DYSGLYCEMIA-BASED CHRONIC DISEASE: AN AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS POSITION STATEMENT

Area of Science:

• Endocrinology
• Preventive Medicine
• Chronic Disease Management

Background:

• The American Association of Clinical Endocrinologists (AACE) addresses the continuum of dysglycemia, from insulin resistance to type 2 diabetes (T2D) and its complications.
• Managing prediabetes is often debated, but viewing it as an intermediate stage of a progressive chronic disease highlights opportunities for prevention.
• Cardiometabolic risk and cardiovascular events are significant concerns associated with dysglycemia.

Purpose of the Study:

• To introduce a novel dysglycemia-based chronic disease (DBCD) multimorbidity care model.
• To establish a framework for preventive care across the insulin resistance-prediabetes-T2D spectrum.
• To advocate for early intervention and structured lifestyle changes to mitigate T2D and cardiovascular risks.

Main Methods:

• Development of a four-stage care model: Stage 1 (insulin resistance), Stage 2 (prediabetes), Stage 3 (type 2 diabetes), and Stage 4 (vascular complications).
• Emphasis on a preventive care paradigm.
• Integration with existing AACE care models, such as adiposity-based chronic disease (ABCD).

Main Results:

• The DBCD model provides actionable stages for preventive care.
• It frames prediabetes as a critical intermediate stage within a chronic disease continuum.
• The model supports patient-centered, evidence-based management of complex endocrine conditions.

Conclusions:

• The DBCD model encourages proactive, structured lifestyle interventions at the earliest signs of dysglycemia.
• Further research may lead to reclassifying prediabetes as a distinct disease state.
• Transformative changes in diagnostic coding and reimbursement are needed to improve population-level endocrine health care for T2D and related conditions.