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diagnosed adults, based on data from White European populations\nFigure 2.1 —Flowchart for investigation of suspected type 1 diabetes in newly diagnosed adults, based on data from White European populations.1No sin- | [
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gle clinical feature con firms type 1 diabetes in isolation.2Glutamic acid decarboxylase (GAD) should be the primary antibody measured and, if negative,\nshould be followed by islet tyrosine phosphatase 2 (IA-2) and/or zinc transporter 8 (ZnT8) where these tests are available. In individuals who have no t | [
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been treated with insulin, antibodies against insulin may also be useful. In those diagnosed at <3 5y e a r so fa g ew h oh a v en oc l i n i c a lf e a t u r e so ft y p e2d i a -\nbetes or monogenic diabetes, a negative result does not change the diagnosis of type 1 diabetes, since 5 –10% of people with type 1 diabet... | [
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antibodies.3Monogenic diabetes is suggested by the presence of one or more of the following features: A1C <58 mmol/mol ( <7.5%) at diagnosis, one\nparent with diabetes, features of a speci fic monogenic cause (e.g., renal cysts, partial lipodystrophy, maternally inherited deafness, and severe insulin resis- | [
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tance in the absence of obesity), and monogenic diabetes prediction model probability >5% (diabetesgenes.org/exeter-diabetes-app/ModyCalculator).\n4A C-peptide test is only indicated in people receiving insulin treatment. A random sample (with concurrent glucose) within 5 h of eating can replace a f or- | [
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mal C-peptide stimulation test in the context of classi fication. If the result is $600 pmol/L ( $1.8 ng/mL), the circumstances of testing do not matter. If\nthe result is <600 pmol/L ( <1.8 ng/mL) and the concurrent glucose is <4m m o l / L( <70 mg/dL) or the person may have been fasting, consider repeating | [
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the test. Results showing very low levels (e.g., <80 pmol/L [ <0.24 ng/mL]) do not need to be repeated. Where a person is insulin treated, C-peptide\nmust be measured prior to insulin discontinuation to exclude severe insulin defi ciency. Do not test C-peptide within 2 weeks of a hyperglycemic emer- | [
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gency.5Features of type 2 diabetes include increased BMI ( $25 kg/m2), absence of weight loss, absence of ketoacidosis, and less marked hyperglycemia.\nLess discriminatory features include non-White ethnicity, family history, longer duration and milder severity of symptoms prior to presentation, features | [
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of the metabolic syndrome, and absence of a family history of autoimmunity.6If genetic testing does not confi rm monogenic diabetes, the classi fication\nis unclear and a clinical decision should be made about treatment.7Type 2 diabetes should be strongly considered in older individuals. In some cases, in- | [
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vestigation for pancreatic or other types of diabetes may be appropriate.8A person with possible type 1 diabetes who is not treated with insulin will re-\nquire careful monitoring and education so that insulin can be rapidly initiated in the event of glycemic deterioration.9C-peptide values 200 –600 pmol/L | [
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(0.6–1.8 ng/mL) are usually consistent with type 1 diabetes or maturity-onset diabetes of the young but may occur in insulin-treated type 2 diabetes, par-\nticularly in people with normal or low BMI or after long duration. Reprinted and adapted from Holt et al. (36).diabetesjournals.org/care Diagnosis and Classificatio... | [
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©AmericanDiabetesAssociation | [
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half of these individuals have autoanti-\nbodies that are seen in type 1 diabetes,\nsupporting alternate pathobiology. Thisimmune-related adverse event occurs injust under 1% of checkpoint inhibitor – | [
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treated individuals but most commonlyoccurs with agents that block the pro-grammed cell death protein 1/programmedcell death ligand 1 pathway alone or in com-bination with other checkpoint inhibitors\n(67). To date, the majority of immune\ncheckpoint inhibitor –related cases of type 1 | [
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checkpoint inhibitor –related cases of type 1\ndiabetes occur in people with high-riskHLA-DR4 (present in 76% of individuals),whereas other high-risk HLA alleles are notmore common than those in the generalpopulation (67). To date, risk cannot be pre-dicted by family history or autoantibodies,so all health care profess... | [
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these medications or caring for people who\nhave a history of current or past exposure tothese agents should be mindful of this ad-verse effect and educate and monitor indi-viduals appropriately.\nA number of viruses have been associated | [
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A number of viruses have been associated\nwith type 1 diabetes, including enterovirusessuch as Coxsackievirus B. During the corona-virus disease 2019 (COVID-19) pandemic,c a s e so fh y p e r g l y c e m i a ,D K A ,a n dn e wdiabetes increased, suggesting that severe\nacute respiratory syndrome coronavirus 2 | [
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acute respiratory syndrome coronavirus 2\n(SARS-CoV-2) is a trigger for or can unmasktype 1 diabetes (68). Possible mechanismsofb-cell damage include virus-triggered\nb-cell death, immune-mediated loss of\npancreatic b-cells, and damage to b-cells | [
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pancreatic b-cells, and damage to b-cells\nbecause of infection of surrounding exo-crine cells. The cytokine storm associatedwith COVID-19 infection is a highly in flam-\nmatory state that could also contribute. Tobetter characterize and understand thepathogenesis of new-onset COVID-19 –re- | [
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lated diabetes, a global registry, CoviDIAB,has been established (69).\nIdiopathic Type 1 Diabetes\nSome forms of type 1 diabetes have noknown etiologies. Individuals have per-manent insulinopenia and are prone toDKA but have no evidence of b-cell auto-\nimmunity. However, only a minority ofpeople with type 1 diabetes ... | [
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category.\nIndividuals with autoantibody-negative\ndiabetes of African or Asian ancestry may\nsuffer from episodic DKA and exhibit vary-ing degrees of insulin de ficiency between\nepisodes (70). This form of diabetes isusually considered a form of type 2diabetes (ketosis-prone type 2 diabetes),\nis strongly inherited, a... | [
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is strongly inherited, and is not HLA asso-\nciated. An absolute requirement for insu-lin replacement therapy in affectedindividuals may be intermittent. Futureresearch is needed to determine thecause of b-cell dysfunction/destruction in\nthis rare clinical scenario.\nScreening for Type 1 Diabetes Risk | [
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this rare clinical scenario.\nScreening for Type 1 Diabetes Risk\nT h ei n c i d e n c ea n dp r e v a l e n c eo ft y p e1d i -abetes are increasing (71). People withtype 1 diabetes often present with acute\nsymptoms of diabetes and markedly ele-\nvated blood glucose levels, and 25 –50%\nare diagnosed with life-threat... | [
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are diagnosed with life-threatening DKA\n(30–32). Multiple studies indicate that\nmeasuring islet autoantibodies in relativesof those with type 1 diabetes (47) or in\nchildren from the general population\n(72,73) can effectively identify those who\nwill develop type 1 diabetes. A study re-ported the risk of progression... | [
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abetes from the time of seroconversion to\nautoantibody positivity in three pediatric\ncohorts from Finland, Germany, and the\nU.S. Of the 585 children who developed\nmore than two autoantibodies, nearly\n70% developed type 1 diabetes within\n10 years and 84% within 15 years (42).\nThese findings are highly signifi cant,... | [
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These findings are highly signifi cant, be-\ncause while the German group was re-cruited from offspring of parents withtype 1 diabetes, the Finnish and American\ngroups were recruited from the general\npopulation. Remarkably, the findings in all\nthree groups were the same, suggestingthat the same sequence of events led t... | [
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clinical disease in both “sporadic ”and fa-\nmilial cases of type 1 diabetes. Indeed,the risk of type 1 diabetes increases as\nthe number of relevant autoantibodies\ndetected increases (55,74,75). In The\nEnvironmental Determinants of Diabetes\nin the Young (TEDDY) study, type 1 diabe- | [
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in the Young (TEDDY) study, type 1 diabe-\ntes developed in 21% of 363 subjectswith at least one autoantibody at 3 years\nof age (76). Such testing, coupled with\neducation about diabetes symptoms and\nclose follow-up, has been shown to en-\nable earlier diagnosis and to prevent\nDKA (77,78).\nSeveral screening program... | [
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DKA (77,78).\nSeveral screening programs are available\nin Europe (e.g., Fr1da and gppad.org) and\nthe U.S. (e.g., trialnet.org, askhealth.org,and cascadekids.org). Family history ofautoimmune diabetes and personal or\nfamily history of allergic diseases or otherautoimmune diseases increases the risk of\nautoimmune dia... | [
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autoimmune diabetes compared with the\ngeneral population (78,79). Individualswho test autoantibody positive should be\nprovided with or referred for counseling\nabout the risk of developing diabetes, dia-\nbetes symptoms, and DKA prevention and\nshould be given consideration for addi-tional testing as applicable to he... | [
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mine if they meet criteria for intervention\naimed at delaying progression.\nPREDIABETES AND TYPE 2\nDIABETES\nRecommendations\n2.9 Screening for prediabetes and\ntype 2 diabetes with an assessment\nof risk factors or validated risk calcula-tor should be done in asymptomatic\nadults. B\n2.10a Testing for prediabetes or... | [
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adults. B\n2.10a Testing for prediabetes or type 2\ndiabetes in asymptomatic people should\nbe considered in adults of any age with\noverweight or obesity who have one\nor more risk factors ( Table 2.4 ).B\n2.10b For all other people, screening\nshould begin at age 35 years. B\n2.11 If tests are normal, repeat screen- | [
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2.11 If tests are normal, repeat screen-\ning recommended at a minimum of3-year intervals is reasonable, sooner\nwith symptoms or change in risk (e.g.,\nweight gain). C\n2.12 To screen for prediabetes and\ntype 2 diabetes, FPG, 2-h PG during\n75-g OGTT, and A1C are each appro-\npriate ( Table 2.1 andTable 2.2 ).B\n2.13... | [
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-0.020206144079566002,
-0.06538543105125427,
-0.008329016156494617,
-0.008288225159049034,
0.007080267183482647,
0.13415473699569702,
-0.07010580599308014,
-0.0070375194773077965,
0.018612762913107872,
-0.004225744865834713,
-0.08123383671045303,
-... |
2.13 When using OGTT as a screen for\nprediabetes or diabetes, adequate car-bohydrate intake (at least 150 g/day)should be assured for 3 days prior to\ntesting. A\n2.14 Risk-based screening for predia-\nbetes or type 2 diabetes should be con-\nsidered after the onset of puberty or\nafter 10 years of age, whichever occu... | [
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0.015439427457749844,
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0.06101001799106598,
0.12327737361192703,
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0.023609234020113945,
0.005025287624448538,
-0.11580581218004227,
0.01... |
after 10 years of age, whichever occurs\nearlier, in children and adolescents\nwith overweight (BMI $85th percen-\ntile) or obesity (BMI $95th percentile)\nand who have one or more risk factors\nfor diabetes. (See Table 2.5 for evi-\ndence grading of risk factors.) B\n2.15a Consider screening people for | [
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0.05553928017616272,
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0.09892595559358597,
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-0.062331121414899826,
0.0490... |
dence grading of risk factors.) B\n2.15a Consider screening people for\nprediabetes or diabetes if on certainmedications, such as glucocorticoids,statins, thiazide diuretics, some HIVS26 Diagnosis and Classification of Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.06819450855255127,
0.09321385622024536,
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0.019377030432224274,
0.001925306161865592,
-0.05890005826950073,
-0.07750694453716278,
0.022... |
medications, and second-generation\nantipsychotic medications, as theseagents are known to increase the riskof these conditions. E\n2.15b In people who are prescribed\nsecond-generation antipsychotic medi-cations, screen for prediabetes anddiabetes at baseline and repeat 12 –16 | [
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-0.01343146339058876,
0.03460529446601868,
-0.04824550822377205,
-0.004... |
weeks after medication initiation or soon-er, if clinically indicated, and annually. B\n2.16 People with HIV should be\nscreened for diabetes and prediabeteswith an FPG test before starting antire-troviral therapy, at the time of switchingantiretroviral therapy, and 3 –6m o n t h s\nafter starting or switching antiretr... | [
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0.032699331641197205,
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0.018204515799880028,
0.012484541162848473,
0.06396143138408661,
-0.05327177420258522,
0.0371750... |
after starting or switching antiretroviral\ntherapy. If initial screening results are\nnormal, FPG should be checked annu-ally.E\nPrediabetes\nPrediabetes is the term used for individ-\nuals whose glucose or A1C levels do not | [
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0.0219... |
uals whose glucose or A1C levels do not\nmeet the criteria for diabetes yet haveabnormal carbohydrate metabolism thatresults in elevated glucose levels (dysgly-cemia) intermediate between normogly-cemia and diabetes (28,80). People withprediabetes are defi ned by the presence\nof IFG and/or IGT and/or A1C 5.7 –6.4% | [
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of IFG and/or IGT and/or A1C 5.7 –6.4%\n(39–47 mmol/mol) ( Table 2.2 ). As predi-\nabetes is an intermediate state betweennormoglycemia and diabetes, it is clearlyas i g n i ficant risk factor for progression todiabetes as well as cardiovascular disease | [
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0.08764050900936127,
0.08555228263139725,
0.0006008166819810867,
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-0.... |
and several other cardiometabolic out-comes. Criteria for screening for diabetesor prediabetes in asymptomatic adults areoutlined in Table 2.4 . Prediabetes is asso- | [
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-0.025286... |
ciated with obesity (especially abdominalor visceral obesity), dyslipidemia with hightriglycerides and/or low HDL cholesterol,and hypertension. The presence of predi-abetes should prompt comprehensivescreening for cardiovascular risk factors.\nDiagnosis of Prediabetes\nIFG is de fined as FPG levels from 100 to | [
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0.03348234295845032,
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-0.0945739671587944,
-0.... |
Diagnosis of Prediabetes\nIFG is de fined as FPG levels from 100 to\n125 mg/dL (from 5.6 to 6.9 mmol/L)(78,79) and IGT as 2-h PG levels during75-g OGTT from 140 to 199 mg/dL (from7.8 to 11.0 mmol/L) (10). It should benoted that the World Health Organization\nand a number of diabetes organizationsdefine the IFG lower limi... | [
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0.010514508932828903,
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0.06579221785068512,
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0.021175608038902283,
-0.12141519784927368,
0.0... |
(6.1 mmol/L). The ADA also initially endorsedthis IFG lower limit in 1997 (10). However, in\n2003 the ADA adopted the new range of\n100– 125 mg/dL (5.6– 6.9 mmol/L) to better\ndefine IFG so that the population risk of de-\nveloping diabetes with IFG would be similar\nto that with IGT (11).\nAs with the glucose measures,... | [
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0.021747220307588577,
-0.025045353919267654,
0.039547886699438095,
-0.14148899912834167,
0.027... |
to that with IGT (11).\nAs with the glucose measures, several\nprospective studies that used A1C to pre-\ndict the progression to diabetes as de fined\nby A1C criteria demonstrated a strong,\ncontinuous association between A1C and\nsubsequent diabetes. In a systematic re-view of 44,203 individuals from 16 cohortstudies ... | [
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0.03770113363862038,
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0.049519751220941544,
0.04946999251842499,
0.08159517496824265,
0.0028822962194681168,
0.0006244084215722978,
-0.0763477236032486,
0.07545237988233566,
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5.6 years (range 2.8 –12 years), those with\nA1C between 5.5% and 6.0% (between 37\nand 42 mmol/mol) had a substantially in-creased risk of diabetes (5-year incidence\nfrom 9% to 25%). Those with an A1C range\nof 6.0 –6.5% (42– 48 mmol/mol) had a\n5-year risk of developing diabetes be-t w e e n2 5 %a n d5 0 %a n dar e ... | [
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0.06698838621377945,
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0.14264188706874847,
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0.002400824800133705,
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0.030183421447873116,
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-0.... |
20 times higher than that with A1C of\n5.0% (31 mmol/mol) (81). In a commu-nity-based study of African Americanand non-Hispanic White adults withoutdiabetes, baseline A1C was a stronger\npredictor of subsequent diabetes and\ncardiovascular events than fasting glu-cose (82). Other analyses suggest thatA1C of 5.7% (39 mm... | [
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-0.03284735232591629,
-0.05544034019112587,
0.07584044337272644,
-0.057698655873537064,
-0.02857299894094467,
0.020321860909461975,
0.08343392610549927,
0.038770392537117004,
-0.0604766383767128,
-0.010223370045423508,
0.02918272279202938,
-0.07509131729602814,
-0.0... |
associated with a diabetes risk similar\nto that of the high-risk participants in theDiabetes Prevention Program (DPP) (83),and A1C at baseline was a strong pre-\ndictor of the development of glucose-\ndefined diabetes during the DPP and\nits follow-up (7).Table 2.4 —Criteria for screening for diabetes or prediabetes in... | [
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0.011325761675834656,
-0.03674780949950218,
0.0367424339056015,
0.01943066157400608,
0.06403089314699173,
0.040129102766513824,
0.11306639760732651,
-0.048894383013248444,
0.050552837550640106,
-0.044759493321180344,
0.036970093846321106,
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-0.044... |
adults\n1. Testing should be considered in adults with overweight or obesity (BMI $25 kg/m2or$23 kg/m2\nin Asian American individuals) who have one or more of the following risk factors:\n/C15First-degree relative with diabetes\n/C15High-risk race and ethnicity (e.g., African American, Latino, Native American, Asian\nA... | [
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0.09904100000858307,
-0.04350903630256653,
0.034482356160879135,
-0.014255539514124393,
-0.022953609004616737,
0.0322284996509552,
0.00448269909247756,
-0.03960752859711647,
-0.004829382058233023,
0.011455281637609005,
-0.08218532055616379,
-0.08554918318986893,
-0.00... |
American, Paci fic Islander)\n/C15History of cardiovascular disease\n/C15Hypertension ( $130/80 mmHg or on therapy for hypertension)\n/C15HDL cholesterol level <35 mg/dL ( <0.9 mmol/L) and/or a triglyceride level >250 mg/dL\n(>2.8 mmol/L)\n/C15Individuals with polycystic ovary syndrome\n/C15Physical inactivity | [
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0.0796385332942009,
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-0.06443610787391663,
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0.06695589423179626,
-0.010418446734547615,
-0.09734150767326355,
0.001941968104802072,
-0.08282382041215897,
-0.09078904986381531,
-0.0... |
/C15Physical inactivity\n/C15Other clinical conditions associated with insulin resistance (e.g., severe obesity,acanthosis nigricans)\n2. People with prediabetes (A1C $5.7% [$39 mmol/mol], IGT, or IFG) should be tested yearly.\n3. People who were diagnosed with GDM should have lifelong testing at least every 3 years. | [
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0.008195356465876102,
0.034649092704057693,
0.016783885657787323,
-0.021067719906568527,
0.031190011650323868,
0.10174145549535751,
-0.048020195215940475,
-0.0034146371763199568,
0.033077433705329895,
-0.006313483230769634,
-0.08280566334724426,
... |
4. For all other people, testing should begin at age 35 years.\n5. If results are normal, testing should be repeated at a minimum of 3-year intervals, with\nconsideration of more frequent testing depending on initial results and risk status.\n6. People with HIV, exposure to high-risk medicines, history of pancreatitis | [
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0.03297053650021553,
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-0.03322887793183327,
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0.045234695076942444,
-0.0009183171787299216,
0.06117180362343788,
-0.07607457041740417,
0.03603873774409294,
0.05956881865859032,
0.016208196058869362,
-0.046466995030641556,
0... |
GDM, gestational diabetes mellitus; IFG, impaired fasting glucose; IGT, impaired glucose tolerance.\nTable 2.5 —Risk-based screening for type 2 diabetes or prediabetes in\nasymptomatic children and adolescents in a clinical setting\nScreening should be considered in youth* who have overweight ( $85th percentile) or | [
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0.06471788883209229,
0.011758660897612572,
-0.04056573286652565,
0.051479801535606384,
0.006000159308314323,
0.08585013449192047,
0.10763590037822723,
-0.09910412132740021,
0.028316225856542587,
0.018023187294602394,
0.01713332161307335,
-0.11983316391706467,
0.01121... |
obesity ( $95th percentile) Aand who have one or more additional risk factors based\non the strength of their association with diabetes:\n/C15Maternal history of diabetes or GDM during the child ’s gestation A\n/C15Family history of type 2 diabetes in first- or second-degree relative A | [
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0.05252862721681595,
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0.06597089767456055,
0.03410540893673897,
0.03721332922577858,
0.052262190729379654,
0.058271437883377075,
-0.07495798915624619,
0.027120929211378098,
0.02510063908994198,
-0.036675531417131424,
-0.08288563787937164,
-0.04269... |
/C15Race and ethnicity (e.g., Native American, African American, Latino, Asian American,\nPacific Islander) A\n/C15Signs of insulin resistance or conditions associated with insulin resistance (acanthosis\nnigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-\nage birth weight) B | [
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0.03997368738055229,
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0.0010947369737550616,
0.05212550237774849,
0.024986278265714645,
-0.04767357558012009,
-0.033758506178855896,
0.034044552594423294,
-0.1248670369386673,
-0.08380035310983658,
-0.0... |
age birth weight) B\nGDM, gestational diabetes mellitus. *After the onset of puberty or after 10 years of age, which-ever occurs earlier. If tests are normal, repeat testing at a minimum of 3-year intervals (or more\nfrequently if BMI is increasing or risk factor pro file is deteriorating) is recommended. Reports of | [
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0.03570860996842384,
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0.03049393743276596,
0.027049250900745392,
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0.032036688178777695,
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-0.06576977670192719,
0.05... |
type 2 diabetes before age 10 years exist, and this can be considered with numerous risk factors.diabetesjournals.org/care Diagnosis and Classification of Diabetes S27\n©AmericanDiabetesAssociation | [
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0.05364685878157616,
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-0.0036114396061748266,
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0.05809658393263817,
-0.06889079511165619,
0.03... |
An A1C range of 5.7– 6.4% (39–\n47 mmol/mol) identi fies a group of indi-\nviduals at high risk for diabetes and car-\ndiovascular outcomes. Similar to thosewith IFG and/or IGT, individuals with A1Cof 5.7 –6.4% (39– 47 mmol/mol) should be | [
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0.031092284247279167,
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0.045541971921920776,
0.12937134504318237,
0.012254416942596436,
-0.00522556621581316,
-0.0010636146180331707,
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0... |
informed of their increased risk for diabe-tes and cardiovascular disease and coun-seled about effective strategies to lowertheir risks (see Section 3, “Prevention\nor Delay of Diabetes and AssociatedComorbidities ”). Similar to glucose meas- | [
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0.10873599350452423,
-0.04469643160700798,
0.04853126406669617,
-0.01378671731799841,
-0.0007660208502784371,
0.0576898455619812,
0.10602523386478424,
0.0047540972009301186,
0.01762612722814083,
-0.029257820919156075,
0.02146686241030693,
-0.021977998316287994,
-0.00... |
urements, the continuum of risk is contin-uous: as A1C rises, the diabetes risk risesdisproportionately (81). Aggressive inter-ventions and vigilant follow-up shouldbe pursued for those considered at veryhigh risk (e.g., those with A1C >6.0%\n[>42 mmol/mol] and individuals with\nboth IFG and IGT).\nTable 2.4 outlines t... | [
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-0.024839084595441818,
-0.035190824419260025,
0.05492110550403595,
-0.008931935764849186,
0.06894979625940323,
0.04896649345755577,
0.12735386192798615,
-0.005873914808034897,
0.02219030074775219,
-0.014685271307826042,
-0.0003071215469390154,
-0.06378220021724701,
-... |
both IFG and IGT).\nTable 2.4 outlines the criteria for\nscreening for prediabetes. The ADA risktest is an additional option for assess-ment to determine the appropriatenessof screening for diabetes or prediabetesin asymptomatic adults ( Fig. 2.2)( o n l i n e | [
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0.05003888159990311,
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0.021435387432575226,
0.08534181118011475,
0.04908859357237816,
0.10988274216651917,
0.11004289239645004,
-0.05567995086312294,
0.013018126599490643,
-0.01814623922109604,
-0.01082422025501728,
-0.10980857163667679,
0.02329... |
at diabetes.org/socrisktest). For additionalbackground regarding risk factors andscreening for prediabetes, see\nSCREENING\nAND TESTING FOR PREDIABETES AND TYPE 2DIABETES IN\nASYMPTOMATIC ADULTS and SCREENING AND TESTING\nFOR PREDIABETES AND TYPE 2DIABETES IN CHILDREN\nAND ADOLESCENTS , below. For details regard- | [
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0.031432803720235825,
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-0.0120621332898736,
0.012645463459193707,
0.02218872867524624,
0.041452351957559586,
0.08459644764661789,
-0.03579717501997948,
0.03527156263589859,
-0.0003692144528031349,
0.05665447935461998,
-0.12626726925373077,
0.041837... |
AND ADOLESCENTS , below. For details regard-\ning individuals with prediabetes mostlikely to bene fit from a formal behavioral\nor lifestyle intervention, see Section 3,“Prevention or Delay of Diabetes and\nAssociated Comorbidities. ”\nType 2 Diabetes\nType 2 diabetes accounts for 90 –95% of | [
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0.04413224756717682,
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0.09546458721160889,
0.014076313935220242,
-0.02407362312078476,
-0.017939021810889244,
0.045439667999744415,
0.02443697862327099,
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Type 2 Diabetes\nType 2 diabetes accounts for 90 –95% of\nall diabetes. This form encompasses indi-viduals who generally have relative (rather\nthan absolute) insulin de ficiency and have\nperipheral insulin resistance (i.e., decreased\nbiological response to insulin).\nThere are various causes of type 2 dia-\nbetes. Al... | [
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betes. Although the speci fic etiologies\nare not known, autoimmune destructionofb-cells does not occur, and individuals\ndo not have any of the other knowncauses of diabetes. Most, but not all,people with type 2 diabetes have over-\nweight or obesity. Excess weight itself | [
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weight or obesity. Excess weight itself\ncauses some degree of insulin resistance.Individuals who do not have obesity oroverweight by traditional weight criteriamay have an increased percentage ofbody fat distributed predominantly inthe abdominal region, including sites in- | [
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volved in nonalcoholic fatty liver disease(also known as metabolic dysfunction-associated steatotic liver disease) and/orectopic sites (e.g., skeletal muscle).\nDKA seldom occurs spontaneously in\ntype 2 diabetes; when seen, it usuallyarises in individuals already treated with in-sulin (e.g., missed or inadequate doses... | [
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people with ketosis-prone type 2 diabetes,\nin association with the stress of another ill-ness such as infection (e.g., COVID-19) ormyocardial infarction, or in association withillicit drug use (e.g., cocaine) or with the use\nof certain medications such as glucocorti- | [
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of certain medications such as glucocorti-\ncoids, second-generation antipsychotics, orsodium –glucose cotransporter 2 inhibitors\n(84,85). Type 2 diabetes frequently goes un-\ndiagnosed for many years, because hyper-\nglycemia develops gradually and, at earlierstages, is often not severe enough for theindividual to no... | [
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symptoms caused by hyperglycemia, such\nas dehydration or unintentional weightloss. Nevertheless, even undiagnosed peo-ple with diabetes are at increased risk of\ndeveloping macrovascular and microvascu-\nlar complications.\nPeople with type 2 diabetes early in\nthe disease course may have insulin levelsthat appear nor... | [
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failure to normalize blood glucose re flects\na relative defect in glucose-stimulated\ninsulin secretion that is insuf ficient to\ncompensate for insulin resistance. Insu-lin resistance may improve with weight\nreduction, physical activity, and/or phar- | [
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reduction, physical activity, and/or phar-\nmacologic treatment of hyperglycemiabut is seldom restored to normal. Recentinterventions with intensive diet and exer-\ncise, newer pharmacological agents (e.g.,\nglucagon-like peptide 1 receptor agonists),or surgical weight loss have led to diabe-tes remission (86 –92) (see... | [
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“Obesity and Weight Management for\nthe Prevention and Treatment of Type 2Diabetes ”).\nThe risk of developing type 2 diabetes\nincreases with age, obesity, and lack of\nphysical activity (93,94). It occurs more\nfrequently in individuals with prediabetes,prior gestational diabetes mellitus, or poly-cystic ovary syndro... | [
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mon in people with hypertension or\ndyslipidemia and in certain racial and eth-nic subgroups (e.g., African American, Na-tive American, Hispanic/Latino, and AsianAmerican). It is often associated with a\nstrong genetic predisposition or family his- | [
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strong genetic predisposition or family his-\ntory in first-degree relatives (more so thantype 1 diabetes). However, the genetics oftype 2 diabetes are poorly understood and\nunder intense investigation in this era ofprecision medicine (52). In adults without\ntraditional risk factors for type 2 diabetes | [
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traditional risk factors for type 2 diabetes\nand/or of younger age, consider islet auto-antibody testing (e.g., GAD autoantibod-\nies) to exclude the diagnosis of type 1\ndiabetes (36) ( Fig. 2.1 ).\nScreening and Testing for\nPrediabetes and Type 2 Diabetes inAsymptomatic Adults\nScreening for prediabetes and type 2 ... | [
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Screening for prediabetes and type 2 dia-\nbetes risk through a targeted assessmentof risk factors ( Table 2.4 )o rw i t ha n\nassessment tool, such as the ADA risk\ntest ( Fig. 2.2 ) (online at diabetes.org/\nsocrisktest), is recommended to guide\nhealth care professionals on whether\nperforming a diagnostic test ( Ta... | [
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performing a diagnostic test ( Table 2.1 )\nis appropriate. Prediabetes and type 2\ndiabetes meet criteria for conditions inwhich early detection via screening is ap-\npropriate. Both conditions are common\nand impose signi ficant clinical and public\nhealth burdens. There is often a long pre-\nsymptomatic phase before ... | [
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symptomatic phase before the diagnosis\nof type 2 diabetes. Simple tests to detectpreclinical disease are readily available\n(95). The duration of glycemic burden is\na strong predictor of adverse outcomes.There are effective interventions that pre-vent progression from prediabetes to dia-\nbetes. It is important to in... | [
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betes. It is important to individualize\nrisk-to-bene fit ratio of formal intervention\nfor people with prediabetes and consider\nperson-centered goals. Risk models have\nexplored the bene fit, in general finding\nhigher bene fit of intervention in those at\nhighest risk (96) (see Section 3, “Prevention | [
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highest risk (96) (see Section 3, “Prevention\nor Delay of Diabetes and AssociatedComorbidities ”) and reduce the risk of dia-\nbetes complications (97) (see Section 10,\n“Cardiovascular Disease and Risk Man-\nagement, ”Section 11, “Chronic Kidney\nDisease and Risk Management, ”and Sec-\ntion 12, “Retinopathy, Neuropat... | [
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tion 12, “Retinopathy, Neuropathy, and\nFoot Care ”). In the most recent National In-\nstitutes of Health (NIH) Diabetes Preven-\ntion Program Outcomes Study (DPPOS)\nreport, prevention of progression from pre-\ndiabetes to diabetes (98) resulted in lowerrates of developing retinopathy and ne-\nphropathy (99). Similar ... | [
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phropathy (99). Similar impact on diabe-\ntes complications was reported withscreening, diagnosis, and comprehensiverisk factor management in the U.K. Clini-\ncal Practice Research Datalink database | [
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cal Practice Research Datalink database\n( 9 7 ) .I nt h a tr e p o r t ,p r o g r e s s i o nf r o mS28 Diagnosis and Classification of Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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prediabetes to diabetes augmented risk\nof complications.\nDespite the numerous bene fits of screen-\ning and early diagnosis for prediabetes ordiabetes, unfortunately many people in theU.S. and globally either remain undiagnosedor are diagnosed late, when complicationshave already arisen.Additional considerations regar... | [
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testing for type 2 diabetes and prediabe-tes in asymptomatic individuals are de-scribed below.®American \nDiabetesAssociation\n®\nAre you at risk for type 2 diabetes?Connected for Life\nDiabetes Risk Test:\n1. How old are you? ...................................................\n2. Are you a man or a woman? .............. | [
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2. Are you a man or a woman? .................................\n3. If you are a woman, have you ever been \n diagnosed with gestational diabetes?..................Less than 40 years (0 points)\n40–49 years (1 point)\n50–59 years (2 points)\n60 years or older (3 points) | [
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50–59 years (2 points)\n60 years or older (3 points)\n4. Do you have a mother, father, sister or brother with diabetes? ........................................................\n5. Have you ever been diagnosed with high \n blood pressure? ..................................................... | [
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6. Are you physically active? ....................................\n7. What is your weight category? .............................\nSee chart at right.\nYou are at increased risk for having type 2 diabetes. \nHowever, only your doctor can tell for sure if you do \nhave type 2 diabetes or prediabetes, a condition in | [
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have type 2 diabetes or prediabetes, a condition in \nwhich blood glucose levels are higher than normal \nbut not yet high enough to be diagnosed as diabetes. \nTalk to your doctor to see if additional testing is needed.\nType 2 diabetes is more common in African Americans, \nHispanics/Latinos, Native Americans, Asian ... | [
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Hispanics/Latinos, Native Americans, Asian Americans, \nand Native Hawaiians and Pacific Islanders.\nHigher body weight increases diabetes risk for everyone. \nAsian Americans are at increased diabetes risk at lower body weight than the rest of the general public (about 15 pounds lower).If you scored 5 or higher:\nLowe... | [
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Lower Your Risk\nThe good news is you can manage your risk for type 2 diabetes. Small steps make a big difference in helping you live a longer, \nhealthier life.\nIf you are at high risk, your first step is to \nvisit your doctor to see if additional testing is needed.\nVisit diabetes.org or call 1-800-DIABETES | [
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Visit diabetes.org or call 1-800-DIABETES \n(800-342-2383) for information, tips on getting started, and ideas for simple, small \nsteps you can take to help lower your risk.Adapted from Bang et al., Ann Intern Med151:775–783, 2009 \x81 Original algorithm was validated \nwithout gestational diabetes as part of the m... | [
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Yes(1 point) No(0 points)\nYes(1 point) No(0 points)\nYes(1 point) No(0 points)\nYes(0 points) No(1 point)\nLearn more at diabetes.org/risktest | 1-800-DIABETES (800-342-2383)\nDiabetes Risk Test |American Diabetes Association ®If you weigh less than the amount inthe left column: 0 points4’ 10”\n4’ 11”\n5’ 0”5’ 1”\n5’ ... | [
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4’ 11”\n5’ 0”5’ 1”\n5’ 2”\n5’ 3”\n5’ 4”\n5’ 5”\n5’ 6”\n5’ 7”\n5’ 8”\n5’ 9”\n5’ 10”\n5’ 11”\n6’ 0”\n6’ 1”\n6’ 2”\n6’ 3”6’ 4”119–142 143–190 191+124–147 148–197 198+128–152 153–203 204+\n132–157 158–210 211+136–163 164–217 218+\n141–168 169–224 225+\n145–173 174–231 232+\n150–179 180–239 240+\n155–185 186–246 247+\n159–1... | [
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0.03522069379687309,
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0.0004007211828138679,
0.012551668100059032,
... |
155–185 186–246 247+\n159–190 191–254 255+\n164–196 197–261 262+\n169–202 203–269 270+\n174–208 209–277 278+\n179–214 215–285 286+\n184–220 221–293 294+\n189–226 227–301 302+\n194–232 233–310 311+\n200–239 240–318 319+205–245 246–327 328+WRITE YOUR SCORE\nIN THE BOX.\nADD UP\nYOUR SCORE.Height Weight (lbs.)\n1 point 2 ... | [
0.008878979831933975,
0.05417890474200249,
-0.05284061282873154,
-0.0070567079819738865,
-0.06828249245882034,
0.0769333764910698,
-0.00960673950612545,
0.04156386852264404,
-0.020858895033597946,
-0.032777395099401474,
-0.05119705572724342,
-0.08178985863924026,
0.04161137342453003,
-0.02... |
ADD UP\nYOUR SCORE.Height Weight (lbs.)\n1 point 2 points 3 points\nFigure 2.2 —ADA risk test (diabetes.org/socrisktest).diabetesjournals.org/care Diagnosis and Classification of Diabetes S29\n©AmericanDiabetesAssociation | [
0.021987060084939003,
0.003181347157806158,
-0.08713675290346146,
0.034644365310668945,
-0.016592586413025856,
0.05399392917752266,
0.07289636880159378,
0.046429265290498734,
-0.07312144339084625,
-0.045111216604709625,
-0.01272624358534813,
-0.0984264463186264,
0.011785276234149933,
-0.02... |
Age\nAge is a major risk factor for diabetes.\nTesting should begin at no later than age35 years for all people (100). Screeningshould be considered in adults of anyage with overweight or obesity and one\nor more risk factors for diabetes.\nMedications\nCertain medications, such as glucocorti- | [
0.052131760865449905,
0.03539125993847847,
-0.09702610224485397,
-0.02371525764465332,
-0.019974008202552795,
0.08842198550701141,
0.0414605587720871,
0.08654554933309555,
-0.09765228629112244,
0.0341525599360466,
-0.006452270317822695,
0.04807036742568016,
-0.06283605098724365,
0.09070897... |
Medications\nCertain medications, such as glucocorti-\ncoids, statins (101), proprotein convertasesubtilisin/kexin type 9 (PCSK9) inhibitors,thiazide diuretics, some HIV medications\n(19), and second-generation antipsychotic | [
-0.010142148472368717,
0.028240136802196503,
0.013262984342873096,
-0.03715003654360771,
0.02243294194340706,
0.03138762339949608,
-0.014538601040840149,
0.0763920396566391,
0.05058194696903229,
0.0615726038813591,
-0.011737864464521408,
0.020352249965071678,
-0.02734414115548134,
0.037974... |
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