Dysglycemia-Based Chronic Disease

Noncommunicable metabolic disease has markedly increased in prevalence worldwide over recent decades. Driven by insulin resistance, with coincident associated risks and potential complications, the progression of an individual patient with dysglycemia-based chronic disease (DBCD) may be classified in a 4-stage system. The recognition of early stages, including patients with insulin resistance or patients with mild hyperglycemia, also known as prediabetes, allows for early intervention. Such identification should trigger a review and substantive modification in routine lifestyle choices that significantly reduce the risks of progression and complication. In patients already at more advanced stages of DBCD, such as those with type 2 diabetes or atherosclerotic disease, lifestyle interventions still provide clinical benefits and reduction in risk of further adverse developments. The evaluation of patients with DBCD includes scrutiny of nearly every aspect of lifestyle. Commonly actionable factors include dietary patterns, physical activity, tobacco use, alcohol consumption, marijuana use, stress reduction, sleep and circadian rhythm, exposure to endocrine-disrupting chemicals, and social determinants of health. In each of these categories, clinical evidence is suggestive for optimization. However, a further study of all aspects can lead to novel approaches, support consensus views, guidelines, and policy development, and lead to a more complete understanding of the evaluation and treatment of patients with DBCD.