When Is Diabetes Distress Clinically Meaningful?
Abstract OBJECTIVE To identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Recruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA1c, diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms. RESULTS Significant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA1c (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA1c (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0–2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2. CONCLUSIONS In two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA1c, diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress. RESEARCH DESIGN AND METHODS Subjects Baseline samples f Continue reading >>
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Scales And Measures Bdi
The DDS is a 17-item scale that captures four critical dimensions of distress:emotional burden, regimen distress, interpersonal distress and physician distress. First published in2005, ithas been used widely around the world as a clinicalinstrument for opening conversation with ones patients aswell as a critical outcome measures in numerous studies. This copyrighted scale is available free of chargeto non-profit institutions for use in clinical careand research.However, payment of a per use licensing fee is required for all for-profit companies and other for-profitinstitutions. To find out more about licensing procedures and fees in regards to for-profit organizations, pleasecontact us [email protected]. A caution regarding subscale scoring: It has come to our attention that several of the translated versions have changed the order and some content of the DDS items. This may make the order and content of the subscales unreliable. We caution anyone who is using translated versions and who wishes to make use of the subscales to make certain that the order and content of the items match the original English version. Continue reading >>
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![Association Between Diabetes Distress And All-cause Mortality In Japanese Individuals With Type 2 Diabetes: A Prospective Cohort Study (diabetes Distress And Care Registry In Tenri [ddcrt 18])](https://diabetestalk.net/images/ObbXJwPPPxzgLmLg.jpg)
Association Between Diabetes Distress And All-cause Mortality In Japanese Individuals With Type 2 Diabetes: A Prospective Cohort Study (diabetes Distress And Care Registry In Tenri [ddcrt 18])
, Volume 61, Issue9 , pp 19781984 | Cite as Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18]) for the Diabetes Distress and Care Registry at Tenri Study Group The absence of data on the direct association between diabetes-specific distress and all-cause mortality in individuals with diabetes prompted us to examine the temporal association between Problem Areas in Diabetes (PAID) survey scores and the subsequent risk of all-cause mortality in a cohort of individuals with type 2 diabetes. Longitudinal data from 3305 individuals with diabetes were obtained from a large Japanese diabetes registry. Independent correlations between quintiles of PAID total scores or PAID scores of 40 and all-cause mortality (median follow-up of 6.1years) were examined using Cox proportional hazards models with adjustment for potential confounders. The study population included 1280 women and 2025 men with a mean age of 64.9years, BMI of 24.6kg/m2 and HbA1c level of 58.7mmol/mol (7.5%). In the multivariable-adjusted model, compared with the first quintile of PAID scores, the multivariable-adjusted HRs (95% CIs) for all-cause mortality for the second to fifth quintiles were 1.11 (0.77, 1.60; p = 0.56), 0.87 (0.56, 1.35; p = 0.524), 0.95 (0.63, 1.46; p = 0.802) and 1.60 (1.09, 2.36; p = 0.016), respectively. Compared with a PAID score of <40, the multivariable-adjusted HR for all-cause mortality of those with a score of 10 was 1.56 (95% CI 1.17, 2.08; p = 0.002). In subgroup analyses, the association between PAID score and all-cause mortality was found in men (HR 1.76; 95% CI 1.26, 2.46) but not in women (HR 1.09; 95% CI 0.60, 2.00), with a significant in Continue reading >>
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Diabetes Distress: Why Its Common And What We Can Do About It!
Diabetes Distress: Why Its Common and What We Can Do About It! Twitter Summary: Providers and caregivers can help PWD by providing a sense of hope, and more. At the recent IDF World Diabetes Congress in Vancouver, behavioral diabetes guru Dr. Bill Polonskygave a talk on diabetes distress, covering what this emotional state looks like, how and why it occurs, and simple strategies for addressing it. This reflects his research dedicated to one big question: how can we help people with diabetes feel motivated to succeed? Dr. Polonsky stressed that providers often communicate the wrong message rather than hope, patients hear negatives and feel fear. The reason for vigilant management is not to live a long and healthy life, but to avoid complications. That framing makes a difference, as people with diabetes often go on to develop distress: an attitude of feeling defeated by diabetes. We share Dr. Polonskys belief that all patients want to live healthy lives. The hard question, however, is how patients, providers, and caregivers should reframe conversations about diabetes. Heres what Dr. Polonsky said: Dr. Polonsky shared what diabetes distress sounds like in practice: Diabetes is taking up too much of my mental and physical energy every day I am often failing with my diabetes regimen. Friends or family are not supportive enough of my self-care efforts. I will end up with serious long-term complications no matter what I do. How common is diabetes distress? (You are not alone!) The rate of diabetes distress is far greater than is often appreciated; 39% of type 1 and 35% of type 2 patients experience significant levels of diabetes distress at any given time.This distress cannot be treated with depression medications becauseit is not depression! Rather, it requiresa greater focu Continue reading >>
International Journal Of Medicine And Biomedical Research Volume 2 Issue 2 May €“ August 2013 Www.ijmbr.com © Michael Joanna Publications
Original Article Int J Med Biomed Res 2013;2(2):113-124 113 Diabetes distress among type 2 diabetic patients Islam MR 1* , Karim MR 2 , Habib SH 3 , Yesmin K 4 1 Research and Training Monitoring Department, Bangladesh College of Physicians and Surgeons (BCPS),Mohakhali, Dhaka, Bangladesh ,2 National Nutrition Services, Institute of Public Health Nutrition, Mohakhali, Dhaka, Bangladesh , 3 BIRDEM, Dhaka, Bangladesh, 4 Musapur Union Sub- center Raipura, Narsingdi, Bangladesh *Corresponding author: [email protected] INTRODUCTION Diabetes mellitus (DM) is one of the most common non-communicable diseases (NCDs) globally. [1] It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many economically ABSTRACT Background: Diabetes mellitus is being increasingly recognized as a serious global health problem and is frequently associated with co-morbid distress, contributing double burden for the individual and the society. Aim: This study documents the proportion of diabetes distress and factors associated with it. Methods: A cross-sectional study was conducted from January to June 2012. Data were collected through interview and record review of 165 adults with type 2 diabetes. Results: The proportion of diabetes distress among the study population was 48.5%, which includes 22.4% high distress and 26.1% moderate distress. The remainder had little or no distress. The Mean ± SD of total diabetes distress score was2.17 ± 0.75. The Mean ± SD for each domain score such as emotional burden, physician-related distress, regimen- related distress and interpersonal distress was (3.49 ± 1.52), (1.13 ± 0.32), (2.12 ± 0.85), (1.40± 0.65) respectively. Emotional burden was considered as the mo Continue reading >>
Diabetes Distress Learning Center - Diabetes University Dmcp
Diabetes Distress leads to frustration, anger, disappointment,fatigue, disorganization, and burnout for both the clinician and the patient.This leads to a sense of failure and a feeling that nothing can be done by office staff,clinicians, and patients. Actions, words, and non verbal behavior from all three groupsindicate this in one way or another. Suspect Diabetes Distress in any patient who is notachievingtheir goals for A1C, LDL B/P or has significant difficulty with selfmanagemente.g nutrition, weight,orphysicalactivity. Start with the DDS2 a 2 question screening test--if the scores are 3 or greater then go to DDS17 a 17 question test. Dr. Fisher cautions that use of the DDS 2 may not be effective and it is of more value to use the full scale or a few sub scales. Although the test can be self administered I find it helpful for it to beadministeredby the clinician or other Health Care Provider (HCP) to the patient. The DDS 17 is available in English and Spanish. Click here to download the questionnaires and scoring sheet. If you would like to learn more about Diabetes Distress you can download slides (pdf format) that provide more information by clicking here . After reviewing the slides and you wish to obtain a Diabetes Distress Learning Center Certificate (below) you will need to take a test. The test is set up for you to make 100. Click here to take the test. Thequestionnairecan be selfadministeredbut I have found it helpful to read thequestionnairewith the patient. This provides theopportunityforthe patient toexpand on theiranswer and Health CarePractitioner (HCP)candiscover more about patient feelings. When the HCP administersthequestionnaire this createstrust andstrengtheningof the bond with thepatient. It also provides opportunityto start treatment. Treatment Continue reading >>
Is Diabetes Distress On Your Radar Screen?
Is Diabetes Distress on Your Radar Screen? Clinician Reviews. 2017 June;27(6):30-31,34-37 Elizabeth A. Beverly and Todd R. Fredricks are in the Department of Family Medicine and Nedyalko N. Ivanov and Autumn B. Court are in the Department of Medicine at the Ohio University Heritage College of Osteopathic Medicine, Athens. The authors reported no potential conflict of interest relevant to this article. This article originally appeared in The Journal of Family Practice (2017;66[1]:9-14). Diabetes distress, which affects almost half of those with diabetes, contributes to worsening glycemic control. Recognizing and responding to it is essential. 1. Gafarian CT, Heiby EM, Blair P, et al. The diabetes time management questionnaire. Diabetes Educ. 1999;25:585-592. 2. Wdowik MJ, Kendall PA, Harris MA. College students with diabetes: using focus groups and interviews to determine psychosocial issues and barriers to control. Diabetes Educ. 1997;23:558-562. 3. Rubin RR. Psychological issues and treatment for people with diabetes. J Clin Psychol. 2001;57:457-478. 4. Ali MK, Bullard KM, Gregg EW. Achievement of goals in US diabetes care, 1999-2010. N Engl J Med. 2013;369:287-288. 5. Lloyd CE, Smith J, Weinger K. Stress and diabetes: Review of the links. Diabetes Spectr. 2005;18:121-127. 6. Weinger K. Psychosocial issues and self-care. Am J Nurs. 2007;107(6 suppl):S34-S38. 7. Weinger K, Jacobson AM. Psychosocial and quality of life correlates of glycemic control during intensive treatment of type 1 diabetes. Patient Educ Couns. 2001;42:123-131. 8. Albright TL, Parchman M, Burge SK. Predictors of self-care behavior in adults with type 2 diabetes: an RRNeST study. Fam Med. 2001;33:354-360. 9. Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in Continue reading >>
Diabetes-related Distress Assessment Among Type 2 Diabetes Patients
Diabetes-Related Distress Assessment among Type 2 Diabetes Patients 1Taif University School of Medicine, Taif, Saudi Arabia 2Diabetes and Endocrinology Center, Prince Mansoure Hospital, Taif, Saudi Arabia Correspondence should be addressed to Khaled Alswat Received 7 October 2017; Revised 20 January 2018; Accepted 4 February 2018; Published 26 March 2018 Copyright 2018 Majed O. Aljuaid et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background and Objectives. Diabetes is one of the most common chronic diseases; it is a debilitating and hard to live with. Diabetes-related distress (DRD) refers to the emotional and behavioral changes caused by diabetes. Our study aims to assess the prevalence of DRD among type 2 diabetes (T2D) patients using Diabetes Distress Scale-17 items (DDS-17) and its relation to complications and treatment modalities. Methods. A cross-sectional study of adult T2D patients with follow-up visits at the Diabetes and Endocrinology Center in Taif, Saudi Arabia, between January and July 2017. We excluded patients with other forms of diabetes, untreated hypothyroidism, and psychiatric illness. The total score of DDS-17 was calculated by summing the 17 items results and then dividing the total by 17. If the total score was >2, then it was considered as clinically significant results (moderate distress), but if it is 3, then it is classified as a high distress. Results. A total of 509 T2D patients with a mean age of 58 14 years were included. The majority of participants were male, married, not college educated, and reported a sedentary lifestyle. We found 25% of the screened T2D pati Continue reading >>
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(pdf) Diabetes Distress Among Type 2 Diabetic Patients
Key words: Diabetes mellitus, diabetes distress, HbA1c, glycaemic status Islam et al.: Diabetes distress and type 2 diabetes mellitus countries.[1] Diabetes is undoubtedly one of the most challenging health problems in the distribution of diabetes over the last 20 years continue to confirm that it is the low- and middle-income countries (LMICs) that face the greatest burden of diabetes.[1] However, planners still remain largely unaware of the current magnitude, or, more importantly, the future potential for increases in diabetes and More than 80% of diabetes deaths occur in low- and middle-income countries. The World diabetes deaths will increase by two thirds between 2008 and 2030. Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes mellitus Epidemiological evidences suggest that the incidence of diabetes is increasing worldwide. It is now believed that low and middle-income countries will face the greatest burden of mellitus and the management and prevention of the complications are important challenges evidences from applied clinical research that morbidity and mortality risks associated with Diabetes distress (DD) is defined as patient care, is an important condition distinct from depression.[5] Diabetes-distress is a part of diabetes and it is a non-psychiatric distress.[5] Addressing diabetes-distress improves both requires.[5] This often includes frustration with the ongoing obligations of diet, physical activity, blood glucose monitoring and taking Fisher and his colleagues reported that they screening instrument that can be used in a clinical setting.[6] This scale builds upon a 17- item Diabetes Distress Scale that had been briefer version of the scale, Dr. Fisher Continue reading >>
- Medication Adherence and Improved Outcomes Among Patients With Type 2 Diabetes
- Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives
- Rates of new diagnosed cases of type 1 and type 2 diabetes on the rise among children, teens
Two-item Screening Tool Can Help Identify Diabetes-specific Distress
Two-Item Screening Tool Can Help Identify Diabetes-Specific Distress This article is intended for primary care clinicians, endocrinologists, psychiatrists, and other specialists caring for patients with distress related to diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Describe the sensitivity and specificity of composites derived from items on the 17-item Diabetes Distress Scale. Describe a 2-item composite (DDS2) and its value in screening for diabetes-related distress. As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships. Disclosure: Brande Nicole Martin has disclosed no relevant financial information. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.25 AMA P Continue reading >>
Development Of A Brief Diabetes Distress Screening Instrument
Go to: Abstract PURPOSE Previous research has documented that diabetes distress, defined as patient concerns about disease management, support, emotional burden, and access to care, is an important condition distinct from depression. We wanted to develop a brief diabetes distress screen instrument for use in clinical settings. METHODS We assessed 496 community-based patients with type 2 diabetes on the previously validated, 17-item Diabetes Distress Scale (DDS17) and 6 biobehavioral measures: glycated hemoglobin (HbA1c); non–high-density-lipoprotein (non-HDL) cholesterol; kilocalories, percentage of calories from fat, and number of fruit and vegetable servings consumed per day; and physical activity as measured by the International Physical Activity Questionnaire. RESULTS An average item score of ≥3 (moderate distress) discriminated high- from low-distressed subgroups. The 4 DDS17 items with the highest correlations with the DDS17 total (r = .56–.61) were selected. Composites, comprised of 2, 3, and 4 of these items (DDS2, DDS3, DDS4), yielded higher correlations (r=.69–.71). The sensitivity and specificity of the composites were .95 and .85, .93 and .87, and .97 and .86, respectively. The DDS3 had a lower sensitivity and higher percentages of false-negative and false-positive results. All 3 composites significantly discriminated subgroups on HbA1c, non-HDL cholesterol, and kilocalories consumed per day; none discriminated subgroups on fruit and vegetable servings consumed per day; and only the DDS3 yielded significant results on the International Physical Activity Questionnaire. Because of its psychometric properties and brevity, the DDS2 was selected as a screening instrument. CONCLUSIONS The DDS2 is a 2-item diabetes distress screening instrument asking respo Continue reading >>
Diabetes Distress: A Real And Normal Part Of Diabetes
CLINICAL CARE 28 Diabetes Voice 29Diabetes VoiceVolume 62 - Issue 3 September 2016 Volume 62 - Issue 3 September 2016 28 Diabetes Voice 29Diabetes VoiceVolume 62 - Issue 3 September 2016 Volume 62 - Issue 3 September 2016 EXPERT INTERVIEW Elizabeth Snouffer with Lawrence Fisher Living successfully with type 1 or type 2 diabetes requires the very large task of managing a serious chronic condition. The tasks associated with diabetes can be complex and demanding and most people in their life journey with diabetes report great frustration with the burden of the disease. These physical and emotional demands generate emotional distress that can include worry, fear, sadness and anger regarding the emergence of complications, hypoglycaemic episodes, unpredictable blood glucose and feelings of ‘diabetes burnout’. Diabetes Distress is distinct from clinical depression, but high levels of distress are linked to poor glycaemic “management†and problematic self- care behaviours. Diabetes Distress often leads to the thought pattern of “I just can’t do this anymore†and for the primary diabetes healthcare provider, this is a signal that an open discussion can help individuals connect all the things they must ‘do’ with all of the emotions a person living with diabetes ‘feels’. Lawrence Fisher, PhD, from the Department of Family and Community Medicine and the University of California, San Francisco and William Polonsky, PhD, at the Department of Psychiatry, University of San Diego California developed the Diabetes Distress Scales (DDS) for people with type 2 diabetes and the T1DDS for people with type 1 diabetes to help providers and their patients gain a better understanding of the emotional side of diabetes, recognize b Continue reading >>
Depression And Diabetes Distress In Adults With Type 2 Diabetes: Results From The Australian National Diabetes Audit (anda) 2016
Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016 Scientific Reportsvolume8, Articlenumber:7846 (2018) | Download Citation This study explores the prevalence of, and factors associated with, likely depression and diabetes distress in adults with type 2 diabetes in a large, national sample. Australian National Diabetes Audit data were analysed from adults with type 2 diabetes attending 50 diabetes centres. The Brief Case find for Depression and Diabetes Distress Score 17 were administered to screen for likely depression and diabetes-related distress, respectively. A total of 2,552 adults with type 2 diabetes participated: (mean SD) age was 63 13 years, diabetes duration was 12 10 years, and HbA1c was 8 2%. Twenty-nine percent of patients had likely depression, 7% had high diabetes distress, and 5% had both. Difficulty following dietary recommendations, smoking, forgetting medications, and diabetes distress were all associated with greater odds of depression whereas higher own health rating was associated with lower odds (all p < 0.02). Female gender, increasing HbA1c, insulin use, difficulty following dietary recommendations and depression were all associated with greater odds of diabetes distress & older age, higher own health rating and monitoring blood glucose levels as recommended were associated with lower odds (all p < 0.04). Depression was associated with sub-optimal self-care, while diabetes distress was associated with higher HbA1c and sub-optimal self-care. Driven by ageing, obesity and sedentary lifestyles, type 2 diabetes mellitus (T2DM) currently affects just under 400 million individuals worldwide and is expected to rise exponentially, affecting 592 million by 2035 1 . Globally, Continue reading >>
The Validity And Reliability Of The English Version Of The Diabetes Distress Scale For Type 2 Diabetes Patients In Malaysia
Abstract Several disease specific instruments have been developed to identify and assess diabetes distress. In Malaysia, the Problem Areas in Diabetes Scale has been validated in Malay, but it does not have specific domains to assess the different areas of diabetes-related distress. Hence, we decided to use the Diabetes Distress Scale instead. To date, only the Malay version of the Diabetes Distress Scale has been validated in Malaysia. However, English is widely spoken by Malaysians, and is an important second language in Malaysia. Therefore, our aim was to determine the validity and reliability of the English version of the Diabetes Distress Scale among patients with type 2 diabetes in Malaysia. The Diabetes Distress Scale was administered to 114 patients with type 2 diabetes, who could understand English, at baseline and 4 weeks later, at a primary care clinic in Malaysia. To assess for convergent validity, the Depression Anxiety Stress Scale was administered at baseline. Discriminative validity was assessed by analysing the total diabetes distress scores of participants with poor (HbA1c > 7.0%) and good glycaemic control (HbA1c ≤ 7.0%). The majority of our participants were male 65(57.0%), with a median duration of diabetes of 9.5 years. Exploratory factor analysis showed that the Diabetes Distress Scale had 4 subscales, as per the original Diabetes Distress Scale. The overall Cronbach’s α was 0.920 (range = 0.784–0.859 for each subscale). The intraclass correlation ranged from 0.436 to 0.643 for test-retest. The Diabetes Distress Scale subscales were significantly correlated with the different subscales of the Depression Anxiety Stress Scale (spearman’s rho range = 0.427–0.509, p < 0.001). Patients with poor glycaemic control had significantly higher dia Continue reading >>
What Is Diabetes Distress?
WRITTEN BY: Elizabeth Snouffer We had been invited to a small gathering in Hanoi for dinner. My husband, daughter and I had flown in on an early evening flight and the airport taxi rushed to get us there in time through a maze of unfinished highways thick with motorbikes and dust. I was exhausted. Later, after the dinner plates had been removed, and conversations continued in other areas of the house, I had gone to the kitchen in search of something to drink, like juice. I don’t remember the rest. I woke up out of a daze, sitting on the floor saturated in sticky water with a large bump on my head. Even my underwear was soaked. The entire dinner party was standing around me and was elated when I opened my eyes. Elizabeth, are you OK? What had happened? I looked around the room. My husband was on the phone. Andy, Elizabeth passed out and seized at a friend’s house – oh yeah, sorry, we’re in Vietnam. Anyway, we concocted a ton of sugar water and poured it down her throat – pretty much had to force her to drink it. She’s OK now. There aren’t ambulances here and the hospitals aren’t recommended. What should we do next? Andy is my doctor in California and he did help out from afar, calling on me and checking to ensure I was OK until I made it home. I was fine in the end, but it had been a very frightening and unfortunate situation. It was the first severe hypoglycemic episode I had experienced in my nearly 40 years of living with Type 1 diabetes. There was a lot of head slapping and should haves — why weren’t we carrying Glucagon? Why didn’t the CGM alert? Why didn’t I call for help? My husband was visibly distraught, and our 13-year-old daughter had been the one to find me unconscious. She squeezed my hand as hard as she could all the way back to the Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Diabetes doctors: Which specialists treat diabetes?
