Dysglycemia-based Chronic Disease— Diabetes Re-worked

Abstract

T ype 2 diabetes (T2D) is a complex, chronic disease with a significant quality of life burden for affected individuals, as well as socio-economic burdens on a population scale. Efforts to mitigate morbidity, mortality, and risks for other acute and chronic diseases have been compromised by a traditional chronic disease model that focuses on tertiary prevention (i.e., waiting until the disease is fully manifest and in many cases with severe complications). More specifically, the role for prevention at an earlier “prediabetes” stage has been questioned. A re-examination of the biology and clinical data on T2D pathogenesis can modulate the way we think about T2D. The new Dysglycemia-Based Chronic Disease (DBCD) model addresses these challenges by positioning T2D and prediabetes along a continuous spectrum from insulin resistance to prediabetes to T2D to vascular complications. It is hoped that by conceptualizing T2D in the DBCD framework, health care professionals can provide more efficient, cost-effective care.