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Diabetes Canada 2013 Clinical Practice Guidelines

Quality Of Clinical Practice Guidelines For Glycemic Control In Type 2 Diabetes Mellitus

Quality Of Clinical Practice Guidelines For Glycemic Control In Type 2 Diabetes Mellitus

Quality of Clinical Practice Guidelines for Glycemic Control in Type 2 Diabetes Mellitus Haley K. Holmer , Lauren A. Ogden , Brittany U. Burda , Susan L. Norris Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America Affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America Several studies have reported that clinical practice guidelines (CPGs) in a variety of clinical areas are of modest or variable quality. The objective of this study was to evaluate the quality of an international cohort of CPGs that provide recommendations on pharmaceutical management of glycemic control in patients with type 2 diabetes mellitus (DM2). We searched the National Guideline Clearinghouse (NGC) on February 15th and June 4th, 2012 for CPGs meeting inclusion criteria. Two independent assessors rated the quality of each CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Twenty-four guidelines were evaluated, and most had high scores for clarity and presentation. However, scope and purpose, stakeholder involvement, rigor of development, and applicability domains varied considerably. The majority of guidelines scored low on editorial independence, and only seven CPGs were based on an underlying systematic review of the evidence. The overall quality of CPGs for glycemic control in DM2 is moderate, but there is substa Continue reading >>

Canadian Diabetes Educator Certification Board - Cp - Faq's

Canadian Diabetes Educator Certification Board - Cp - Faq's

Volunteer CDEs answer questions sent to the Certification Maintenance by Credit Portfolio Committee. If you have a question please email: [email protected] . Before submitting a question, please check to see if the answer to your question can be found in the How to Guide or in the current FAQs. For instruction on how to do a keyword search of the How to Guide refer to FAQ 1.1. When you submit a question please be as specific as possible. Attaching an example with your question is encouraged, e.g., a copy of the activity form. The committee does not answer questions from February 1st to May 31st. Submit your question by December 1st to guarantee a response before the application deadline. 2.2 When applying for Certification Maintenance which How to Guide should I consult? 4.5 Can I get an extension on the credit collection period? 5.0.1 What should I do if I need help or have questions about a specific activity to be used for the Credit Portfolio? 5.1 Activity category 1.0 Practice Review/Self-Assessment 5.1.1 Can my self-assessment and learning plan form for my professional body (Provincial Dietitians Association) replace form 1C? 5.2 Activity category 2.0 Organized Learning Activities 5.2.4 If I have read the Building CompetenciesThe Essentials or Advancing Practice can they be claimed for credit? 5.3 Activity category 3.0 Personally Designed Learning Activities 5.3.3 How do I know if a journal is peer reviewed? (Also applies to 5A) 5.4 Activity category 4.0 Educational Development/Teaching 5.5.1 How do I know if a journal is peer reviewed? (Also applies to 3B) 5.6.1 I've started to work as a committee member on our Education Committee to plan the yearly educational event. I'm assuming that this would be covered under Section 6A and that I would have to get the Con Continue reading >>

Metabolic And Cardiovascular Diseases

Metabolic And Cardiovascular Diseases

Diabetes is a chronic condition resulting from the bodys inability to sufficiently produce and/or properly use insulin.1 As of 2009, the estimated prevalence of diabetes in Canada was 6.8% of the population 2.4 million Canadians a 230% increase compared to prevalence estimates in 1998. By 2019, that number is expected to grow to 3.7 million. 2 Janssen provides an oral medication to help lower blood sugar in adults with type 2 diabetes. 1. Public Health Agency of Canada. Diabetes Facts. Available at: 2. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212. The main job of the kidneys is to remove wastes and excess water from the body. A slow loss of kidney function over time is known as chronic kidney disease. The two most common causes for chronic kidney disease are diabetes and high blood pressure, although many other diseases and conditions can lead to kidney damage.1 Between 2007 and 2009, 12.5% of Canadian adults (2.9 million people) were living with chronic kidney disease, an important risk factor for end-stage renal disease and all-cause mortality.2 1. PubMed Health. Chronic Kidney Disease. Available at: 2. Arora P, Vasa P, Brenner D, et al. Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ 2013. DOI:10.1503/cmaj.120833 Continue reading >>

Diabetes Info Pharmacy 101

Diabetes Info Pharmacy 101

Pharmacy101 is proud to be a Community Pharmacy Partner with the Diabetes Canada (previously known as: Canadian Diabetes Association, CDA). Susie takes private appointments to discuss your diabetes. Please call or email to make an appointment. Pharmacist, CDE, CPT BCGP / Certified Fitter for Compression Stockings Susie is a pharmacist, Certified Diabetes Educator, Certified Insulin Pump and Continuous Glucose Sensor Trainer, Board Certified Geriatric Pharmacist and Certified Fitter for Compression Therapy. Her professional experience in Diabetes Education includes a variety of practice settings such as her local hospital Diabetes Education Program, her local Community Health Centre, within a medical clinic, and now, primarily, in her community pharmacy. In her volunteer work, Susie has served on the Dissemination and Implementation Committee of the Canadian Diabetes Association (CDA)for the 2008 and now the 2013 Clinical Practice Guidelines (CPGs), taking on a leadership role as Co-Lead of Organization of Care/Team Care. She is the co-chair of her local DES chapter and, on a National level, serves on the DES Executive as Director of Finance. Susie is actively involved in interprofessional education as seen through her guideline and recommendation development work with the CDA 2018 CPGs and Wounds Canada (previously: Canadian Association of Wound Care (CAWC)). In addition, Susie is often writing, reviewing and presenting for both the public and an interprofessional audience. Susie has been privileged to serve on a variety of committees, such as the Banting and Best Diabetes Centre Advisory Board and the provincial Clinical Advisory Committee for the Ontario Telehomecare Program, which all work toward improving the care of people living with chronic diseases. She has bee Continue reading >>

Canadian Journal Of Diabetes

Canadian Journal Of Diabetes

Check the status of your submitted manuscript in EVISE Once production of your article has started, you can track the status of your article via Track Your Accepted Article. CiteScore: 1.74 CiteScore measures the average citations received per document published in this title. CiteScore values are based on citation counts in a given year (e.g. 2015) to documents published in three previous calendar years (e.g. 2012 14), divided by the number of documents in these three previous years (e.g. 2012 14). The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. 2016 Journal Citation Reports (Clarivate Analytics, 2017) 5-Year Impact Factor: 2.415 Five-Year Impact Factor: To calculate the five year Impact Factor, citations are counted in 2016 to the previous five years and divided by the source items published in the previous five years. 2016 Journal Citation Reports (Clarivate Analytics, 2017) Publishing your article with us has many benefits, such as having access to a personal dashboard: citation and usage data on your publications in one place. This free service is available to anyone who has published and whose publication is in Scopus. Canadian Journal of Diabetes is Canada's only diabetes-oriented, peer-reviewed, interdisciplinary journal for diabetes healthcare professionals. Published bimonthly, Canadian Journal of Diabetes contains original articles, resource reviews, a journal watch, shorter articles such as Perspectives in Practice... Canadian Journal of Diabetes is Canada's only diabetes-oriented, peer-reviewed, interdisciplinary journal for diabetes healthcare professionals. Published bimonthly, Canadian Journal of Diabetes contains original articles, resource revie Continue reading >>

Canadian Journal Of Diabetes

Canadian Journal Of Diabetes

Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada Volume 37, Supplement 1, Pages A1-A16, S1-S216 (April 2013) Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Maureen Clement, Betty Harvey, Doreen M. Rabi, ... Diana Sherifali Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Helen Jones, Lori D. Berard, Gail MacNeill, ... Catherine Yu Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Lori D. Berard, Ian Blumer, Robyn Houlden, ... Vincent Woo Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Ronald J. Sigal, Marni J. Armstrong, Pam Colby, ... Michael C. Riddell Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Paula D. Dworatzek, Kathryn Arcudi, Rjeanne Gougeon, ... Sandra L. Williams Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, James A. Stone, David Fitchett, Steven Grover, ... Peter Lin Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, G.B. John Mancini, Robert A. Hegele, Lawrence A. Leiter Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Richard E. Gilbert, Doreen Rabi, Pierre LaRochelle, ... Vincent Woo Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Philip McFarlane, Richard E. Gilbert, Lori MacCallum, Peter Senior Canadian Diabetes Association Clinical Practice Guideline Expert Committee, Shelley R. Boyd, Andrew Advani, Filiberto Altomare, Frank Stockl Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Stewart B. Harris, Onil Bhattacharyya, Roland Dyck, ... Ellen L. Toth Cookies are used by this site. For more information, Continue reading >>

Sick Day Guidelines For Those With Type 2 Diabetes

Sick Day Guidelines For Those With Type 2 Diabetes

I N F O R M A T I O N B O O K L E T It is important to know how to take care of yourself if you are ill, have an infection or injury, or are under stress. You need to know that: • Hypoglycemia (low blood glucose) can occur if you are not able to eat or drink, or if you have symptoms of an illness, such as vomiting and/or diarrhea. • Hyperglycemia (high blood glucose) can occur in response to the body’s release of stress hormones when you are ill or under stress. Other causes include certain medications, such as steroids, a missed insulin dose, or injection site issues. • Hyperosmolar Hyperglycemic State (HHS) can occur as a result of hyperglycemia. HHS is a life threatening condition and requires immediate medical attention. Warning signs include: hyperglycemia, dehydration, nausea, vomiting, a decreased level of awareness, weakness, loss of vision, etc. Do not confuse these symptoms with symptoms of the flu! Developed by the Diabetes Education Team at the OSMH Diabetes Education Centre. Adapted from materials developed by the Canadian Diabetes Association (CDA) and based on the 2013 CDA Clinical Practice Guidelines. Revised July 2013. 7. Seek immediate medical assistance if: • You are not well enough or able to follow these guidelines or are worried about your symptoms; • You have vomited and/or have had diarrhea 1 or more times in 4 hours; • You are unable to eat or drink; • You are showing signs of dehydration, like a very dry mouth, cracked lips, dry skin or sunken eyes; • Your blood glucose has been higher than 20 mmol/L for more than 12 hours; and/or • You cannot keep your blood glucose above 4 mmol/L or you are having a severe hypoglycemic reaction. 8. Prepare for tests and procedures. Plan in advance. Continue reading >>

Drsue.ca: New Canadian Diabetes Association Clinical Practice Guidelines Update

Drsue.ca: New Canadian Diabetes Association Clinical Practice Guidelines Update

New Canadian Diabetes Association Clinical Practice Guidelines Update While the full Canadian Diabetes Association (CDA) Clinical Practice Guidelines are formally updated every 5 years (with the next edition due in 2018), interim updates are published if new evidence emerges that is considered to be practice changing. As such, the CDA has just released an interim update with revised recommendations , in light of the new cardiovascular outcome trial of a diabetes medication called liraglutide. As blogged previously , in people with type 2 diabetes who were at high risk of cardiovascular disease, the liraglutide cardiovascular trial (called the LEADER trial) demonstrated that liraglutide reduced the risk of cardiovascular events by 13%. Put another way: if 66 people are treated for 3 years with liraglutide, one cardiovascular event would be prevented. In the LEADER trial, 81% of patients had a past history of established cardiovascular disease, while 19% of patients did not (but they were still considered to be at high risk of CV events due to their risk factors). Subgroup analyses suggested that it was patients who had a history of established cardiovascular disease who had the reduction in risk with liraglutide. As patients had to be age 50 or older to be included in the study, we do not know if these findings apply to a younger population. In the revised CDA Guidelines, liraglutide now joins another medication called empagliflozin , as medications to consider after metformin, in patients with type 2 diabetes and established cardiovascular disease, who are not at target blood sugar control. As ongoing cardiovascular outcome trials of diabetes medications are completed and published, the CDA Guidelines will be updated accordingly. I have pasted the new algorithm below, Continue reading >>

Proper Management Of Gestational Diabetes Improves Health For Baby And Mom

Proper Management Of Gestational Diabetes Improves Health For Baby And Mom

Proper management of gestational diabetes improves health for baby and mom Pregnancy is a time of promise and expectation, but it can also raise the possibility for some women that they will develop gestational diabetes mellitus (GDM). Unlike other types of diabetes, gestational diabetes is not permanent. In most women, the condition disappears within a few days of delivery. GDM is a condition that develops during pregnancy, when the body is not able to make enough insulin to overcome the bodys resistance to insulin. The lack of insulin causes the womens blood glucose level to become elevated compared to the usual levels seen during pregnancy. In Canada, GDM is higher than previously thought, varying from 3.7 percent in non-Aboriginal women to up to 18 percent in Aboriginal women. GDM is caused by hormones that are released by the placenta, which in turn can change the way insulin works by blocking the interaction between insulin and glucose. These hormonal changes are a natural part of every pregnancy and usually dont cause any maternal or fetal health problems. As the placenta grows, it produces more of these hormones, making it increasingly difficult for the body to use insulin, hence creating whats known as insulin resistance. During this insulin resistance period, the pancreatic beta cells compensate by increasing their insulin production usually up to three times as much insulin as normal. However, in some women, the pancreas cannot produce an adequate amount of insulin and therefore they will experience higher than normal glucose levels and in turn develop gestational diabetes. The extra blood glucose can also cross the maternal placenta and increase fetal blood glucose levels as well, which in turn will stimulate the fetal pancreas to produce more insulin to no Continue reading >>

Eating Strategies To Prevent And Control Diabetes

Eating Strategies To Prevent And Control Diabetes

Mireille Moreau RD, MSc Human Nutrition [email protected] DIABETES MELLITUS A disease characterized by elevated blood glucose levels and inadequate or ineffective insulin Type 1 Type 2 Prediabetes 5 -10% of cases 90-95% of cases ~5.4 million ppl Autoimmune disorder - little to no insulin secretion Lose sensitivity to insulin Impaired fasting glucose, impaired glucose tolerance FPG ≥ 7.0mmol/L 2HPG ≥ 11.1mmol/L FPG ≥ 7.0mmol/L 2HPG ≥ 11.1mmol/L FPG ≥ 6.1-6.9mmol/L 2HPG 7.8-11mmol/L Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. PREVALENCE OF DIABETES THROUGHOUT THE WORLD Public Health Agency of Canada. Diabetes in Canada: Facts and figures from a public health perspective. Ottawa, 2011. Age-standardized prevalence and number of cases of diagnosed diabetes among individuals aged ≥ 1 year, 1998/99 to 2008/09 in Canada Risk factors Age ≥ 40 years Having a close relative who has type 2 diabetes; Member of a high-risk population (Aboriginal, Hispanic, Asian, South Asian or African descent); History of prediabetes/ gestational diabetes; Heart disease; High blood pressure; High cholesterol or other fats in blood; Being overweight Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes. COMPLICATIONS OF DIABETES Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes. DIABETES: A SILENT DISEASE Signs and symptoms can include Unusu Continue reading >>

Aace/ace Clinical Practice Guidelines

Aace/ace Clinical Practice Guidelines

American Association of Clinical Endocrinologists The American Association of Clinical Endocrinologists The Voice of Clinical Endocrinology Founded in 1991 Keep up to date with the latest in Legislative and Regulatory news AACE recognizes the importance of providing continued education to its members, which may require financial support from an outside entity through unrestricted educational grants. Outside support will not be used for the development and/or writing of AACE consensus statements/conference proceedings, white papers, or guidelines. Outside support may be accepted for the administration/ logistical support of a consensus conference and for the dissemination and distribution of the final written paper. The content of these documents is developed solely by AACE members and, as always, will remain free of any outside entity influence. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions, but are in no way a substitute for a medical professional's independent judgment and should not be considered medical advice. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment of the authors was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with, and not a replacement for, their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines Continue reading >>

A Critical Evaluation Of Existing Diabetic Foot Screening Guidelines

A Critical Evaluation Of Existing Diabetic Foot Screening Guidelines

To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure.A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'.Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them.Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. A Critical Evaluation of Existing Diabetic Foot Screening Guidelines. Rev Diabet Stud. 2016 Summer-Fall; 13(2-3): 158186. Publishe Continue reading >>

Clinical Practice Guidelines (french)

Clinical Practice Guidelines (french)

Effective January 3, 2017,full accessto JOGC content published after January 1, 2016 (including Clinical Practice Guidelines, Committee Opinions, Technical Updates, and all articles) is a benefit of SOGC membership. As part of our commitment to quality, open access to Abstracts, Recommendations, and Summary Statements will continue for all users. Members -to access the JOGC, please follow these instructions: 1. Please click here to log in as an SOGC member. Upon successful login, you will be taken to the JOGC website where you will be recognized as an SOGC member and will have access to all content. You cannot log in directly from www.jogc.com. You must go through the SOGC website to access content. If you do not have your SOGC member details, please enter your email address on this page to retrieve your username and reset your password: If you are still having problems, please send a screenshot of the error to Josephine Sciortino at [email protected] so that she can investigate and find a solution for you. Are you having trouble locating a specific guideline? Please email [email protected] We are working through indexing and adding older guidelines (pre-2002) to this page. Thank you for your patience. Current < 5 years or has been reaffirmed for continued use until further notice Current > 5 years: is being reviewed to determine if it requires updating - use this version with discretion, as it is possible that some information may be out-of-date > 5 years: has recently been reviewed and an updated version will be soon be published - use this version with discretion as some information has been deemed to be outdated deemed to have dated information, and therefore should not be consulted for clinical use but rather for historical research only Continue reading >>

Diabetes Management - Canadian Stroke Best Practice Recommendationscanadian Stroke Best Practice Recommendations

Diabetes Management - Canadian Stroke Best Practice Recommendationscanadian Stroke Best Practice Recommendations

Note: These recommendations are applicable to ischemic stroke and transient ischemic attack. 5.0 Patients with diabetes who have had an ischemic stroke or transient ischemic attack should have their diabetes assessed and optimally managed [Evidence level A]. Patients with ischemic stroke or transient ischemic attack (TIA) should be screened for diabetes with either a fasting plasma glucose, or 2 hour plasma glucose, or glycated hemoglobin (A1C), or 75 g oral glucose tolerance test in either inpatient or outpatient setting [Evidence Level C; Diabetes Canada 2016]. For patients with diabetes and either ischemic stroke or transient ischemic attack, glycated hemoglobin (A1C) should be measured as part of a comprehensive stroke assessment [Evidence Level B]. Refer to Prevention of Stroke Section 3 for information on blood pressure management in an individual with stroke and diabetes; refer to Prevention of Stroke Section 4 for information on lipid management in an individual with stroke and diabetes. Glycemic targets should be individualized: however, lowering A1C values to 7% in both type 1 and type 2 diabetes and stroke or transient ischemic attack, provides strong benefits for the prevention of microvascular complications [Evidence Level A]. To achieve a target of A1C 7.0%, most patients with type 1 or type 2 diabetes should aim for a fasting plasma glucose or preprandial plasma glucose target of 4.0 to 7.0 mmol/L [Evidence Level B]. The 2-hour postprandial plasma glucose target is 5.0 to 10.0 mmol/L [Evidence Level B]. If A1C targets cannot be achieved with a postprandial target of 5.0 to 10.0 mmol/L, further postprandial blood glucose lowering, to 5.0 to 8.0 mmol/L, should be considered [Evidence Level C]. Note: For recommendations on the use of SGLT-2 inhibitors, plea Continue reading >>

2013 Clinical Practice Guidelines Return

2013 Clinical Practice Guidelines Return

Useful links Useful documents Store Mobile tools For health professionals Maps Glossary Over a hundred diabetes specialists, including physicians, nurses, pharmacists, dietitians and diabetes educators, contributed to the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada. Several specialists from Quebec were also involved. These Guidelines update the previous guidelines produced in 2008. Highlights of some of the major changes in the 2013 Guidelines, compared to 2008: For the diagnosis of type 2 diabetes in adults, a value of glycated hemoglobin (A1C) greater than or equal to 6.5% is now a diagnostic criteria. Furthermore, the use of A1C is not advised for diagnosing type 1 diabetes or when a disease is present that could affect the test. A1C is also used to diagnose prediabetes when the value is between 6.0% and 6.4%. In addition, the Guidelines suggest individualizing target A1C values for each person. A value of less than 7.0% remains the target for most people with diabetes, but values ranging from ? 6.0% to ? 8.5% can be targets for certain individuals. Alternative dietary patterns and certain specific foods can be beneficial for people with type 2 diabetes. In addition to reiterating the benefits of vegetarianism and the DASH diet, the Guidelines mention that the Mediterranean diet can improve glycemic control and prevent cardiovascular disease, as can a diet incorporating legumes or nuts. The Reference Guide to the Clinical Practice Guidelines advises that treatment following a diagnosis of diabetes should be individualized, based on lifestyle changes and should take cost into consideration when choosing a medication. Furthermore, since being overweight is a diabetes risk factor and increases i Continue reading >>

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