Take Charge Early: Stay One Step Ahead of Diabetes, Obesity & Dementia

Introduction

The early stages of metabolic and neurodegenerative disease—prediabetes, pre-obesity, and mild cognitive impairment —are indicators for increased risk of morbidity and mortality. While they may appear subclinical or asymptomatic, these conditions forecast progression to type 2 diabetes, obesity, and dementia, respectively, all of which are leading contributors to disability and death in the United States and globally.

A delay in appropriate treatment to prevent disease progression exists.  Overcoming these barriers is crucial to reducing the escalating burden of lifestyle-related chronic disease.  To reduce the potential risks for advanced disease, there is an opportunity for patients to be proactive regarding their therapy.

Rethinking Disease Thresholds: Subclinical Risk Matters

Traditional diagnostic thresholds for conditions like diabetes and obesity may underestimate true risk.

  • Prediabetes, classically defined as fasting glucose between 100–125 mg/dL, is associated with elevated cardiovascular and all-cause mortality. However, evidence now shows that glucose levels between 85–100 mg/dL—currently considered “normal”—are linked to increased risk, suggesting a subclinical identification of dysglycemia merits early attention.

  • Pre-obesity, recently coined by The Lancet Obesity Commission (2025), describes individuals with a body mass index just below the obesity threshold (Body Mass Index (BMI) is a numerical value calculated using a person’s weight and height to estimate whether they are underweight, at a healthy weight, overweight, or obese). While often dismissed as benign, pre-obesity confers elevated cardiometabolic risk—especially when accompanied by other metabolic abnormalities.

  • Mild Cognitive Impairment, akin to “pre-dementia”, precedes Alzheimer’s disease and vascular dementia. Lifestyle interventions such as diet, physical activity, cognitive engagement, and vascular risk management have shown promise in delaying or preventing cognitive decline.  Subsequently, identification and proactive intervention are necessary to lower the risk of progression toward advanced disease.

  • Mortality from lifestyle-related diseases arises from a network of risk factors, each of which contributes to disease progression and death, both in isolation and synergistically.  For example, a person with obesity and concurrent dysglycemia has a dramatically higher risk of death than someone with elevated BMI alone. Thus, body weight must be evaluated within the broader metabolic context—recognizing that the presence of multiple risk factors, not BMI alone, drives clinical outcomes.

Prediabetes, Early Detection and Treatment

Early detection of prediabetes is crucial, as clinical trials have shown that interventions like lifestyle changes and the drug metformin can significantly reduce the risk of progression to diabetes and its serious complications. A landmark study found that while 11% of untreated prediabetics developed diabetes, this rate dropped to 8% with metformin and just 5% with lifestyle improvements. Despite these proven therapies, awareness and treatment rates remain alarmingly low in the United States: over 80% of the 100 million adults with prediabetes are unaware of their condition, and very few participate in prevention programs or receive metformin. Increasing public awareness, improving provider education, and expanding access to prevention programs are essential steps to curb the diabetes epidemic and reduce its public health impact.

Why Do We Continue to Fail at Prevention?

Despite evidence that delaying therapy for early stages of disease can have a significantly unfavorable clinical outcome, there is a failure to act on early warning signs. This paradox is largely explained by two entrenched phenomena:

  1. Patients and clinicians must recognize the importance of early intervention but often actions are delayed due to time constraints, skepticism toward the effectiveness of medical interventions, or perceived patience resistance.
  2. Even when treatment intensification is clearly warranted, action is postponed—sometimes for years.

These barriers were noted in studies as early as the 1980s and reaffirmed by the Lancet Diabetes Commission in 2021.

Solutions: From Knowledge to Action

While caregiver education about the benefits of treating diseases at early stages is important, knowledge is not enough.  Additional steps must be taken such as engineering systems and culture to support timely, prevention-focused care. Recommended approaches include:

  • Nursing-led risk management programs, which improve screening, counseling, and adherence.
  • Early metabolic surveillance at the subclinical stage.
  • Public health campaigns to destigmatize early intervention and promote patient engagement.

In addition to these approaches, patients can be proactive about their therapy.  Here are four ways patients can be proactive with their doctor regarding early stages of disease and treatment.

Learn About Early Disease and Treatment Options

Be informed about the early stages and detection of metabolic and neurodegenerative disease—prediabetes, pre-obesity, and mild cognitive impairment.  Knowledge regarding available treatments empowers patients to have meaningful conversations with a doctor. Use credible sources to research a disease so you can ask relevant questions and participate in shared decision-making.

Build a Collaborative Relationship with Your Doctor

Establishing a rapport and open communication with your doctor is essential. Patients should feel comfortable expressing concerns, discussing goals of care, and making decisions together with their provider. This partnership approach leads to better health outcomes and greater satisfaction.

Track and Communicate Symptoms and Health Changes

Patients should regularly monitor their health, take note of any symptoms or changes (even minor ones), and bring this information to medical appointments. Detailed tracking helps the doctor understand the progression of the disease and make informed treatment decisions.

Follow the Agreed-Upon Care Plan and Be Honest

Adhering to the treatment plan, including taking medications as prescribed and following lifestyle recommendations, is crucial. Patients should also be honest with their care team about what they are doing or not doing, as this transparency allows for timely adjustments to the treatment plan.

These proactive steps help ensure that treatment is tailored to the patient’s needs and values and can lead to improved outcomes and a more positive healthcare experience.

Conclusion

Prediabetes, pre-obesity, and mild cognitive impairment represent early but actionable stages of chronic disease. Early detection is critical, and can lead to treatments that prevent progression to full blown disease and other major health risks.

A reimagined model of care—focused on early detection, lifestyle-based intervention, and coordinated risk management—offers a scalable, effective pathway to halt progression and improve outcomes in millions of at-risk individuals.

Active patient involvement with doctors in diagnosis and treatment of subclinical disease is crucial because it ensures therapeutic plans are tailored to individual needs.  Additionally, active participation empowers patients, increases their satisfaction, and fosters a sense of ownership over their health, making therapy more effective and sustainable in the long term.

References

  1. Charles, M.A. (2000). Diabetes Management; Complication Risk Assessment, Diagnosis, and Therapeutic Options. Mary Ann Liebert, Inc.
  2.  Charles, M.A., Leslie, R.D. (2021). Diabetes: Concepts of β-Cell Organ Dysfunction and Failure. Diabetes, 70, 2444–2456.
  3. Charles, M.A. (2023). The Origins of Diabetes. Index of Sciences Ltd, London.
  4. Ngandu, T. et al. (2015). A multidomain intervention to prevent cognitive decline in elderly at risk. The Lancet, 385, 2255–2263.
  5. Rubino, F. et al. (2025). Definition and diagnostic criteria of clinical obesity. The Lancet Diabetes & Endocrinology.
  6. Stokes, A., Preston, S.H. (2017). Deaths Attributable to Diabetes in the U.S. PLOS ONE, 12, e0170219.

Disclaimer: This blog post is intended solely for educational and scientific informational purposes. Any mention of therapeutic drug names, including FDA-approved medications, is for the purpose of accurate reporting and discussion of biomedical research and does not constitute medical advice, endorsement, or promotion. Readers should not interpret the content as a recommendation for any specific treatment. Always consult a qualified healthcare professional for medical advice or treatment decisions.

 

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