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Diabetes In Elderly Ppt

Glycemic Control In Older Adults: Applying Recent Evidence To Clinical Practice

Glycemic Control In Older Adults: Applying Recent Evidence To Clinical Practice

Glycemic goals and the decision to intensify glycemic control among older adults with diabetes must be individualized based on comorbid conditions and the risks associated with treatment. The duration of diabetes mellitus, baseline glycosylated hemoglobin value, prior history of cardiovascular disease, and history of severe hypoglycemia are important factors to consider. This article reviews how the management of diabetes mellitus in this subgroup is changing in view of three recently reported randomized trials of intensive glycemic control. Diabetes mellitus (DM) is a serious concern among older adults,[ 1 ] and its occurrence has increased both with the aging of the population as well as a rise in the prevalence of DM.[ 2 ] It has been pointed out in several articles that the approach to treatment of hyperglycemia in older adults is different from that in younger people with DM.[ 3 , 4 , 5 ] In 2003, the California Health Foundation and the American Geriatrics Association published guidelines for the care of older adults with DM6 that focused on individualizing care for each patient, especially in terms of glycemic control targets. The issue of glycemic control in general has been brought to the forefront by three recently reported randomized controlled trials: Action to Control Cardiovascular Risk in Diabetes (ACCORD),[ 7 ] Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE),[ 8 ] and the Veteran Affairs Diabetes Trial (VADT).[ 9 ] The results from these trials are reshaping our thinking of how we should treat older adults with diabetes, especially the oldest adults. However, the fundamentals of clinical decision making remain the same: balance the risks and benefits for the individual patient. This articl Continue reading >>

Diabetes Care In The Elderly (slides With Transcript)

Diabetes Care In The Elderly (slides With Transcript)

Diabetes Care in the Elderly (Slides with Transcript) This activity is intended for endocrinologists, diabetologists, primary care physicians, and other healthcare professionals treating patients with diabetes. Upon completion of this activity, participants should be able to: Describe the time-action profiles of available insulins and list key differences between human and analog insulins. Discuss the importance of insulin therapy for the treatment of special populations, including racial and ethnic minorities, elderly people, and children and adolescents with type 2 diabetes. List 3 challenges faced when providing care for racial and ethnic minorities with type 2 diabetes and describe 2 strategies for overcoming them. List 3 challenges faced when providing care for elderly people with type 2 diabetes and describe 2 strategies for overcoming them. List 3 challenges faced when providing care for children and adolescents with type 2 diabetes and describe 2 strategies for overcoming them. In compliance with the ACCME, it is the policy of CAHE and IMP to ensure fair balance, independence, objectivity, and scientific rigor in all programming. All individuals involved in planning (eg, CME provider staff, faculty, and planners) are expected to disclose any significant financial relationships with commercial interests over the past 12 months. CAHE also requires that faculty identify and reference off-label product or investigational use of pharmaceutical and medical device products. In accordance with ACCME Standards for Commercial Support, parallel documents from other accrediting bodies, and the Center for Accredited Healthcare Education policy, identification and resolution of conflict of interest has been made in the form of external peer review of educational content. CME Continue reading >>

Diabetes Care For Older Adults Ada Guidelines | Ndei

Diabetes Care For Older Adults Ada Guidelines | Ndei

Individuals aged 65 with diabetes are a high-priority population for depression screening and treatment Screen for and manage by adjusting glycemic targets and pharmacologic interventions Functional and cognitively intact older adults with long life expectancy Provide diabetes care with goals similar to those for younger adults Glycemic goals may be relaxed based in selected individuals But avoid hyperglycemia leading to symptoms or risk of acute hyperglycemic complications Individualize screening for diabetes complications Pay close attention to complications leading to functional impairment Lipid-lowering and aspirin therapy may benefit those with life expectancy at least equal to the timeframe of primary and secondary prevention trials Pharmacologic Therapy Considerations for Older Adults May be a significant factor due to polypharmacy Contraindicated in patients with renal insufficiency or significant heart failure Use cautiously in individuals with, or at risk for, heart failure Continue reading >>

Phd Public Health, Suez Canal University, Egypt

Phd Public Health, Suez Canal University, Egypt

Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs. Diabetes mellitus may present with characteristic symptoms such as thirst, polyuria, blurring of vision, and weight loss. In its most severe forms, ketoacidosis or a non–ketotic hyperosmolar state may develop and lead to stupor, coma and, in absence of effective treatment, death. Often symptoms are not severe, or may be absent, and consequently hyperglycaemia sufficient to cause pathological and functional changes may be present for a long time before the diagnosis is made. The long–term effects of diabetes mellitus include progressive development of the specific complications of retinopathy with potential blindness, nephropathy that may lead to renal failure, and/or neuropathy with risk of foot ulcers, amputation, Charcot joints, and features of autonomic dysfunction, including sexual dysfunction. People with diabetes are at increased risk of cardiovascular, peripheral vascular and cerebrovascular disease. The development of diabetes is projected to reach pandemic proportions over the next10-20 years. International Diabetes Federation (IDF) data indicate that by the year 2025, the number of people affected will reach 333 million –90% of these people will have Type 2 diabetes. In most Western societies, the overall prevalence has reach Continue reading >>

Endocrine Practice Vol 21 No. 4 April 2015

Endocrine Practice Vol 21 No. 4 April 2015

American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan Writing Committee Cochairpersons Yehuda Handelsman MD, FACP, FACE, FNLA Zachary T. Bloomgarden, MD, MACE George Grunberger, MD, FACP, FACE Guillermo Umpierrez, MD, FACP, FACE Robert S. Zimmerman, MD, FACE 1 Copyright © 2015 AACE. May not be reprinted in any form without express written permission from AACE. AACE Clinical Practice Guidelines for Diabetes Mellitus Writing Committee Task Force 2 Timothy S. Bailey, MD, FACP, FACE, ECNU Lawrence Blonde MD, FACP, FACE George A. Bray, MD, MACP, MACE A. Jay Cohen MD, FACE, FAAP Samuel Dagogo-Jack, MD, DM, FRCP, FACE Jaime A. Davidson, MD, FACP, MACE Daniel Einhorn, MD, FACP, FACE Om P. Ganda, MD, FACE Alan J. Garber, MD, PhD, FACE W. Timothy Garvey, MD Robert R. Henry, MD Irl B. Hirsch, MD Edward S. Horton, MD, FACP, FACE Daniel L. Hurley, MD, FACE Paul S. Jellinger, MD, MACE Lois JovanoviÄ, MD, MACE Harold E. Lebovitz, MD, FACE Derek LeRoith, MD, PhD, FACE Philip Levy, MD, MACE Janet B. McGill, MD, MA, FACE Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU Jorge H. Mestman, MD Etie S. Moghissi, MD, FACP, FACE Eric A. Orzeck, MD, FACP, FACE Paul D. Rosenblit, MD, PhD, FACE, FNLA Aaron I. Vinik, MD, PhD, FCP, MACP, FACE Kathleen Wyne, MD, PhD, FNLA, FACE Farhad Zangeneh, MD, FACP, FACE  Reviewers Lawrence Blonde MD, FACP, FACE Alan J. Garber, MD, PhD, FACE Copyright © 2015 AACE. May not be reprinted in any form without express written permission from AACE. AACE DM CPG Objectives and Structure This CPG aims to provide the following: An evidence-based education resource for the development of a diabetes comprehensive care plan Easy-to-follow structur Continue reading >>

Medical Overview Of Diabetes In Older Adults

Medical Overview Of Diabetes In Older Adults

2 Our plan is to present the varied and complicated spectrum of diabetes in older adults as illustrated by 3 cases. Much of our information on caring for diabetes as a chronic disease in older patients comes from well-conceived studies in younger adults with only limited data derived from studies that either include or focus on older adults as subjects. Additionally, much of the data that can be derived from clinical studies must exclude patients that have multiple complicating co-morbidities, obviously a common circumstance for those of us that treat older adults. The AGS and CHF recently generated some guidelines that address the care of diabetes in older adults. Much of the discussion of the following cases is meant to relate back to the themes and points developed by those guidelines. Death Blindness Renal failure Amputation CVD Disability Onset Retinopathy Nephropathy Neuropathy Depression Complications Hyperglycemia Natural History - Type 2 Diabetes Genetics Environment aging obesity sedentary lifestyle Insulin resistance Hyperinsulinemia Dyslipidemia Atherosclerosis Hypertension Prediabetes: IGT, IFG Continue reading >>

Efficacy Of Januvia (sitagliptin) In Patients Aged 65 Years & Older

Efficacy Of Januvia (sitagliptin) In Patients Aged 65 Years & Older

Products > JANUVIA > Clinical Trial Experience > As an adjunct to diet and exercise for appropriate patients with type 2 diabetes Strong A1C lowering with JANUVIA vs placebo in patients aged 65 years and older1 aFull-analysis-set; bSitagliptin 100 mg or 50 mg once daily, depending on renal function. No overall differences in safety or effectiveness were observed between subjects 65 years and over and younger subjects. While this and other reported clinical experience have not identified differences in responses between the elderly and younger patients, greater sensitivity of some older individuals cannot be ruled out. This drug is known to be substantially excreted by the kidney. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection in the elderly, and it may be useful to assess renal function in these patients prior to initiating dosing and periodically thereafter. Reference: 1. Barzilai N, Guo H, Mahoney EM, et al. Efficacy and tolerability of sitagliptin monotherapy in elderly patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. Curr Med Res Opin. 2011;27(5):10491058. Selected Important Risk Information About JANUVIA (sitagliptin) tablets JANUVIA is contraindicated in patients with a history of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema. There have been postmarketing reports of acute pancreatitis, including fatal and nonfatal hemorrhagic or necrotizing pancreatitis, in patients taking JANUVIA. After initiating JANUVIA, observe patients carefully for signs and symptoms of pancreatitis. If pancreatitis is suspected, promptly discontinue JANUVIA and initiate appropriate management. It is unknown whether patients with a history of pancre Continue reading >>

Challenges In The Management Of Type 2 Diabetes In The Elderly

Challenges In The Management Of Type 2 Diabetes In The Elderly

Challenges in the Management of Type 2 Diabetes in the Elderly US Endocrinology, 2008;4(1):47-50 DOI: Citation US Endocrinology, 2008;4(1):47-50 DOI: It is estimated that diabetes currently affects 195 million people worldwide. This figure is expected to rise to over 330 million by 2030.1,2 The overwhelming scale of the problem will present significant challenges to healthcare systems and clinical practices. Furthermore, the population in general is aging. Both the prevalence and the incidence of type 2 diabetes rise with increasing age, leading to a large rise in the number of elderly people with diabetes: approximately 15% of people over 60 years of age in the US are affected by diabetes, and it is estimated that half of all type 2 diabetes cases occur in those above 65 years of age.3 In Europe, data from the Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe (DECODE) study suggest that the prevalence of diabetes is 1020% in those 60 and 69 years of age, rising to 1520% in the oldest age groups.4 The management of diabetes in the elderly has unique challenges. With increasing age, there is an increased prevalence of comorbid illnesses and functional disability that contributes to the complexity of managing diabetes in the elderly cohort. Thus, treatment must take into consideration not only the standard micro- and macrovascular complications associated with both aging and diabetes, but also conditions such as cognitive impairment and impaired function. Importantly, elderly patients with diabetes have an increased risk for cardiovascular disease.5 The diagnosis of diabetes in the elderly also presents challenges, and it is estimated that half of the elderly population with diabetes are not diagnosed correctly with the condition. This is due Continue reading >>

Management Of Diabetes In The Elderly

Management Of Diabetes In The Elderly

Published by April Eaton Modified about 1 month ago Presentation on theme: "Management Of Diabetes In The Elderly" Presentation transcript: Challenges & Solutions Dr Manash P Baruah, MD, DM Director & Consultant Endocrinologist, Excel Centre, Guwahati, INDIA 2 This presentation was made in the 1st BITS-World Congress of Diabetes in Beijing on 16th June, 2012 3 Disclaimer Research Grant: Novo Nordisk, USV(I) Travel Grant: Novo Nordisk, USV(I), MSD pharma, Novartis, Abbot, Aventis Consultancy Fees: USV(I), MSD pharma, Novartis, Abbot, Aventis Do we have a problem here? If so, Whats the magnitude of the problem? 5 Elderly population: Definition & Statistics Definition of elderly or older person= >65y. Global perspective 2050: Absolute number about 2 billion (1/3 rd of total population) India 2002, the absolute number about 75 million. BY 2016, 9% of all Indians will be >65y China 2006, 108 million , 8% of total; China 2050, 322million ,24% of total. UN World Population Ageing; 2009 Population projection for India and states Census of India 1991 (Report). New Delhi: Registrar General, India; 1996. Inter-Ministerial Committee on Ageing Report. Ministry of Community Development: Singapore: 1999. Parks Text Book of Preventive and Social Medicine. In: M/s Banarsidas Bhanot Publishers, India. 2007 6 Longest living homosapiens will be female NHANES III Percentage of Population Many in the first green will survive with care to live through their 50s and reversely many in the econd green will live unto their 60s so adding up the green column Harris MI, et al. Diab Care. 1998;21: Resnick HE, et al. Diab Care. 2000;23: MSB 8 Prevalence of diabetes mellitus in South Asian Association for regional Cooperation (SAARC)countries 9 Critical questions 1.Why elderly are more prone to Diabet Continue reading >>

Educate Physicians And Nurses On Practical Management Tips For Diabetes Control.

Educate Physicians And Nurses On Practical Management Tips For Diabetes Control.

Type 2 Diabetes Common in Hispanics, Native Americans and Pima Indians Incidence of ESRD is lower, but the disease is more frequent – thus it is the most common cause of renal failure United Kingdom Prospective Diabetes Study UKPDS – large British study, (predominantly Caucasians) Adler, AI, Stevens, RJ, Manley, SE, Bilous, RW, Cull, CA & Holman, RR: Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int, 63:225-32, 2003. Incidence of microalbuminuria 25% but incidence of ESRD only 0.8% Microlbuminuria patients spent an average of 11 years before progressing to overt proteinuria Only 2.3% progress from macroalbuminuria to ESRD 1. Hypertension in people with Type 2 diabetes: knowledge-based diabetes-specific guidelines. Diabet Med, 20:972-87, 2003. 2. Abbott, KC & Bakris, GL: What have we learned from the current trials? Med Clin North Am, 88:189-207, 2004. 3. Anderson, PW, McGill, JB & Tuttle, KR: Protein kinase C beta inhibition: the promise for treatment of diabetic nephropathy. Curr Opin Nephrol Hypertens, 16:397-402, 2007. 4. Baghdasarian, SB, Jneid, H & Hoogwerf, BJ: Association of dyslipidemia and effects of statins on nonmacrovascular diseases. Clin Ther, 26:337-51, 2004. 5. Bakris, GL, Weir, MR, Shanifar, S, Zhang, Z, Douglas, J, van Dijk, DJ & Brenner, BM: Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study. Arch Intern Med, 163:1555-65, 2003. 6. Bando, Y, Ushiogi, Y, Okafuji, K, Toya, D, Tanaka, N & Miura, S: Non-autoimmune primary hypothyroidism in diabetic and non-diabetic chronic renal dysfunction. Exp Clin Endocrinol Diabetes, 110:408-15, 2002. 7. Berl, T, Hunsicker, LG, Lewis, JB, Pfeffer, MA, Porush, JG, Rouleau, JL Continue reading >>

Diabetes And The Older Patient

Diabetes And The Older Patient

Objectives 1. Review treatment options in caring for older patients with diabetes 2. Understand risks of hyperglycemia and hypoglycemia in older patients 3. Appreciate importance of cardiovascular risk reduction in older patients with diabetes by treating hypertension and hyperlipidemia 4. Gain awareness of association: diabetes, HTN, and vascular risk factors with dementia 5. Discuss the Treatment-Risk Paradox and how this applies to medical management in older patients Outline Prevalence Acute complications Treatment options and goals Risks of longstanding diabetes Reducing cardiovascular events: treating hypertension and dyslipidemia Dementia: association with cardiovascular risk factors; ?can we prevent it? The Treatment-Risk Paradox: Paper review Case Study #1 78 y/o nursing home resident presents for evaluation of recurrent severe hypoglycemia. Diagnosed age 65 , treated with sulfonylurea without response, subsequently treated with insulin, currently 70/30 14 u in AM, 10 u QHS. Logs: 4-6 readings/day, ranging from 30’s (usually in afternoon or early AM) to mid 500’s, average 195. PE: 61â€, 98 lbs, 138/66, 82. Exam unremarkable A1c=8.6%; Creatinine=1.3, TC=150, HDL=70, LDL=70, TG=50 This is a case of type 1 diabetes. Type 1 diabetes can present at any age. Review characteristics of type 1 and type 2 diabetes discussed in lecture. Case study #2 92 year old woman comes to you on glyburide at 10 mg a day. She, after much discusssion, is unable to check her own glucose. She is very afraid of having a hypoglycemic reaction as she lives alone. Her Hgb A1C is currently 9.8%. She is otherwise healthy, on no other medications, and is completely active and independent. Case # 2 What is the goal of treatment in this woman? What are the risks and the benefits Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

Niddk Diabetes Research

Niddk Diabetes Research

Judith Fradkin, M.D. Director, Division of Diabetes, Endocrinology and Metabolic Diseases, NIDDK Clinical Studies: Diabetes Normal Pre- diabetes Type 2 Diabetes Complications Type 1 Diabetes This slide illustrates how NIDDK clinical trials are aimed at improving health for people at risk for type 2 diabetes, early in the course of the disease, and later in the disease process. All of these studies have heavily recruited--or are heavily recruiting--disproportionately affected minorities (40% or more) DPPOS, Look AHEAD, and TODAY have results. D2d, GRADE, and RISE still recruiting. 2 The DPP Study Lifestyle Metformin Placebo 3234 participants (45% minority) with IGT who were overweight or obese Compared 3 approaches to diabetes prevention for 3 years: Caucasian 55% African American 20% Hispanic American 16% Asian/Pacific Islander 4% American Indian 5% DPP Study Population Caucasian 1768 African-American 645 Hispanic-American 508 Asian-American & 142 Pacific Islander American Indian 171 DPP Diabetes Rates Lifestyle Metformin Placebo 0 4 8 12 Caucasian (n=1768) African American (n=645) Hispanic (n=508) American Indian (n=171) Asian (n=142) Cases/100 person-yr Vitamin D for Prevention of Type 2 Diabetes 4000 units Vitamin D daily vs placebo 2500 Participants with prediabetes BMI >22.5 for Asian/PI participants Recruitment ongoing; Asian/PI currently constitute 5.5% of participants To provide an unbiased comparison of the most commonly used drugs to treat diabetes in metformin-treated patients with relatively recent-onset type 2 diabetes. To determine patient characteristics and mechanisms associated with differential responses to medications to facilitate individualization of diabetes care. Practical and generalizable with potential for immediate translation Capture characte Continue reading >>

Depression And Diabetes: Clinical Assessment And Pharmacotherapy

Depression And Diabetes: Clinical Assessment And Pharmacotherapy

Sam Ellis, PharmD, CDE Ellen Fay-Itzkowitz, LCSW, CDE Barbara Davis Center for Childhood Diabetes University of Colorado Health Sciences Center Keystone 2008 Depression in Kids without Diabetes 2.5% of children (5-9) are depressed 8.3% of teens (12-17) are depressed(1) Early Onset Depression  persist, recurs and may predict more severe depression and suicidal bxs later in life(2) Birmaher, B. et.al. (1996) Journal of Child and Adolescent Psychiatry Weissman, MM. et.al. (1999) Journal of the American Medical Association Indicators of Depressive Symptoms in 12 to 17 year olds with type 1 Diabetes 49 participants (12-17yo) Beck Depression Inventory (BDI) 36.7% with depressive symptoms Girls: problems with decision making and sleep Boys: change in appetite Reviera, A. et.al. (2007) PR Health Science Journal Role of Socioeconomic Status, Depression, QOL and Glycemic Control on Teens with Type 1 222 Participants (12-17yo) Children’s Depression Inventory (CDI) Poor glycemic control was associated with lower SES and increased depression Hassan, K. et.al. (2006) Journal of Pediatrics Depressive Symptoms in Children and Adolescents with Type 1 Diabetes 145 Participants (10-18yo) Children’s Depression Inventory (CDI) 15.2% had depressive symptoms - less SMBG - increased A1C (>8.7%) - increased family conflict Hood, K. (2006) Diabetes Care Prevalence and Correlates of Depressed Mood among Youth with Diabetes: SEARCH 2672 Participants (10-21yo) includes type 1 and type 2 Center for Epidemiologic Studies Depression Scale (CES-D) 14% Mild Depressive Symptoms 8% Moderate to Severe  A1C and  ED visits Depression among youth with diabetes = kids without diabetes Lawrence, J.M. (2006) Pediatrics First- Know the Symptoms  A1C Frequent ED admissions ï Continue reading >>

Reference

Reference

This purpose of this talk is to overview the 2017 American Diabetes Association Standards of Medical Care in Diabetes. These Standards comprise all of the current and key clinical practice recommendations of the American Diabetes Association. [SLIDE] 2 Reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S1 A few notes on the Standards of Care: The Association funds development of the Standards of Care and all Association position statements out of its general revenues and does not use industry support for these purposes [CLICK] The slides are organized to correspond with sections within the 2017 Standards of Care. As we go through I’ll make note of where we are within the document. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Association’s Board of Directors, which includes health care professionals, scientists, and lay people. [SLIDE] 3 These Standards of Care are revised annually by the ADA’s multidisciplinary Professional Practice Committee (PPC) [CLICK] For the 2017 revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2016. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee Continue reading >>

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