This past Wednesday (November 28, 2018) the American Association of Clinical Endocrinologists (AACE) announced publication of a new Position Statement which identifiesÂ four separate disease stages associated with an abnormal glucose response includingÂ Type 2 Diabetes;
Stage 1: Insulin Resistance
Stage 2: Prediabetes
Stage 3: Type 2 Diabetes
Stage 4: Vascular Complications â€” including retinopathy (disease of the eyes that can result in vision loss),Â nephropathy (disease of the kidneys which can lead to kidney failure) and neuropathy (disease of the nerves â€”especially of the toes and feet which can lead to amputations), as well as other chronic disease risks associated with Type 2 Diabetes.
For those who have read the first two articles in this series (links below), the existence of a stage before blood sugar becomes abnormal (Prediabetes) and two stages before a diagnosis of Type 2 Diabetes will sound very familiar!
In the two previous articles, I explained the findings of a recent a large-scale study that involved 7800 subjects and which found thatÂ 3 out of 4 adultsÂ have totally normal fasting blood glucose test resultsÂ and normal blood glucose 2 hours after a standard glucose load,Â but have very abnormal glucose spikes after eatingÂ and very abnormal levels of circulating insulin (“hyperinsulinemia”) that is associated with these dysfunctional glucose spikes.
It has been reported that hyperinsulinemia is present a decade before fasting blood glucose levels become abnormal, so it should come as no surprise that it is now recognized that there are two stages BEFORE a diagnosis of Type 2 Diabetes.Â Those who have read the two preceding articles will know that it is the hyperinsulinemia that leads to the insulin resistance, so in effect the first stage in this disease process really includes both of these together.
This Position Statement also recognizes;
“According to a recent analysis using data from the
U.S. National Health and Nutrition Examination Surveys
(NHANES; 1988-2014), patients with prediabetes have
increased prevalence rates of hypertension, dyslipidemia,
chronic kidney disease and cardiovascular disease (CVD)
The Position Statement focuses onÂ early intervention to reduce chronic disease risk which includeÂ diet andÂ lifestyle changesÂ as well as weight-loss. The goal of the release of the statement is toÂ prevent the progression to Type 2 Diabetes, cardiovascular disease (CVD) and the metabolic diseases associated with it.
What is the importance of these two early stages?
What these stages mean is that long before blood sugar becomes abnormal, the progression to Type 2 Diabetes has already begun.
What it also implies is thatÂ people need to be given additional lab tests when their fasting blood sugar results are still normalÂ in order to detect the presence ofÂ abnormal glucose spikes 30 minutes and 60 minutes after a glucose loadÂ as well tests measuring the abnormal insulin spikes associated with itÂ as it is chronic hyperinsulinemia (high insulin levels) that leads toÂ insulin resistanceÂ and the progression to Type 2 Diabetes as well as the associated chronic diseases.
Since 3 out 4 adults may have normal fasting blood glucose but with hyperinsulinemia, if we are going to stop the tsunami of Type 2 Diabetes, we must start treating it when fasting blood glucose is normal.
As I said in my last article, the timeÂ to think about implementingÂ dietary changesÂ and using updatedÂ lab testing proceduresÂ is now. We must act toÂ keep people from becoming carbohydrate intolerant and from developing hyperinsulinemia, Pre-diabetes, Type 2 Diabetes and the host of metabolic diseases that go along with it. This proactive approach is long overdue.
If you would like my help in lowering your risk to developing Type 2 Diabetes and the chronic disease risks associated with hyperinsulinemia or in reversing their symptoms, please send me a note using theÂ Contact MeÂ form on the tab above. I provide bothÂ in-person consultationsÂ as well as byÂ Distance Consultation,using Skype and phone. Please let me know how I can help.
To your good health!
Note: If you haven’t yet read the two previousÂ related articles,Â I would encourage you to have a look. The first articleÂ explains the existence of ‘silent Diabetes’ in those with normal Fasting Blood Glucose test results and is titledÂ When Normal Fasting Blood Glucose Results Aren’t Necessarily “Fine”Â and can be readÂ here.
The second article titledÂ Carbohydrate Intolerance & the Chronic Disease Risk of High Insulin LevelsÂ explains what hyperinsulinemiaÂ is (chronically high levels of circulating insulin) and why it’s a problem andÂ can be read here.
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American Association of Clinical Endocrinologists Announces Framework for Dysglycemia-Based ChronicÂ Disease Care Model, November 28, 2018,Â AACE Online Newsroom, url:Â https://media.aace.com/press-release/american-association-clinical-endocrinologists-announces-frameworkdysglycemia-based-c
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