What Are the Stages of Diabetes?

Within the past decade, professional organizations, like the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE), have created guidelines that outline the various stages of diabetes development.

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

Below, we’ve outlined the various 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 the JDRF and Endocrine Society outlining the various stages of type 1 diabetes. Using the guideline below, clinicians can more easily diagnose this condition at an earlier stage, even when symptoms might not be present.

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

Pre-Stage 1

In this stage, genetic analysis can help identify underlying genotypes that are commonly associated with type 1 diabetes.

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

Stage 1

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

Stage 2

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

Stage 3

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

• excessive hunger or thirst
• blurry vision
• severe fatigue
• frequent urination
• unexplained weight loss

In 2018, the AACE created the dysglycemia-based chronic disease (DBCD) multimorbidity care model. Much like the previous guidelines above from 2015, the DBCD care model helps clinicians take preventative steps to reduce type 2 diabetes complications.

Stage 1

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

Stage 2

In this stage, also known as prediabetes, cells become so insulin resistant that the extra insulin isn’t enough to lower blood sugar levels back to normal. In some cases, beta cell dysfunction may also be present. During this stage, blood glucose levels remain higher than normal, but not high enough to be classified as diabetes.

Stage 3

In this stage, blood sugar levels remain abnormally high, leading to a diagnosis of type 2 diabetes. Both insulin resistance and beta cell dysfunction can lead to high blood sugar levels in type 2 diabetes. Without treatment, these elevated levels can cause long-term damage to the body.

Stage 4

In this stage, vascular complications can occur as a result of high blood sugar. As blood sugar levels remain high, damage can occur within the vascular system, leading to potential complications like:

• albuminuria
• chronic kidney disease
• coronary artery disease
• heart failure
• peripheral neuropathy
• stroke

While “end-stage diabetes” isn’t a commonly used term, diabetes can lead to what’s known as end-stage diabetic complications, or advanced complications. In people with diabetes, advanced complications, like end-stage renal disease, occur after many years of living with diabetes.

A study from 2019 found that microvascular complications from diabetes, like nephropathy, increase risk for cardiovascular events and death in people with type 1.

While there’s no cure for diabetes, it can be managed through the appropriate treatment, which may include medications, dietary changes, and lifestyle interventions.

• Medications. Medications for diabetes can include insulin injections, amylinomimetic drugs, alpha-glucosidase inhibitors, and other drugs that help keep blood sugar levels 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 levels balanced. When you have diabetes, it’s important to focus on eating a diet high in whole foods, like fruits, vegetables, whole grains, and lean protein. It’s also important to limit your intake of foods that are high in:
  • sugar
  • salt
  • saturated fat
  • trans fat
• Lifestyle interventions. Lifestyle interventions for diabetes begin with proper management of the condition. This includes regularly checking your blood glucose, blood pressure, and cholesterol levels. When possible, you should try to get at least 30 minutes or more per day of physical activity. If you smoke or drink alcohol regularly, consider cutting back.

Although it can feel overwhelming to manage a chronic health condition like diabetes, your healthcare team is there to help you create a diabetes treatment plan that works best for you.

If you’re concerned about managing your diabetes, the first step is to reach out to your doctor or care team to create a diabetes treatment plan. Depending on your diagnosis and personal needs, your treatment plan may include reaching out to:

• an endocrinologist, who can help you manage your blood sugar levels
• a dietitian, who can suggest dietary changes to help manage your blood sugar, blood pressure, and cholesterol levels
• a specialist doctor, like a dentist or ophthalmologist, who can help you manage potential diabetes complications
• 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 various stages of both type 1 and type 2 diabetes allows physicians and patients to see the progression of the disease so that treatment and long-term management can be improved.

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