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of$3.0), evaluated pioglitazone (target\ndose of 45 mg daily) compared with pla-cebo. At 4.8 years, the risk of stroke ormyocardial infarction, as well as the risk\nof diabetes, was lower in the pioglitazone\ng r o u pt h a nw i t hp l a c e b o ;w e i g h tg a i n ,edema, and fractures were higher in the\npioglitazone... | [
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pioglitazone treatment group (116 –119).\nLower doses may mitigate the adverse ef-\nfects but may also be less effective (120).\nPERSON-CENTERED CARE GOALS\nRecommendations\n3.12 In adults with overweight or obe-\nsity at high risk of type 2 diabetes,\ncare goals should include weight lossand maintenance, minimizing th... | [
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gression of hyperglycemia, and atten-\ntion to cardiovascular risk. B\n3.13 Pharmacotherapy (e.g., for weight\nmanagement, minimizing the progres-\nsion of hyperglycemia, and cardiovascu-lar risk reduction) may be considered to\nsupport person-centered care goals. B\n3.14 More intensive preventive ap-\nproaches should ... | [
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proaches should be considered in indi-\nviduals who are at particularly highrisk of progression to diabetes, includ-ing individuals with BMI $35 kg/m\n2,\nthose at higher glucose levels (e.g.,fasting plasma glucose 110 –125 mg/dL\n[6.1–6.9 mmol/L], 2– h postchallenge glu-\ncose 173– 199 mg/dL [9.6 –11.0 mmol/L],\nand A... | [
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and A1C $6.0% [ $42 mmol/mol]),\nand individuals with a history of ges-tational diabetes mellitus. A\nIndividualized risk-to-bene fit ratio should\nbe considered in screening, intervention,\nand monitoring to lower the risk of type 2diabetes and associated comorbidities.\nMultiple factors, including age, BMI, and\nother... | [
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other comorbidities, may in fluence the\nrisk of progression to diabetes and lifetimerisk of complications (121,122). Prediabe-\ntes is associated with increased cardiovas-\ncular disease and mortality (102), whichemphasizes the importance of attendingto cardiovascular risk in this population.\nIn the DPP, which enrolle... | [
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In the DPP, which enrolled high-risk indi-\nviduals with IGT, elevated fasting glucose,\nand elevated BMI, the crude incidence of\ndiabetes within the placebo group was11 cases per 100 person-years, with a cu-mulative 3-year incidence of diabetes of29% (4). Characteristics of individuals in\nthe DPP/DPPOS who were at p... | [
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the DPP/DPPOS who were at particularly\nhigh risk of progression to diabetes (crudeincidence of diabetes 14 –22 cases per 100\nperson-years) included BMI $35 kg/m\n2,\nhigher glucose levels (e.g., fasting plasma\nglucose 110– 125 mg/dL [6– 6.9 mmol/L],\n2–h postchallenge glucose 173 –199 mg/dL\n[9.6–11.0 mmol/L], and A... | [
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[9.6–11.0 mmol/L], and A1C $6.0%\n[$42 mmol/mol]), and a history of GDM\n(4,91,92). In contrast, in the community-based Atherosclerosis Risk in Communi-\nties (ARIC) study, observational follow-upof adults with mean age 75 years withlaboratory evidence of prediabetes(based on A1C 5.7 –6.4% [39 –47 mmol/mol]\nand/or fas... | [
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and/or fasting glucose 100 –125 mg/dL\n[5.6–6.9 mmol/L]), but not meeting speci fic\nBMI criteria, found lower progression todiabetesjournals.org/care Prevention or Delay of Diabetes S47\n©AmericanDiabetesAssociation | [
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diabetes over 6 years: 9% of those with\nA1C-de fin e dp r e d i a b e t e s ,8 %w i t hI F G( 1 2 2 ) .\nThus, it is important to individualize the\nrisk-to-bene fit ratio of intervention and\nconsider person-centered goals. Risk mod-els have generally found higher bene fito f | [
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the intervention in those at highest risk( 1 2 ) .D i a b e t e sp r e v e n t i o nt r i a l sa n do b s e r -\nvational studies highlight key principlesthat may guide person-centered goals. In\nthe DPP, which enrolled a high-risk popu-\nlation meeting criteria for overweight orobesity, weight loss was an important me... | [
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diator of diabetes prevention or delay,\nwith greater metabolic bene fit seen with\ngreater weight loss (12,123). In the DPP/\nDPPOS, progression to diabetes, duration\nof diabetes, and mean level of glycemia\nwere important determinants of the de-\nvelopment of microvascular complications(10). Achieving normal glucose ... | [
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even once, during the DPP was associated\nwith a lower risk of diabetes and lowerrisk of microvascular complications (124).\nObservational follow-up of the Da Qing\nstudy also showed that regression fromIGT to normal glucose tolerance or re-\nmaining with IGT rather than progressing\nto type 2 diabetes at the end of th... | [
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to type 2 diabetes at the end of the\n6-year intervention trial resulted in signi fi-\ncantly lower risk of cardiovascular disease\nand microvascular disease over 30 years\n(125).\nPharmacotherapy for weight manage-\nment (see Section 8, “Obesity and Weight\nManagement for the Prevention andTreatment of Type 2 Diabetes,... | [
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details), minimizing the progression of hy-\nperglycemia (see Section 9, “Pharmacologic\nApproaches to Glycemic Treatment, ”for\nmore details), and cardiovascular risk re-\nduction (see Section 10, “Cardiovascular\nDisease and Risk Management, ”for more\ndetails) can be considered to support indi-vidualized person-cent... | [
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intensive preventive approaches consideredin individuals at high risk of progression.\nPHARMACOLOGIC\nINTERVENTIONS TO DELAYSYMPTOMATIC TYPE 1 DIABETES\nRecommendation\n3.15 Teplizumab-mzwv infusion to de-\nlay the onset of symptomatic type 1\ndiabetes (stage 3) should be considered inselected individuals aged $8y e a ... | [
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stage 2 type 1 diabetes. Managementshould be in a specialized setting withappropriately trained personnel. BTeplizumab has been approved to delay\nthe onset of stage 3 type 1 diabetes in\npeople 8 years of age and older with\nstage 2 type 1 diabetes based in part on\nthe results of a single trial in relatives of\npeopl... | [
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people with type 1 diabetes (126). In\nthis study, 44 individuals were random-\nized to a 14-day course of teplizumab\nand 32 to placebo. The median time tostage 3 type 1 diabetes diagnosis was\n48.4 months in the teplizumab group and\n24.4 months in the placebo group. Type 1\ndiabetes was diagnosed in 19 (43%) of | [
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diabetes was diagnosed in 19 (43%) of\nparticipants who received teplizumab and\n23 (72%) of those who received placebo\n(HR 0.41 [95% CI 0.22 –0.78]). In prespeci-\nfied analyses, the presence of HLA-DR4,\nabsence of HLA-DR3, and absence of anti –\nzinc transporter 8 antibody predicted re-\nsponse to teplizumab (HR 0.2... | [
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sponse to teplizumab (HR 0.20 [95% CI\n0.09–0.45], 0.18 [0.07 –0.45], and [0.07\n[0.02 to 0.26], respectively). The mostcommon adverse reactions were transient\nlymphopenia (73%) followed by rash\n(36%).\nNumerous clinical studies are being\nconducted to test methods for preventing\nor delaying the onset of stage 3 typ... | [
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or delaying the onset of stage 3 type 1 di-\nabetes in those with evidence of autoim-\nmunity without symptoms or for delaying\nloss of insulin secretory capacity after on-\nset of stage 3, some with promising re-\nsults (see ClinicalTrials.gov and TrialNet\n.org).\nReferences\n1. Ziegler AG, Rewers M, Simell O, et al. | [
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.org).\nReferences\n1. Ziegler AG, Rewers M, Simell O, et al.\nSeroconversion to multiple islet autoantibodies\nand risk of progression to diabetes in children.\nJAMA 2013;309:2473– 2479\n2. Steck A, Dong F, Taki I, et al. Continuousglucose monitoring predicts progression to diabetes\nin autoantibody-positive children.... | [
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in autoantibody-positive children. J Clin Endocrinol\nMetab 2019;104:3337 –3344\n3. Ylescupidez A, Speake C, Pietropaolo SL, et al.OGTT metrics surpass continuous glucose\nmonitoring data for T1D prediction in multiple-\nautoantibody-positive individuals [published\ncorrection appears in J Clin Endocrinol Metab | [
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correction appears in J Clin Endocrinol Metab\n2023;dgad574]. J Clin Endocrinol Metab 2023;\ndgad472\n4. Knowler WC, Barrett-Connor E, Fowler SE,\net al.; Diabetes Prevention Program Research\nGroup. Reduction in the incidence of type 2\ndiabetes with lifestyle intervention or metformin.\nN Engl J Med 2002;346:393– 403 | [
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N Engl J Med 2002;346:393– 403\n5. Lindstr €om J, Ilanne-Parikka P , Peltonen M,\net al.; Finnish Diabetes Prevention Study Group.\nSustained reduction in the incidence of type 2\ndiabetes by lifestyle intervention: follow-up of\nthe Finnish Diabetes Prevention Study. Lancet\n2006;368:1673– 1679 | [
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the Finnish Diabetes Prevention Study. Lancet\n2006;368:1673– 1679\n6. Li G, Zhang P , Wang J, et al. Cardiovascularmortality, all-cause mortality, and diabetes\nincidence after lifestyle intervention for peoplewith impaired glucose tolerance in the Da QingDiabetes Prevention Study: a 23-year follow-up\nstudy. Lancet D... | [
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study. Lancet Diabetes Endocrinol 2014;2:474–480\n7. Nathan DM, Bennett PH, Crandall JP , et al.;\nDPP Research Group. Does diabetes preventiontranslate into reduced long-term vascular\ncomplications of diabetes? Diabetologia 2019;62:\n1319 –1328 | [
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complications of diabetes? Diabetologia 2019;62:\n1319 –1328\n8 . G o n gQ ,Z h a n gP ,W a n gJ ,e ta l . ;D aQ i n gDiabetes Prevention Study Group. Morbidity andmortality after lifestyle intervention for peoplewith impaired glucose tolerance: 30-year results\nof the Da Qing Diabetes Prevention Outcome\nStudy. Lancet... | [
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Study. Lancet Diabetes Endocrinol 2019;7:452 –\n461\n9. Knowler WC, Fowler SE, Hamman RF, et al.;\nDiabetes Prevention Program Research Group.10-year follow-up of diabetes incidence and\nweight loss in the Diabetes Prevention Program\nOutcomes Study. Lancet 2009;374:1677 –1686 | [
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Outcomes Study. Lancet 2009;374:1677 –1686\n10. Diabetes Prevention Program ResearchGroup. Long-term effects of lifestyle interventiono rm e t f o r m i no nd i a b e t e sd e v e l o p m e n ta n dmicrovascular complications over 15-year follow-\nup: the Diabetes Prevention Program Outcomes\nStudy. Lancet Diabetes End... | [
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0.10685686022043228,
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0.044195160269737244,
-0.10562024265527725,
-0.0... |
Study. Lancet Diabetes Endocrinol 2015;3:866 –\n875\n11. Diabetes Prevention Program (DPP) Research\nGroup. The Diabetes Prevention Program (DPP):description of lifestyle intervention. Diabetes Care\n2002;25:2165– 2171\n12. Hamman RF, Wing RR, Edelstein SL, et al. | [
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0.012288433499634266,
-0.11337340623140335,
-0.06... |
2002;25:2165– 2171\n12. Hamman RF, Wing RR, Edelstein SL, et al.\nEffect of weight loss with lifestyle intervention onrisk of diabetes. Diabetes Care 2006;29:2102–2107\n13. Evert AB, Dennison M, Gardner CD, et al.\nNutrition therapy for adults with diabetes or\nprediabetes: a consensus report. Diabetes Care\n2019;42:73... | [
-0.050972502678632736,
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0.07784992456436157,
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-0.07572169... |
prediabetes: a consensus report. Diabetes Care\n2019;42:731– 754\n14. U.S.Department of Health and HumanServicesand U.S. Department of Agriculture.2015– 2020 Dietary Guidelines for Americans .8 t h\nEd. Accessed 7 October 2023. Available from\nhttps://health.gov/sites/default/ files/2019-09/\n2015-2020_Dietary_Guideline... | [
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0.01311533898115158,
0.07734841853380203,
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2015-2020_Dietary_Guidelines.pdf\n15. Salas-Salvad /C19o J, Guasch-Ferr /C19eM ,L e eC H ,\nEstruch R, Clish CB, Ros E. Protective effects of\nthe Mediterranean diet on type 2 diabetes andmetabolic syndrome. J Nutr 2015;146:920S –927S\n16. Bloom field HE, Koeller E, Greer N, MacDonald | [
-0.018953924998641014,
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0.04656267911195755,
0.02674679085612297,
-0.061564452946186066,
-0.0... |
16. Bloom field HE, Koeller E, Greer N, MacDonald\nR, Kane R, Wilt TJ. Effects on health outcomes of aMediterranean diet with no restriction on fatintake: a systematic review and meta-analysis. AnnIntern Med 2016;165:491 –500\n17. Estruch R, Ros E, Salas-Salvad /C19oJ ,e ta l . ; | [
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17. Estruch R, Ros E, Salas-Salvad /C19oJ ,e ta l . ;\nPREDIMED Study Investigators. Primary preventionof cardiovascular disease with a Mediterraneandiet supplemented with extra-virgin olive oil ornuts. N Engl J Med 2018;378:e34\n18. Stentz FB, Brewer A, Wan J, et al. Remission\nof pre-diabetes to normal glucose tolera... | [
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of pre-diabetes to normal glucose tolerance\nin obese adults with high protein versus high\ncarbohydrate diet: randomized control trial. BMJOpen Diabetes Res Care 2016;4:e000258\n1 9 . C h i uT H T ,P a nW H ,L i nM N ,L i nC L .V e g e t a r i a n\ndiet, change in dietary patterns, and diabetes risk:a prospective stud... | [
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20. Lee Y, Park K. Adherence to a vegetarian diet\nand diabetes risk: a systematic review and meta-\nanalysis of observational studies. Nutrients 2017;9:603S48 Prevention or Delay of Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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4. Comprehensive Medical\nEvaluation and Assessment ofComorbidities:\nStandards of Care\nin Diabetes— 2024\nDiabetes Care 2024;47(Suppl. 1):S52 –S76|https://doi.org/10.2337/dc24-S004American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes ” | [
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includes the ADA ’s current clinical practice recommendations and is intended to\nprovide the components of diabetes care, general treatment goals and guide- | [
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lines, and tools to evaluate quality of care. Members of the ADA ProfessionalPractice Committee, an interprofessional expert committee, are responsible forupdating the Standards of Care annually, or more frequently as warranted. For adetailed description of ADA standards, statements, and reports, as well as theevidence... | [
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... |
and reports, as well as theevidence-grading system for ADA ’s clinical practice recommendations and a full | [
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list of Professional Practice Committee members, please refer to Introductionand Methodology. Readers who wish to comment on the Standards of Care are\ninvited to do so at professional.diabetes.org/SOC.\nPERSON-CENTERED COLLABORATIVE CARE\nRecommendations\n4.1A person-centered communication style that uses person-cente... | [
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sensitive, and strength-based language and active listening; elicits individual prefer-\nences and beliefs; and assesses literacy, numeracy, and potential barriers to careshould be used to optimize health outcomes and health-related quality of life. B\n4.2People with diabetes can bene fit from a coordinated interprofess... | [
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that may include and is not limited to diabetes care and education specialists,primary care and subspecialty clinicians, nurses, registered dietitian nutritionists,exercise specialists, pharmacists, dentists, podiatrists, and behavioral health pro-fessionals. E\nA successful medical evaluation depends on bene ficial int... | [
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son with diabetes and the care team. The Chronic Care Model (1 –3) (see Section 1,\n“Improving Care and Promoting Health in Populations ”) is a person-centered ap-\nproach to care that requires a close working relationship between the person with di- | [
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abetes and clinicians involved in treatment planning. People with diabetes shouldreceive health care from a coordinated interprofessional team that may include but isnot limited to diabetes care and education specialists, primary care and subspecialtyclinicians, nurses, registered dietitian nutritionists, exercise spec... | [
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dentists, podiatrists, behavioral health professionals, and community partners such as\ncommunity health workers and community paramedics. Individuals with diabetes andtheir care partners must assume an active role in their care. Based on the preferences*A complete list of members of the American | [
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Diabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association | [
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Suggested citation: American Diabetes Association\nProfessional Practice Committee. 4. Comprehensivemedical evaluation and assessment of com-orbidities: S t a n d a r d so fC a r ei nD i a b e t e s —2024.\nDiabetes Care 2024;47(Suppl. 1):S52 –S76\nThe\nBONE HEALTH subsection has received endorsement | [
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The\nBONE HEALTH subsection has received endorsement\nfrom the American Society for Bone and MineralResearch.\n© 2023 by the American Diabetes Association.\nReaders may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.4. MEDICAL EVALUATION AND COMORBIDITIESS52 Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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and values of the person with diabetes,\nelicited by the care team, the family orsupport group and health care team to-gether formulate the management plan,which includes lifestyle management (seeSection 5, “Facilitating Positive Health\nBehaviors and Well-being to ImproveHealth Outcomes ”).\nThe goals of treatment for... | [
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The goals of treatment for diabetes are\nto prevent or delay complications and op-\ntimize quality of life ( Fig. 4.1 ). Treatment\ngoals and plans should be cocreated with\npeople with diabetes based on their indi-vidual preferences, values, and goals. Thisindividualized management plan shouldtake into account the per... | [
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tive abilities, school/work schedule and\nconditions, health beliefs, support sys-tems, eating patterns, physical activity, so-\ncial situation, financial concerns, cultural\nfactors, literacy and numeracy (mathemat- | [
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ical literacy), diabetes history (duration,complications, and current use of medica-tions), comorbidities, disabilities, healthpriorities, other medical conditions, pref-erences for care, access to health careservices, and life expectancy. People livingwith diabetes should be engaged in con-versation about these aspect... | [
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in con-versation about these aspects of theirlives and diabetes management, withroutine reassessment as necessary giventheir changing circumstances across thelife span. Various strategies and techniquesshould be used to support the person ’s | [
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self-management efforts, including provid-\ning education on problem-solving skills for\nall aspects of diabetes management.\nHealth care professional communication\nwith people with diabetes and families | [
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with people with diabetes and families\nshould acknowledge that multiple factorsimpact glycemic management but alsoemphasize that collaboratively developedtreatment plans and a healthy lifestyle cansignificantly improve disease outcomes\nand well-being (4 –8). Thus, the goal of\ncommunication between health care pro- | [
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communication between health care pro-\nfessionals and people with diabetes is toestablish a collaborative relationship and toassess and address self-management bar-riers without blaming people with diabetesfor“noncompliance ”or“nonadherence ” | [
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when the outcomes of self-managementare not optimal (9). The familiar terms non-compliance and nonadherence denote apassive, obedient role for a person with di-abetes in “following doctor ’so r d e r s ”that | [
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is at odds with the active role people withdiabetes take in directing the day-to-daydecision-making, planning, monitoring,evaluation, and problem-solving involvedin diabetes self-management. Using a non-judgmental approach that normalizes peri-odic lapses in management and the rolesystemic factors play may help minimiz... | [
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factors play may help minimizethe person ’s resistance to reporting prob- | [
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lems with self-management. Empathizingand using active listening techniques, suchas open-ended questions, refl ective state-\nments, and summarizing what the person\nsaid, can help facilitate communication.Perceptions of people with diabetes abouttheir own ability, or self-ef ficacy, to self-\nmanage diabetes constitute ... | [
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manage diabetes constitute one important\npsychosocial factor related to improved di-abetes self-management and treatmentoutcomes in diabetes (10 –12) and should\nbe goals of ongoing assessment, educa-tion, and treatment planning. | [
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0.... |
be goals of ongoing assessment, educa-tion, and treatment planning.\nFigure 4.1 —Decision cycle for person-centered glycemic management in type 2 diabetes. Adapted from Davies et al. (294). BGM, blood glucose\nmonitoring; BP, blood pressure; CGM, continuous glucose monitoring; CKD, chronic kidney disease; CVD, atherosc... | [
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DSMES, diabetes self-management education and support; HF, heart failure.diabetesjournals.org/care Comprehensive Medical Evaluation and Assessment of Comorbidities S53\n©AmericanDiabetesAssociation | [
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Language has a strong impact on per-\nceptions and behavior. Empowering lan- | [
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ceptions and behavior. Empowering lan-\nguage can help to inform and motivate,while shame and judgement can be dis-couraging. The American Diabetes Asso-ciation (ADA) and the Association ofDiabetes Care & Education Specialists(formerly called the American Associa-tion of Diabetes Educators) joint con-sensus report, “Th... | [
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Diabetes Care and Education, ”provides\nthe authors ’expert opinion regarding the | [
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the authors ’expert opinion regarding the\nuse of language by health care profes-sionals when speaking or writing aboutdiabetes for people with diabetes or forprofessional audiences (13). Although fur-ther research is needed to address the im-pact of language on diabetes outcomes,the report includes five key consensus r... | [
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ommendations for language use:\n\x81Use language that is neutral, non-\njudgmental, and based on facts, ac-tions, or physiology/biology.\n\x81Use language free from stigma.\n\x81U s el a n g u a g et h a ti ss t r e n g t hb a s e d ,r e -spectful, and inclusive and that impartshope. | [
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\x81Use language that fosters collabora-tion between people with diabetesand health care professionals.\n\x81Use language that is person cen-tered (e.g., “person with diabetes ”is\npreferred over “diabetic ”).\nCOMPREHENSIVE MEDICAL\nEVALUATION\nRecommendations\n4.3 A complete medical evaluation\nshould be performed at... | [
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should be performed at the initial visit to:\n\x81Confirm the diagnosis and classify\ndiabetes. A\n\x81Evaluate for diabetes complications,\npotential comorbid conditions, andoverall health status. A\n\x81Identify care partners and sup-\nport system. E\n\x81Assess social determinants of health\nand structural barriers t... | [
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and structural barriers to optimalhealth and health care. A\n\x81Review previous treatment andrisk factor management in peoplewith established diabetes. A\n\x81Begin engagement with the person\nwith diabetes in the formulation of\na care management plan includinginitial goals of care. A | [
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a care management plan includinginitial goals of care. A\n\x81Develop a plan for continuing care. A4.4A follow-up visit should include most\ncomponents of the initial comprehensive\nmedical evaluation ( Table 4.1 ).A\n4.5Ongoing management should be | [
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medical evaluation ( Table 4.1 ).A\n4.5Ongoing management should be\nguided by the assessment of overallhealth status, diabetes complications,cardiovascular risk, hypoglycemia risk,a n ds h a r e dd e c i s i o n - m a k i n gt os e ttherapeutic goals. B\nThe comprehensive medical evaluation\nincludes the initial and f... | [
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includes the initial and follow-up evalua-\ntions, assessment of complications, psy-chosocial assessment, management ofcomorbid conditions, overall health, func-\ntional and cognitive status, and engagement\nof the person with diabetes throughout theprocess. While a comprehensive list is pro-vided in Table 4.1 , in cli... | [
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health care professional may need to pri-oritize the components of the medicalevaluation given the available resourcesand time. Engaging other members of thehealth care team can also support com-\nprehensive diabetes care. The goal of | [
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prehensive diabetes care. The goal of\nthese recommendations is to provide thehealth care team information so it can op-timally support people with diabetes and\ntheir care partners. In addition to the\nmedical history, physical examination, andlaboratory tests, health care professionalsshould assess diabetes self-mana... | [
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behaviors, nutrition, social determinants\nof health, and psychosocial health (seeSection 5, “Facilitating Positive Health\nBehaviors and Well-being to Improve\nHealth Outcomes ”) and give guidance on\nroutine immunizations. The assessment of\nsleep pattern and duration should be con-sidered. Interval follow-up visits ... | [
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cur at least every 3 –6 months individualized\nto the person and then at least annually.\nLifestyle management and behavioral\nhealth care are cornerstones of diabetes\nmanagement. People with diabetes shouldbe referred for diabetes self-management\neducation and support, medical nutrition | [
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education and support, medical nutrition\ntherapy, and assessment of behavioralhealth concerns as appropriate. Peoplewith diabetes should receive recommended\npreventive care services (e.g., immuniza-\ntions and cancer screening); smoking ces-sation counseling; and ophthalmological,dental, podiatric, and other referral... | [
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needed.\nThe assessment of risk of acute and\nchronic diabetes complications and treat-\nment planning are key components of ini-tial and follow-up visits ( Table 4.2 ). Therisk of atherosclerotic cardiovascular\ndisease and heart failure (see Section10,“Cardiovascular Disease and Risk\nManagement ”), chronic kidney di... | [
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Management ”), chronic kidney disease\nstaging (see Section 11, “Chronic Kidney\nDisease and Risk Management ”), pres-\nence of retinopathy and presence of neu-ropathy (see Section 12, “Retinopathy,\nNeuropathy, and Foot Care” ), and risk of\ntreatment-associated hypoglycemia should | [
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treatment-associated hypoglycemia should\nbe used to individualize goals for glycemia(see Section 6, “Glycemic Goals and\nHypoglycemia” ), blood pressure, and lipids\nand to select speci fic glucose-lowering med-\nication(s) (see Section 9, “Pharmacologic\nApproaches to Glycemic Treatment ”), anti-\nhypertension medicat... | [
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hypertension medication(s), and statin treat-\nment intensity.\nAdditional referrals should be arranged\nas necessary ( Table 4.3 ). Clinicians should\nensure that people with diabetes are ap- | [
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ensure that people with diabetes are ap-\npropriately screened for complications,comorbidities, and treatment burden. Dis-cussing and implementing an approach toglycemic management with the person isa part, not the sole goal, of the clinicalencounter.\nIMMUNIZATIONS\nRecommendation\n4.6Provide routinely recommended\nva... | [
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4.6Provide routinely recommended\nvaccinations for children and adults\nwith diabetes as indicated by age(see Table 4.4 ).A\nChildren and adults with diabetes should | [
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Children and adults with diabetes should\nreceive vaccinations according to age-appropriate recommendations (14,15). TheCenters for Disease Control and Preven-tion (CDC) provides vaccination schedulesspecifically for children, adolescents, and | [
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adults with diabetes (cdc.gov/vaccines/).The CDC Advisory Committee on Immuni-zation Practices (ACIP) makes recommen-dations based on its own review and ratingof the evidence, provided in Table 4.4 for\nselected vaccinations. The ACIP evidence re- | [
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selected vaccinations. The ACIP evidence re-\nview has evolved over time with the adop-tion of Grading of Recommendations Assess-ment, Development, and Evaluation (GRADE)\nin 2010 and then the Evidence to Decision\nor Evidence to Recommendation frame-works in 2020 (16). Here, we discuss theparticular importance of spec... | [
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COVID-19\nPeople with underlying medical condi-\ntions, including diabetes, are more likelyS54 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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Personal history of autoimmune diseasePersonal history of autoimmune diseaseTable 4.1 - Components of the comprehensive diabetesTable 4.1 - Components of the comprehensive diabetes\nmedical evaluation at initial, follow-up, and annual visitsmedical evaluation at initial, follow-up, and annual visitsINITIALINITIAL\nVISI... | [
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0.02447... |
VISITVISITANNUALANNUAL\nVISITVISITEVERYEVERY\nFOLLOW-FOLLOW-\nUP VISITUP VISIT\nCharacteristics at onset (e.g., age, symptoms)Characteristics at onset (e.g., age, symptoms)Diabetes historyDiabetes history\nFamily historyFamily history\nInterval historyInterval history | [
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0.03... |
Family historyFamily history\nInterval historyInterval history\nSocial networkSocial networkPersonal history of complications and common comorbiditiesPersonal history of complications and common comorbiditiesReview of previous treatment plans and responseReview of previous treatment plans and response | [
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Assess frequency/cause/severity of past hospitalizationsAssess frequency/cause/severity of past hospitalizations\nFamily history of diabetes in a first-degree relativeFamily history of diabetes in a first-degree relative\nFamily history of autoimmune disorderFamily history of autoimmune disorder | [
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0.06280867755413055,
-0.04087704420089722,
0.06939181685447693,
0.04239552840590477,
0.06270913779735565,
-0.05592447146773338,
-0.035962142050266266,
-0.02593064121901989,
-0.056911054998636246,
-0.06864921003580093,
0.06226... |
Common comorbidities (e.g., obesity, OSA, NAFLD)Common comorbidities (e.g., obesity, OSA, NAFLD)\nHigh blood pressure or abnormal lipidsHigh blood pressure or abnormal lipids\nMacrovascular and microvascular complicationsMacrovascular and microvascular complications | [
0.04201265051960945,
-0.022892529144883156,
-0.015676992014050484,
0.03647328168153763,
-0.03888703137636185,
0.0371781550347805,
0.00309125822968781,
0.03275800868868828,
-0.03416037932038307,
-0.05031166970729828,
0.05833110213279724,
-0.03719000518321991,
-0.06956080347299576,
-0.018562... |
Hypoglycemia: awareness/frequency/causes/timing of episodesHypoglycemia: awareness/frequency/causes/timing of episodes\nPresence of hemoglobinopathies or anemiasPresence of hemoglobinopathies or anemias\nLast dental visitLast dental visit\nLast dilated eye examLast dilated eye exam\nVisits to specialistsVisits to speci... | [
0.0797172486782074,
0.01777292601764202,
-0.02875426411628723,
0.03304135799407959,
-0.09034476429224014,
0.00747449416667223,
0.09867902100086212,
0.08901472389698029,
-0.06889314949512482,
0.022555900737643242,
-0.019960476085543633,
-0.04967429116368294,
-0.056291718035936356,
-0.001480... |
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