Overview: Dysglycemia-Based Chronic Disease—Exposing Lifestyle Medicine Targets

Systemic resistance to insulin is common and associated with many health risks and implications for preventive care. The pathophysiology and clinical phenotype manifest through assorted metabolic regulatory pathways, which ultimately define a driver-based chronic disease, or in the case of insulin resistance, dysglycemia-based chronic disease (DBCD). Patients with DBCD are characterized by a four-stage system based on natural history: stage 1—insulin resistance; stage 2—prediabetes; stage 3—type 2 diabetes; and stage 4—type 2 diabetes with complications (namely, micro- and macrovascular). A host of associated medical conditions may arise with the insulin resistance state due to the systemic effects of metabolic dysregulation. Examples include polycystic ovary syndrome, obstructive sleep apnea, abnormal adiposity, hypertension, and hepatosteatosis. The high prevalence, predictability, progressive nature, and magnitude of potential morbidity associated with DBCD underscore early-stage detection and preventive care with lifestyle medicine. Patients who progress to later stage DBCD also benefit from lifestyle interventions combined with pharmacotherapy and procedures. Key lifestyle interventions include optimizing nutrition, physical activity, sleep hygiene, and behavior. Diabetes care is now re-interpreted based on a new DBCD model with the critical use of early, sustainable, and structured lifestyle medicine.