American Association of Clinical Endocrinologists Announces Framework for Dysglycemia-Based Chronic Disease Care Model

Wednesday, November 28, 2018 8:39 am EST


"Currently, treatment of DBCD often begins at the time of a type 2 diabetes diagnosis"

Marking its continued shift towards formalizing chronic disease preventive care frameworks for a range of endocrine conditions, the American Association of Clinical Endocrinologists (AACE) today announced publication of its position statement introducing a diabetes chronic disease care model.

The complications-centric model, labeled by statement authors as Dysglycemia-Based Chronic Disease (DBCD), identifies four distinct, evidence-based disease stages along the type 2 diabetes spectrum and focuses on early, comprehensive risk reduction strategies, such as structured lifestyle changes and weight-loss therapy, to mitigate the progression to – and potential impact of –  type 2 diabetes, cardiometabolic risk and cardiovascular disease (CVD).

As defined by the position statement, the stages are:

  • Stage 1: DBCD insulin resistance
  • Stage 2: DBCD prediabetes
  • Stage 3: DBCD type 2 diabetes
  • Stage 4: DBCD vascular complications (e.g., retinopathy, nephropathy, neuropathy) and/or type 2 diabetes microvascular events

The position statement argues, in part, that while not commonly recognized as a disease entity, prediabetes falls within the progressive spectrum of DBCD and that the high incidence of complications in this patient population, such as hypertension and dyslipidemia, demands better and more actionable diagnostic criteria and intervention before the disease progresses to type 2 diabetes.

It also suggests that since those with prediabetes have significant cardiovascular disease (CVD) risk factors, introducing aggressive management of CVD treatment as early as possible is paramount.

The position statement features a DBCD care model table that outlines DBCD stage, clinical context, pragmatic relevance and evidence base for each of the four stages.

“Currently, treatment of DBCD often begins at the time of a type 2 diabetes diagnosis,” says statement primary author Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU. “The clinical implications strongly suggest that initiation of therapy only at Stage 3 or Stage 4 is not an optimal care approach.”

Further, while acknowledging traditional views that question the clinical benefits of prediabetes as an actionable diagnosis, accompanied by insurance-related barriers for diagnostics, lifestyle medicine and pharmaceuticals, “The DBCD framework serves as a compelling illustration of a preventative care and treatment approach that can reduce disease progression, the burden of complications, and overall health care costs at all stages of this progressive chronic disease process,” Dr. Mechanick adds.

AACE debuted its first disease care model with the December 2016 publication of a position statement introducing ABCD, Adiposity-Based Chronic Disease, in which authors focused on the characteristic pathophysiological effects of abnormal fat mass, distribution and function, rather than just increased body weight, and provided standardized protocols for weight loss and complications management.

To read the DBCD position statement in its entirety, visit:

To view a brief video about DBCD, click here: 

The ABCD position statement is located online at:


About the American Association of Clinical Endocrinologists (AACE)

The American Association of Clinical Endocrinologists (AACE) represents more than 7,000 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. A majority of AACE members are certified in endocrinology, diabetes and metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. To learn more, visit our site at  or follow AACE on social media:,