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New model developed for four stages of diabetes

New model developed for four stages of diabetes

Publication date: Thursday, 17 January 2019

Leading clinicians and researchers in the USA have proposed a new model for the development of type 2 diabetes which they call ‘Dysglycaemia-based chronic disease’ or DBCD. The four stages of type 2 diabetes have been presented in a recent position statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology. 



The model describes the stages as:

  • Stage 1: Molecular (Insulin resistance)
  • Stage 2: Biochemical cardiometabolic risk (Prediabetes)
  • Stage 3: Biochemical disease (Type 2 diabetes)
  • Stage 4: Vascular complications (Type 2 diabetes with complications)

The document emphasises 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.

In the model, the authors focus on the characteristic pathophysiological effects of abnormal fat mass, distribution and function, rather than just increased body weight, and provide standardised protocols for weight loss and complications management. Professor Jeffrey Mechanick from Mount Sinai Hospital, New York 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.”

This approach encourages early intervention to improve individual patients quality of life, overall health and healthcare costs in the longterm.

More information

The AACE/ACE position statement is available here:

Dysglycemia-based chronic disease: an American Association of Clinical Endocrinologists position statement. Endocrine Practice 2018; 24(11):995-1011. https://www.aace.com/files/position-statements/PS-2018-0139.pdf



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Topics covered:
Category: Have You Heard
Edition: Volume 4, Number 1, BJPCN Online 2019

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