type 2 Diabetes plays a critical role in the treatment and, better yet, prevention of the disease. By identifying the various stages doctors are able to create treatment and lifestyle programs that reduce the risk of further development and can improve long-term management in those who do develop the disease.
If you’re looking for ways to better manage your Type 2 Diabetes, the first step is to sit down with your diabetes physician and care team. This conversation may lead you to seek out assistance from other caregivers, such as a dietician or a certified diabetes care and education specialist (CDCES) who can provide ongoing diabetes education and support.
If you haven’t been diagnosed with diabetes but believe you might be at risk or in early stages of the disease due to family history, obesity, or other factors, visit your doctor and get tested. An easy blood test will provide the answer, and the earlier you know you’re prediabetic, the sooner you can take steps to halt the progression into Type 2 Diabetes.
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