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pean Association for the Study of Obesity(EASO), DXA should be performed every\ntwo years in subjects undergoing bariatric-\nmetabolic surgery.\nBone turnover markers are commonly\nused in clinical practice, although theyare suppressed in people with diabetes\nand have not been shown to predict frac- | [
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and have not been shown to predict frac-\nture risk (65).S60 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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Type 1 Diabetes. Because hip fracture\nrisk in type 1 diabetes starts to increase\nafter the age of 50, clinicians may con-\nsider assessing BMD after the 5th de-cade of life (47). In people with type 1diabetes, BMD underestimates fracturerisk, but studies do not address the ex-tent of underestimation of fracture risk. | [
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According to the International Society\nfor Pediatric and Adolescent Diabetes(ISPAD), regular assessment of bone healthusing bone densitometry in youth withtype 1 diabetes is still controversial andnot recommended, but it may be con-sidered in association with celiac dis-ease because of the involvement ofinflammatory pa... | [
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Management\nMaintaining glucose control and minimiz-ing hypoglycemic episodes are crucial forbone health in people with diabetes. Indi-viduals with prolonged disease, microvas-cular and macrovascular complications,or frequent hypoglycemic episodes facehigher fracture risks and fall risks due to\nfactors like sarcopenia... | [
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factors like sarcopenia and impaired gait.\nHealth care professionals should advo-cate moderate physical activity to en-hance muscle health, gait coordination,and balance as part of fracture preventivestrategies (58,59,67).\nAerobic and weight-bearing exercise | [
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Aerobic and weight-bearing exercise\nshould be recommended to counteractthe potential negative effect of weightloss on bone; speci fic guidelines have\nbeen published for older adults withtype 2 diabetes (68).\nOsteoporosis and fracture prevention\narefirst based on measures applied to the | [
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arefirst based on measures applied to the\ngeneral population. All people with diabe-tes should receive an adequate daily in-take of proteins, calcium, and vitamin D,stop smoking, and have regular physicalactivity (69 –71).\nIntake of calcium should re flect the age-\nspecific recommendations of the general | [
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specific recommendations of the general\npopulation and should be obtained throughdiet and/or oral supplements (72).\nThe optimal level of 25-hydroxyvitamin D\nis a matter of controversy (73), althoughserum levels $20 ng/mL are generally\nthought to be suf ficient (74). Because di- | [
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thought to be suf ficient (74). Because di-\nabetes is a risk factor for fractures, otherguidelines suggest a goal >30 ng/mL\n(75).\nThe safe upper limit is also a matter of\ndebate, and there is substantial disagree-ment over whether to treat to a speci fied\nserum level. In the U.S., the recommendeddaily allowance of v... | [
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people aged 51 –70 years and 800 IU for\npeople aged >70 years (74). In clinical prac-\ntice, this dose of supplement is often notenough to reach recommended goals, andhigher doses of D2 or D3 may be needed.\nFractures are main determinants of | [
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Fractures are main determinants of\nfrailty, a predisability condition that shouldbe mitigated with individualized interven-tions to prevent falls, maintain mobility,\nand delay disability (68). In many circum- | [
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stances, conservative management (cal-cium, vitamin D, and lifestyle measures) arenot enough to reduce fracture risk. Whenpharmacological treatment is needed,medication decision-making strategiesare the same as those used for the generalpopulation. Antiosteoporosis medicationsreduce bone resorption (bisphosphonates, | [
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selective estrogen receptor modulators, | [
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and denosumab), stimulate bone forma-tion (teriparatide and abaloparatide), orhave dual actions by stimulating bone for-mation and reducing bone resorption (ro-mosozumab). These agents improve bonedensity and reduce the risk of vertebraland nonvertebral fractures. Althoughthere are no studies speci fically designed | [
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for people with diabetes, data on antire-\nsorptives and osteoanabolic agents sug-\ngest similar ef ficacy in type 2 diabetes\ncompared with individuals without diabe-tes (76 –78). Using individual patient data | [
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from randomized trials, antiresorptivetherapies show similar effects in peoplewith and without type 2 diabetes for ver-tebral, hip, and nonvertebral fractures(76). No similar studies of ef ficacy of anti-\nosteoporosis treatment in people withtype 1 diabetes have been published.\nPrimary Prevention of Fragility Fracture... | [
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Primary Prevention of Fragility Fractures\nin People With Diabetes. In the general\npopulation, a T-score #/C02.5 is the thresh-\nold to consider pharmacological treatment\nfor osteoporosis. In type 2 diabetes, sinceT-score underestimates fracture risk (asdiscussed above), a T-score #/C02.0 may | [
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be more appropriate for considering initi-ation of a first-line drug, including bi-\nsphosphonates (alendronate, risedronate,and zoledronate) or denosumab.\nDenosumab is preferred in individu-\nals with estimated glomerular filtration\nrate<30–35 mL/min/1.73 m\n2.S e l f - | [
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rate<30–35 mL/min/1.73 m\n2.S e l f -\nmanagement abilities of the person with di-abetes should be considered in medicationselection, as there can be rebound boneloss with missed doses of denosumab ordelays in care. Zoledronic acid may be\nmore appropriate in these cases.\nSecondary Prevention of Fragility Fractures. | [
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Secondary Prevention of Fragility Fractures.\nThe risk of subsequent fracture in indi-viduals with hip or vertebral fracture issignificantly high, especially in the first\n1–2 years after a fracture. Antiosteopo-\nrosis treatment reduces the risk of frac-\nture in older individuals with prior hip\nor vertebral fracture. | [
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ture in older individuals with prior hip\nor vertebral fracture.\nAs in the general population, people\nwith diabetes who experience fragility\nfracture should 1) be given the diagnosis\nof osteoporosis regardless of DXA data\nand 2) receive therapy to prevent future\nfractures (79). Individuals at particularlyhigh ris... | [
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bidities) should be referred to a bone\nmetabolic specialist. In these cases, aspecialist may choose to initiate an os-\nteoanabolic agent to opt imize bone for-\nmation and reduce immediate fracture\nrisk (80). It is strongly recommended that\nall individuals with a fragility fracture be\nstarted on antiosteoporosis t... | [
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started on antiosteoporosis therapy and\nadequate calcium and vitamin D supple-\nmentation, if needed, as early as possi-ble, even during hospitalization (79).\nThere are some additional considera-\ntions related to medication selection inpeople with diabetes. Data from a phase 3trial and population studies have indica... | [
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positive effects of denosumab on fasting\nglucose and on diabetes prevention. The\nFracture Reduction Evaluation of Denosu-\nmab in Osteoporosis Every 6 Months(FREEDOM) trial and its 10-year extension\nhave shown that people with diabetes\ntreated with denosumab experience sig-nificant improvements in BMD and lower | [
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vertebral fracture risk but higher risk ofnonvertebral fractures (81). Romosozu-\nmab, a newer anabolic medication, may\nbe associated with increased risk of myo-cardial infarction and stroke, limiting its\nuse in people with diabetes at higher risk\nfor cardiovascular compilations (82,83).\nGlucose-Lowering Medication... | [
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Glucose-Lowering Medications and Bone\nHealth\nCare plans for type 2 diabetes treatment\nshould consider individual fracture risk\nand the potential effect of medications on\nbone metabolism. Medications other thanTZD are advisable for postmenopausal\nwomen or elderly men with type 2 diabe-\ntes due to their safer bone... | [
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tes due to their safer bone health pro files.\nWhile several studies have shown metfor-\nmin has a safe profi le, special attentiondiabetesjournals.org/care Comprehensive Medical Evaluation and Assessment of Comorbidities S61\n©AmericanDiabetesAssociation | [
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should be paid to the wide use of sulfony-\nlureas because of the high risk of hypogly- | [
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cemic events and fractures (84). Dipeptidylpeptidase 4 (DPP-4) inhibitors and gluca-gon-like peptide 1 (GLP-1) receptor ago-nists have been used in clinical practice formore than 15 years, and both clinical trialsand postmarketing data suggest a neutralimpact on bone health (85,86). Tirzepatidemay play a positive effec... | [
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dependent insulinotropic polypeptide (GIP)\nreceptor agonism, preventing bone loss as-sociated with weight loss (87).\nUse of sodium –glucose cotransporter 2\ninhibitors has raised some concerns. TheCanagli flozin Cardiovascular Assessment\nStudy (CANVAS) study showed that sub-jects treated with canagli flozin had a | [
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significant increase in fracture risk com-\npared with placebo (HR 1.55). Furtheranalyses from the same trial and from the\nCanagli flozin and Renal Events in Diabetes\nwith Established Nephropathy Clinical Eval-\nuation (CREDENCE) study found a neutraleffect on fracture risk (88 –91). Although\nfew data are available, u... | [
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few data are available, use of empagli flo-\nzin, ertugli flozin, or dapaglifl ozin has not\nbeen associated with negative effects onbone health (90 –92) Use of insulin has\nbeen shown to double the risk of hip frac-\ntures (84), likely because of higher risk of\nhypoglycemia, longer duration of the dis-ease, and comorbid... | [
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hypoglycemia, longer duration of the dis-ease, and comorbidities.\nIn conclusion, glucose-lowering medi-\ncations with good bone safety pro files | [
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cations with good bone safety pro files\nshould be preferred, especially in the el-derly, in people with longer duration ofdisease, or in people with complications.Aggressive therapeutic approaches shouldbe avoided in the frail and in the elderly toprevent hypoglycemic events and falls.\nCancer\nDiabetes is associated w... | [
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Cancer\nDiabetes is associated with increased\nrisk of cancers of the liver, pancreas, en- | [
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dometrium, colon/rectum, breast, andbladder (93). The association may resultfrom shared risk factors between type 2diabetes and cancer (older age, obesity,and physical inactivity) but may also bedue to diabetes-related factors (94),such as underlying disease physiologyor diabetes treatments, although evi-\ndence for th... | [
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dence for these links is scarce. People\nwith diabetes should be encouraged toundergo recommended age- and sex-appropriate cancer screenings, coordi-nated with their primary health care pro-fessional, and to reduce their modi fiablecancer risk factors (obesity, physical inac- | [
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tivity, and smoking). New onset of atypi-cal diabetes (lean body habitus and\nnegative family history) in a middle-aged\nor older person may precede the diagno-sis of pancreatic adenocarcinoma (95).\nHowever, in the absence of other symp-\ntoms (e.g., weight loss and abdominal\npain), routine screening of all such indi... | [
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pain), routine screening of all such individ-\nuals is not currently recommended. Met-formin and sulfonylureas may have\nanticancer properties. Pioglitazone has\nmixed data, with a previous concern forb l a d d e rc a n c e ra s s o c i a t i o n .R e c o m m e n -\ndations cannot be made at this time\n(96–98).\nCognit... | [
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(96–98).\nCognitive Impairment/Dementia\nRecommendation\n4.15 In the presence of cognitive im-\npairment, diabetes treatment plans\nshould be simpli fied as much as pos-\nsible and tailored to minimize therisk of hypoglycemia. B\nDiabetes is associated with a signi ficantly\nincreased risk and rate of cognitive de-\nclin... | [
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cline and an increased risk of dementia\n(99,100). A meta-analysis of prospective\nobservational studies found that individ-uals with diabetes had a 43% higher risk\nof all types of dementia, a 43% higher\nrisk of Alzheimer dementia, and a 91%higher risk of vascular dementia com-\npared with individuals without diabete... | [
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0.0014543646248057485,
... |
pared with individuals without diabetes\n(101). The reverse is also true: people\nwith Alzheimer dementia are more likely\nto develop diabetes than people withoutAlzheimer dementia. In a 15-year pro-\nspective study of community-dwelling peo-\nple>60 years of age, the presence of\ndiabetes at baseline signi ficantly inc... | [
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diabetes at baseline signi ficantly increased\nthe age- and sex-adjusted incidence of all-cause dementia, Alzheimer dementia, and\nvascular dementia compared with rates in\nthose with normal glucose tolerance (102).See Section 13, “Older Adults,” for a more\ndetailed discussion regarding assessmentof cognitive impairmen... | [
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Diabetes and COVID-19\nRecommendations\n4.16 Health care professionals should\nhelp people with diabetes aim to\nachieve individualized glycemic goals\nto reduce the risk of macrovascularand microvascular risk as well as re-duce the risk of coronavirus disease2019 (COVID-19) and its complica-\ntions. B\n4.17 As we move... | [
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tions. B\n4.17 As we move into the recovery\nphase, diabetes health care servicesand practitioners should address theimpact of the COVID-19 pandemic in\nhigher-risk groups, including minor-\nity, socioeconomically deprived, andolder populations. B\n4.18 People with diabetes who have | [
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4.18 People with diabetes who have\nbeen infected with severe acute respi-ratory syndrome coronavirus 2 (SARS-CoV-2) should be followed up in the\nlonger term to assess complications\nand symptoms of long COVID-19. E\n4.19 New-onset diabetes cases\nshould receive routine clinic follow-\nup to determine if the condition... | [
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up to determine if the condition is\ntransient. B\n4.20 There is no clear indication to\nchange prescribing of glucose-lowering\ntherapies in people with diabetes in-\nfected by SARS-CoV-2. B\n4.21 People with diabetes should be\nprioritized and offered SARS-CoV-2vaccines and vaccine boosters. B\nSevere acute respirato... | [
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Severe acute respiratory syndrome co-\nronavirus 2 (SARS-CoV-2), the virus that\ncauses the clinical disease COVID-19,\nwasfirst reported in December 2019 in\nChina and has disproportionately im-pacted certain groups, including men,older people, racial and ethnic minority\npopulations, and people with certain | [
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populations, and people with certain\nchronic conditions, including diabetes, car-diovascular disease, kidney disease, andcertain respiratory diseases. COVID-19 isnow recognized as a complex multisystem\ndisease with sequelae including widespread | [
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disease with sequelae including widespread\ninsulin resistance, endothelial dysfunction,hematological disorders, and hyperimmuneresponses (103). There is now evidence ofnot only direct but also indirect adverse ef-\nfects of COVID-19 in people with diabetes. | [
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0.03099... |
fects of COVID-19 in people with diabetes.\nMany people with multiple long-term condi-tions have diabetes, which has also been as-sociated with worse outcomes in peoplewith COVID-19 (104). The association with\nBMI and COVID-19 mortality is U-shaped in\nboth type 1 and type 2 diabetes (105).\nCOVID-19 has disproportion... | [
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0... |
COVID-19 has disproportionately af-\nfected certain groups, such as older peopleand those from some ethnic populationsw h oa r ek n o w nt oh a v eh i g hp r e v a l e n c eo f\nchronic conditions such as diabetes, car- | [
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0.048686038... |
chronic conditions such as diabetes, car-\ndiovascular disease, kidney disease, andcertain respiratory diseases (106). In peo-ple with diabetes, higher blood glucoseS62 Comprehensive Medical Evaluation and Assessment of Comorbidities Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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... |
levels both prior to and during COVID-19\nadmission have been associated withpoor outcomes, including mortality (107).Type 1 diabetes has been associated withhigher risk of COVID-19 mortality than\ntype 2 diabetes (108). The largest study | [
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type 2 diabetes (108). The largest study\nof people with diabetes to date, usingwhole-population data from England withover 3 million people, reported a higher\nassociation for mortality in people with\ntype 1 diabetes than type 2 diabetes(105). Male sex, older age, renal impair-ment, non-Hispanic White race, socioeco- | [
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0.00... |
nomic deprivation, and previous stroke\nand heart failure were associated with in-creased COVID-19 –related mortality in\nboth type 1 and type 2 diabetes (105).\nMuch of the evidence for recommenda-\ntions is from a recent systematic reviewthat was commissioned by the WorldHealth Organization on the latest researchevid... | [
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people with diabetes (108). The review re-\nported that there are no appropriate datato determine whether diabetes is a riskfactor for acquiring SARS-CoV-2 infection.\nDiabetes is a risk factor for severe disease\na n dd e a t hf r o mC O V I D - 1 9 .\nReasons for the higher rates of | [
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Reasons for the higher rates of\nCOVID-19 and severity in minority eth-nic groups are complex and could be\ndue to higher prevalence of comorbid\nconditions (e.g., diabetes), differences inexposure risk (e.g., overcrowded livingconditions and essential worker jobs),and access to treatment (e.g., health in-\nsurance sta... | [
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surance status, specialist services, and\nmedications), which all relate to long-standing structural inequities that varyby ethnicity (109).\nThere is now overwhelming evidence\nthat approximately 30 –40% of people\nwho are infected with COVID-19 getpersistent and sometimes relapsing andremitting symptoms 4 weeks after... | [
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tion, which has been termed postacute\nsequelae of COVID-19, post-COVID-19condition, postacute COVID-19 syndrome,or long COVID (110,111). Currently, data\non long COVID speci fically in people with\ndiabetes are lacking, and people who\nhave been infected with SARS-CoV-2should be followed up in the longer term.\nThere h... | [
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There have also been recent reports\nof development of new-onset diabetesin people who have had COVID-19. Theprecise mechanisms for new-onset dia-betes in people with COVID-19 are not\nknown but may include previously un- | [
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known but may include previously un-\ndiagnosed diabetes presenting early orlater in the disease trajectory, stress hyper-glycemia, steroid-induced hyperglycemia,and possibly direct or indirect effects ofSARS-CoV-2 on the b-cell (112). One large\nU.S. retrospective study of over 27 million\npeople reported that COVID-1... | [
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people reported that COVID-19 was asso-\nciated with signi ficantly increased risk of\nnew-onset type 1 diabetes and a dispro-portionately higher risk in ethnic minority\npopulations (113). Another cross-sectional\npopulation-based Canadian study ob-served a slightly higher but nonsigni ficant\nincrease in diabetes incid... | [
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increase in diabetes incidence in children\nduring the pandemic, which may have re-\nsulted from delays in diagnosis during thepandemic with a catch-up effect (114).There have been several publications onthe risk of diabetic ketoacidosis (DKA) dur-\ning the pandemic. A German diabetes | [
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ing the pandemic. A German diabetes\nprospective study using registry data ofchildren and adolescents found an increasein type 1 diabetes in the first 3 months of\nthefirst wave, and the frequency of DKA at\npresentation was signi ficantly higher than\nthose for 2019 (44.7% vs. 24.5%, adjustedRR 1.84) and 2018 (vs. 24.1%,... | [
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1.85) as well as the proportion with severe\nDKA (115). A larger study using nationaldata in England during the first two waves\nfound that rates of DKA were higher thanthose for preceding years across all pan-\ndemic periods studied (116). The study re- | [
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demic periods studied (116). The study re-\nported lower DKA hospital admissions inpeople with type 1 diabetes but higherrates of DKA in people with type 1 diabetes\nand those newly diagnosed with diabetes.\nThere is also evidence of adverse ef-\nfects of COVID-19 on behavioral health | [
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fects of COVID-19 on behavioral health\n(117) and health-promoting lifestylesduring the pandemic. Some small stud-\nies in people with diabetes have re-\nported longer-term psychological impactof SARS-CoV-2 infection, including fa-tigue and risk of suicide (118). Longitu-\ndinal follow-up of the Action for Health | [
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dinal follow-up of the Action for Health\nin Diabetes (Look AHEAD) study of olderadults with type 2 diabetes reported a1.6-fold higher prevalence for depressivesymptoms and 1.8-fold higher prevalence\nfor loneliness during the pandemic com- | [
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for loneliness during the pandemic com-\npared with prepandemic levels (119). Fur-thermore, many people with diabetesremain fearful of face-to-face contact due\nto the possible threat from mutant strains\nof coronavirus (120). Negative emotionsdue to the pandemic, including lock-downs, have been associated with re- | [
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duced motivation, physical inactivity, and\nsedentary behavior (121). Higher levelsof pandemic-related distress have beenlinked to higher A1C (122). Greater pan-demic-related life disruptions have beenrelated to higher distress in parents ofyouth with diabetes, which may have im-pacted families from racial and ethnic m... | [
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nority groups to a greater degree than\nnon-Hispanic White families (123). On theother hand, for some youth with type 1 di-abetes, increased time at home during the\nearly phases of the COVID-19 pandemic\nprovided opportunities for enhanced fam-ily support for diabetes self-managementand reduced diabetes-related distre... | [
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(124).\nAs we recover from the pandemic, it is\nessential that we prioritize the highest-risk\ngroups for their routine review and assess-ment as well as management of their be-\nhavioral health and risk factors. Diabetes\nprofessional bodies in some countries havepublished guidance on risk strati fication\nand who to p... | [
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and who to prioritize for diabetes review\n(125,126). Factors to consider for priori-\ntization should include demographics,socioeconomic status, education levels,established complications, comorbid-\nities, and modi fiable risk factors, which\nare associated with high risk of progres-\nsion of diabetes-related complica... | [
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sion of diabetes-related complications.\nSeveral pharmacoepidemiologic stud-\nies have examined the association be-\ntween glucose-lowering medications and\nrisk of COVID-19 and have reported con-flicting findings, although most studies\nshowed a lower risk of mortality withmetformin and a higher risk in people on | [
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insulin. However, the absolute differences\nin the risks have been small, and thesefindings could be due to confounding by\nindication (127). The gold standard for as-\nsessing the effects of therapies is by ran-\ndomized controlled trial (RCT), and onlyone RCT, the Dapagli flozin in Patients with\nCardiometabolic Risk F... | [
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Cardiometabolic Risk Factors Hospitalized\nwith COVID-19 (DARE-19), a double-blind,\nplacebo-controlled RCT in people with andwithout type 2 diabetes with at least onecardiovascular risk factor, has been re-\nported (128). In this study, dapagli flozin\nwas well tolerated and resulted in fewer | [
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was well tolerated and resulted in fewer\nevents of organ dysfunction, but resultswere not statistically signifi cant for the\ndual primary outcome of prevention (time\nto new or worsening organ dysfunction or\ndeath) and the hierarchical composite out-come of recovery by 30 days.\nIt is therefore important that people | [
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It is therefore important that people\nwith diabetes have regular SARS-CoV-2\nvaccines (see\nIMMUNIZATIONS ,a b o v e ,f o rd e -\ntailed information on COVID-19 vaccines).diabetesjournals.org/care Comprehensive Medical Evaluation and Assessment of Comorbidities S63\n©AmericanDiabetesAssociation | [
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It is unclear currently how often people\nwith diabetes will require booster vac-cines. Although limited data are availableon COVID-19 vaccination attitudes or up-\ntake in people with diabetes in the U.S. | [
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take in people with diabetes in the U.S.\n(129), diabetes health care professionalsmay be in a position to address questionsand concerns among people with diabetesand encourage vaccination.\nDisability\nRecommendation\n4.22 An assessment of disability should\nbe performed at each visit for people\nwith diabetes. If a d... | [
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0.01794... |
with diabetes. If a disability is impact-\ning functional ability or capacity to\nmanage their diabetes, a referral shouldbe made to an appropriate health careprofessional specializing in disability\n(e.g., physical medicine and rehabili-\ntation specialist, physical therapist,occupational therapist, speech-lan-\nguage... | [
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0.05738863721489906,
-0.09677440673112869,
0.0546714... |
guage pathologist). E\nA disability is de fined as a physical or\nmental impairment that substantially lim-\nits one or more major life activities of anindividual (130,131). Activities of daily liv-\ning (ADLs) and instrumental activities of | [
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0.033... |
ing (ADLs) and instrumental activities of\ndaily living (IADLs) comprise basic andcomplex life care tasks, respectively. Thecapacity to accomplish such tasks serves\nas an important measure of function. Di-\nabetes is associated with a strong in-crease in the risk of physical disability,with estimates of the associatio... | [
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tween diabetes and disability represent-\ning up to a 50 –80% increased risk of\ndisability for people with diabetes com-pared with people without diabetes (132).\nReviews have shown that lower-body\nfunctional limitation was the most preva-lent disability (47 –84%) among people | [
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-0.016393134370446205,
0.10279138386249542,
-0.03982365503907204,
-0.0001889... |
with diabetes (133,134). In a systematicreview and meta-analysis, the presence of\ndiabetes increased the risk of mobility dis-\nability (15 studies; odds ratio [OR] 1.71[95% CI 1.53 –1.91]; RR 1.51 [95% CI\n1.38– 1.64], of IADL disability (10 studies;\nOR 1.65 [95% CI 1.55 –1.74]), and of ADL | [
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0.1148681640625,
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0.0009206210... |
OR 1.65 [95% CI 1.55 –1.74]), and of ADL\ndisability (16 studies; OR 1.82 [95% CI1.63– 2.04]; RR 1.82 [95% CI 1.40– 2.36])\n(132). Diabetic peripheral neuropathy is a\ncommon complication of both type 1 and\n2 diabetes and may cause impaired pos-tural balance and gait kinematics (135),leading to functional disability. ... | [
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0.07721459120512009,
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0.029076386243104935,
0.10219647735357285,
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more, diabetic peripheral neuropathy may\nprogress to cause debilitating neuropathicpain and nontraumatic lower-limb ampu-\ntation, which has a devastating effect on | [
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0.014356966130435467,
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0.062892... |
quality of life (136). In addition to compli-c a t i o n so fd i a b e t e sf r o mm i c r o v a s c u l a rconditions such as diabetic kidney disease,retinopathy, and peripheral neuropathy, itis important to recognize the disabilitiescaused by macrovascular complications ofdiabetes. These macrovascular complica-tions,... | [
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These macrovascular complica-tions, which include coronary heart disease, | [
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stroke, and peripheral arterial disease, can\nlead to further impairments (133).\nAn assessment of disability should be | [
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performed at each visit and a referralmade to an appropriate health care profes-sional specializing in disability (e.g., physi-cal medicine and rehabilitation physician,physical therapist, occupational therapist,or speech-language pathologist). Custom-ized rehabilitation interventions for individ-uals with a disability... | [
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0.05286511778831482,
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0.08480318635702133,
0.0047832089476287365,
0.010856264270842075,
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0.04765405133366585,
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0.0... |
recover function, allowing for safe physical | [
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0.035709407180547714,
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0.02480633370578289,
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activity (137), and improve quality of life(138). Additionally, frailty is commonly as-sociated with diabetes, with progression todisability, morbidity, and mortality in olderadults. People with diabetes as well asfrailty or disability may contend with co-morbid conditions such as hypoglycemia,sarcopenia, falls, and co... | [
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0.0817398726940155,
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0.03742869198322296,
0.05049857124686241,
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0.08934952318668365,
-0.0013306320179253817,
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tion. A thorough medical evaluation is im-\nperative to identify the best approaches topreventative and therapeutic interventionswith respect to frailty and diabetes man-agement (139).\nMoreover, when treating people with | [
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0.05771306... |
Moreover, when treating people with\nan acquired disability from diabetes, it isvital to consider social determinants ofhealth, race/ethnicity, and socioeconomicstatus (140). Rates of diabetes-related ma-jor amputations have been found to be\nhigher in individuals who are from racial | [
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and ethnic minority groups (141), live inrural areas, and are from the lowest socio-economic regions (142). Addressing thecomplex challenges faced by individualswith acquired disabilities from diabetes re-quires a multifaceted approach involvingsolutions from both within and outsidethe health care system. By focusing o... | [
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cial determinants of health, health care\nprofessionals can develop targeted inter-ventions and establish support systemsthat cater to the speci ficn e e d so ft h i s\npopulation.\nHepatitis C\nInfection with hepatitis C virus (HCV) isassociated with a higher prevalence oftype 2 diabetes, which is present in up\nto one... | [
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0.0... |
to one-third of individuals with chronic\nHCV infection. HCV may impair glucosemetabolism by several mechanisms, in-cluding directly via viral proteins andindirectly by altering proin flammatory | [
-0.035775091499090195,
0.025731779634952545,
-0.07284117490053177,
0.009707141667604446,
0.01367131620645523,
0.05423963814973831,
0.06043270602822304,
0.0719117596745491,
-0.010920840315520763,
0.01575673185288906,
-0.06814128905534744,
0.026137320324778557,
0.014631933532655239,
0.089380... |
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