A new model for type 2 diabetes (T2D) progression from insulin resistance to advanced complications has been set out by US endocrinologists.1,2

Published in November 2018, the ‘dysglycaemia-based chronic disease (DBCD) multimorbidity care model’ promotes better understanding of prediabetes within the T2D spectrum. It also emphasises the benefits of employing a range of risk reduction strategies early on.2

Interventions such as diet, exercise and weight loss should be used “to mitigate the progression to – and potential impact of – T2D, cardiometabolic risk and cardiovascular disease,” says the American Association of Clinical Endocrinologists.1,2

Its four stage DBCD model describes dysglycaemia as “any abnormality in glycaemic status that is associated with disease, or the potential for disease”, with insulin resistance as the “essential component”. DBCD starts with insulin resistance increasing to the point where the body is unable to compensate with increased insulin secretion. The resulting hyperglycaemia leads to prediabetes and beyond with more serious consequences if no action is taken:2

·       Stage 1: insulin resistance.

·       Stage 2: prediabetes.

·       Stage 3: type 2 diabetes.

·       Stage 4: vascular complications.