Epidemiology, Drivers, and Public Health Challenges of Prediabetes, Type 2 Diabetes, and Cardiometabolic-Based Chronic Disease

The presence of insulin resistance and the development of associated complications are extremely common in modern times. This state of inefficient glucose metabolism imparts great risk to the individual patient through progression and complications, as well as a large impact on society as a whole. The severity and progression of insulin resistance may be grouped into a four-stage system defining dysglycemia-based chronic disease. Insulin resistance, stage 1, is highly prevalent and often overlooked. Prediabetes, stage 2, is considered a predisease, though considerable risk exists for progression and development of complications. Stage 3 is type 2 diabetes, and stage 4 is type 2 diabetes with complications. The prevalence of each stage has increased substantially in recent decades, mainly due to environmental and behavioral factors. The field of lifestyle medicine is poised to address many of these drivers of disease. Moreover, measures to address modifiable atherosclerotic risk factors outside of insulin resistance, such as tobacco use, excess alcohol intake, hyperlipidemia, and adiposity-based chronic disease, must be included in a comprehensive approach. Modifications to lifestyle choices can mitigate risk and, at times, reverse these highly common conditions.