Stages of diabetes: stages, symptoms and treatments

Over the past decade, professional organizations, such as the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE), have created guidelines outlining the different stages in the development of diabetes.

According to the literature on these guidelines, understanding the various stages of diabetes can enable physicians and patients to take a more holistic approach to preventive care and disease management.

Below, we have outlined the different stages of beta cell dysfunction, type 1 diabetes, and type 2 diabetes as established by current experts in the field of diabetes research.

In 2015, the ADA released a joint statement with JDRF and the Endocrinology Society outlining the different stages of type 1 diabetes. Using the guidelines below, clinicians can more easily diagnose this condition at an earlier stage, even when symptoms may not be present.

It is important to note that type 1 diabetes is an autoimmune disease where the immune system attacks and destroys the beta cells in the pancreas, which are responsible for producing insulin.

Pre-step 1

At this point, genetic analysis can help identify the underlying genotypes that are commonly associated with type 1 diabetes.

According to research, a specific region on chromosome six – called the HLA region – is associated with up to 50 percent of the risk of developing this disease. Other factors, such as having a sibling or close relative with type 1 diabetes, can also increase the risk of the disease.

Step 1

At this point, at least one diabetes-related autoantibody is present in the blood. At this point, these autoantibodies have already started to attack the beta cells in the pancreas. But the blood sugar levels remain within the normal range and no symptoms are present.

2nd step

At this point, at least two diabetes-related autoantibodies are present in the blood. As beta cells continue to be destroyed by the immune system, a lack of insulin leads to increased blood sugar levels due to glucose intolerance. Although the beta cell dysfunction is more severe at this point, there are still no symptoms.

Step 3

At this stage, there is a significant loss of beta cells due to autoimmunity and symptoms are present, resulting in a diagnosis of type 1 diabetes. During this stage, symptoms of type 1 diabetes may include:

In 2018, AACE created the Dysglycemia-Based Chronic Disease Multimorbidity (DBCD) model of care. Much like the previous guidelines above from 2015, the DBCD model of care helps clinicians take preventative measures to reduce complications of type 2 diabetes.

Step 1

This stage, defined as insulin resistance, is when muscle, fat, and liver cells become resistant to insulin and have difficulty getting glucose into the cell. But the pancreas compensates for this by producing more insulin, which helps keep blood sugar levels within a normal range.

2nd step

At this point, also known as prediabetes, the cells become so resistant to insulin that the extra insulin is not enough to bring blood sugar back to normal. In some cases, beta cell dysfunction may also be present. During this stage, blood sugar remains above normal, but not high enough to be classified as diabetes.

Step 3

At this stage, blood sugar remains abnormally high, leading to a diagnosis of Type 2 diabetes. Insulin resistance and beta cell dysfunction can lead to high blood sugar levels in type 2 diabetes. Left untreated, these high levels can cause long-term damage to the body.

Step 4

At this point, vascular complications can occur due to high blood sugar. As blood sugar levels remain high, damage can occur in the vascular system, resulting in a potential complications like:

Although “end-stage diabetes” is not a commonly used term, diabetes can lead to what are known as end-stage diabetic complications or advanced complications. In people with diabetes, advanced complications, such as end-stage kidney disease, occur after many years of living with diabetes.

A 2019 study found that microvascular complications of diabetes, such as kidney disease, increase the risk of cardiovascular events and death in people with type 1.

While there is no cure for diabetes, it can be managed with the right treatment, which can include medications, dietary changes, and lifestyle interventions.

• Medications. Medications for diabetes may include insulin injections, amylinomimetic drugs, alpha-glucosidase inhibitors, and other drugs that help keep blood sugar stable. In many cases, medications for high cholesterol, high blood pressure, and heart health are also used to help reduce the risk of complications.
• Dietary changes. Dietary changes for diabetes involve guidelines to help keep blood sugar, blood pressure and cholesterol balanced. When you have diabetes, it’s important to focus on eating a diet rich in whole foods, such as fruits, vegetables, whole grains, and lean protein. It is also important to limit your intake of foods rich in:
  • sugar
  • salt
  • saturated fat
  • trans fat
• Lifestyle interventions. Lifestyle interventions for diabetes begin with good disease management. This includes checking your blood sugar, blood pressure, and cholesterol levels regularly. If possible, you should try to get at least 30 minutes or more of physical activity per day. If you smoke or drink alcohol on a regular basis, consider reducing your intake.

While it may seem difficult to manage a chronic condition like diabetes, your healthcare team is there to help you create a diabetes treatment plan which works best for you.

If you are concerned about managing your diabetes, the first step is to contact your doctor or healthcare team to create a diabetes treatment plan. Depending on your diagnosis and personal needs, your treatment plan may include:

• an endocrinologist, who can help you manage your blood sugar
• a dietitian, who can suggest dietary changes to help manage your blood sugar, blood pressure, and cholesterol levels
• a specialist doctor, such as a dentist or ophthalmologist, who can help you manage the potential complications of diabetes
• a Certified Diabetes Care and Education Specialist (CDCES), who can provide education and support to better manage your condition

According to experts in the field of diabetes research, diabetes staging plays an important role in the prevention, diagnosis and treatment of diabetes. Understanding the different stages of type 1 and type 2 diabetes allows doctors and patients to see the progression of the disease to improve treatment and long-term management.

If you’ve been diagnosed with diabetes, it’s important to stay informed about your condition so that you can manage it more easily in the long term.