OBJECTIVE: To determine the prevalence rate and associated risk factors for each stage of the Dysglycemia-Based Chronic Disease (DBCD) model, which 4 distinct stages and prompts early prevention to avert Diabetes and cardiometabolic complications. METHODS: Subjects between 25 and 64 years old from a random population-based sample were evaluated in Czechia from 2013 to 2014 using a cross-sectional design. DBCD stages were: stage 1 "insulin resistance" (inferred risk from abdominal obesity or a family history of diabetes); stage 2 "prediabetes"(fasting glucose between 5.6 and 6.9 mmol/L); stage 3 "type 2 diabetes (T2D)" (self-report of T2D or fasting glucose ≥7 mmol/L); and stage 4 "vascular complications" (T2D with cardiovascular disease). RESULTS: A total of 2147 subjects were included (57.8% women) with a median age of 48 years. The prevalence of each DBCD stage were as follows: 54.2% (stage 1); 10.3% (stage 2), 3.7% (stage 3); and 1.2% (stage 4). Stages 2 to 4 were more frequent in men and stage 1 in women (P < .001). Using binary logistic regression analysis adjusting by age/sex, all DBCD stages were strongly associated with abnormal adiposity, hypertension, dyslipidemia, and smoking status. Subjects with lower educational levels and lower income were more likely to present DBCD. CONCLUSION: Using the new DBCD framework and available metrics, 69.4% of the population had DBCD, identifying far more people at risk than a simple prevalence rate for T2D (9.2% in Czechia, 2013-2014). All stages were associated with traditional cardiometabolic risk factors, implicating common pathophysiologic mechanisms and a potential for early preventive care. The social determinants of health were related with all DBCD stages in alarming proportions and will need to be further studied.

Charles University 2nd Faculty of Medicine Department of Internal Medicine Praha Czech Republic

Department of International Clinical Research Center Brno Czech Republic

Department of International Clinical Research Center Brno Czech Republic; Department of Public Health Faculty of Medicine Masaryk University Brno Czech Republic

Department of International Clinical Research Center Brno Czech Republic; Harvard University T H Chan School of Public Health Department of Global Health and Population Boston Massachusetts

Diabetology Department St Anne's University Hospital Brno Czech Republic

Foundation for Clinic Public Health and Epidemiological Research of Venezuela Caracas Venezuela

Harvard University T H Chan School of Public Health Department of Global Health and Population Boston Massachusetts; LifeDoc Diabetes and Obesity Clinic Memphis Tennessee

Icahn School of Medicine at Mount Sinai The Marie Josée and Henry R Kravis Center for Cardiovascular Health at Mount Sinai Heart and Division of Endocrinology Diabetes and Bone New York New York

Mayo Clinic Preventive Cardiology Rochester Minnesota

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Dysglycemia and Abnormal Adiposity Drivers of Cardiometabolic-Based Chronic Disease in the Czech Population: Biological, Behavioral, and Cultural/Social Determinants of Health