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Evidence Based Treatment For Type 2 Diabetes

Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)

Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)

TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body becomes resistant to normal or even high levels of insulin. This causes high blood sugar (glucose) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medicines, which can minimize the risk of diabetes and cardiovascular (heart-related) complications. This topic review will discuss the treatment of type 2 diabetes. Topics that discuss other aspects of type 2 diabetes are also available: (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".) (See "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".) TYPE 2 DIABETES TREATMENT GOALS Blood sugar control — The goal of treatment in type 2 diabetes is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system). Home blood sugar testing — In people with type 2 diabetes, home blood sugar testing might be recommended, especially in those who take certain oral diabetes medicines or insulin. Home blood sugar testing is not usually necessary for people who are diet controlled. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) A normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L), although some people will have a different goal. Continue reading >>

New Developments In The Treatment Of Type 2 Diabetes Mellitus

New Developments In The Treatment Of Type 2 Diabetes Mellitus

Evidence-Based Diabetes Management > March/April Published on: April 11, 2013 New Developments in the Treatment of Type 2 Diabetes Mellitus Benefits May Outweigh Increase to Costs of Care Diabetes, a progressive disease of the endocrine system with a significant economic burden, is estimated to affect more than 371 million people worldwide and over 24 million Americans in 2012. In 2011, 4.6 million deaths could be attributed to diabetes, and diabetes healthcare expenditures, including costs to the healthcare system and the patient, were at least 465 billion US dollars, of which 11% of total healthcare expenditures were from adults aged 20 to 79 years, and 75% of that cost was spent on those aged 50 to 79 years.1 Current American Diabetes Association (ADA) Standards of Care recommend metformin for pharmacologic management of type 2 diabetes mellitus (T2DM), if no contraindications are present, at the time of diagnosis. If therapeutic goals are not met with monotherapy at maximal doses, a second oral agent, such as a glucagon-like peptide-1 (GLP-1) agonist or insulin, are recommended for addition. For patients who are newly diagnosed, markedly symptomatic upon diagnosis, and/or have markedly elevated blood glucose or glycated hemoglobin (A1C) levels, initial pharmacologic therapy with insulin should be considered, with or without the addition of other agents.2 The current classes of medications that are available to treat T2DM include biguanides, sulfonylureas, meglitinides, thiazolidinediones (TZDs), alpha glucosidase inhibitors, dipeptidyl peptidase-IV (DPP-4) inhibitors, GLP-1 agonists, bile acid sequestrants, dopamine-2 agonists, and insulin. Although these agents are effective initially, glucose-lowering effects are not typically sustained long term as beta cell dys Continue reading >>

Evidence-based Insulin Prescribing In Type 2 Diabetes

Evidence-based Insulin Prescribing In Type 2 Diabetes

Evidence-based insulin prescribing in type 2 diabetes Nene and Corby Clinical Commissioning Groups As part of an overall re-design of diabetes services in Northamptonshire, we reviewed the use of insulin in line with NICE CG87. The diabetes specialist nurses and a medicines management pharmacist ran (and continue to run) regular training sessions for practice nurses to provide them with the skills to initiate human isophane insulin. The savings we have consequently made on the prescribing budget have been ring-fenced and used to fund a new community-based Diabetes Multidisciplinary Team. Does the example relate to a general implementation of all NICE guidance? Does the example relate to a specific implementation of a specific piece of NICE guidance? Our aims and objectives for the new diabetes service are to deliver a best practice care model that provides the best possible outcomes for patients. This will be through the provision of education, information, support and care so that patients can make informed choices and be able to manage their condition and will be delivered primarily via a Multi-Disciplinary Team (MDT) in the community.The MDT will be funded through savings to the prescribing spend that will be realised by implementing the NICE CG87; the main element of our work is encouraging the use of human isophane insulin as the first-line insulin for people with type 2 diabetes. Prior to this project, human isophane insulin accounted for only 15% of all long- and intermediate-acting insulin in Northamptonshire. This was virtually the opposite of what we would expect to see if CG87 was being followed. CG87 states, "Begin with human NPH insulin taken at bedtime or twice daily according to need" and specifies the use of analogue insulin only in certain circumstance Continue reading >>

Evidence-based Insulin Treatment In Type 1 Diabetes Mellitus - Sciencedirect

Evidence-based Insulin Treatment In Type 1 Diabetes Mellitus - Sciencedirect

Evaluation of the evidence base for recommending different insulin treatment regimens in type 1 diabetes. A computerised literature survey was conducted using The Cochrane Controlled Trials Register and the Pub Med database for the period of 19822007. A meta-analysis on only 49 out of 1295 references showed that CSII compared with conventional or multiple insulin injections therapy demonstrated a significant reduction in mean HbA1c (primary outcome) of 1.2% CI [0.73; 1.59] (P<0.001) without increasing the risk of hypoglycaemia. The evidence for using four versus two daily insulin injections was based on only one publication demonstrating an improved quality of life but no significant reduction in HbA1c or hypoglycaemia. A comparison of rapid-acting insulin analogues and human soluble insulin demonstrated a statistically significant reduction in HbA1c of 0.1% CI: [0.01; 0.16] (P=0.03) using rapid-acting insulin analogues. The mean frequency of hypoglycaemia was reduced with 143.7% (<0.05). The scientific evidence supporting the three common insulin regimens was rather sparse. Only five studies during the past 25 years fulfil the optimal criteria for a clinical trial, and only 5 trials on insulin analogues were performed as double-blinded. Current evidence suggests that CSII treatment results in a significant reduction in HbA1c without inducing more hypoglycaemia. Rapid-acting insulin analogues compared to human soluble insulin provide statistically significant but clinically minor improvement in HbA1c but seem to reduce the risk for hypoglycaemia. Continue reading >>

Evidence-based Insulin Treatment In Type 1 Diabetes Mellitus

Evidence-based Insulin Treatment In Type 1 Diabetes Mellitus

Type 1 diabetes occurs when destruction of the pancreatic islet beta cells, usually attributable to an autoimmune process, causes the pancreas to produce too little insulin or none at all. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of intensive treatment programmes, psychological interventions, and educational interventions in adults and adolescents with type 1 diabetes? What are the effects of different insulin regimens or frequency of blood glucose monitoring in adults and adolescents with type 1 diabetes? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 42 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review, we present information relating to the effectiveness and safety of the following interventions: different frequencies of insulin administration (continuous subcutaneous insulin infusion compared with multiple daily subcutaneous insulin injections), different frequencies of blood glucose self-monitoring (including continuous blood glucose monitoring compared with intermittent/conventional monitoring), educational interventions, intensive treatment programmes, and psychological interventions. Background: The management of patients with type 1 diabetes mellitus is challenging for most doctors Continue reading >>

Experts Urge Use Of Evidence-based Medicine To Avoid Overtreatment Of Type 2 Diabetes

Experts Urge Use Of Evidence-based Medicine To Avoid Overtreatment Of Type 2 Diabetes

Research supports an evidence-based medicine (EBM) approach that embraces individualized care to prevent overtreatment, specifically for patients with type 2 diabetes. UT Southwestern Medical Center research supports an evidence-based medicine (EBM) approach that embraces individualized care to prevent overtreatment, specifically for patients with type 2 diabetes. This recommended strategy is outlined in a review article published recently in Circulation. Medical care overuse accounts for approximately 20 percent of the estimated $750 billion of wasteful spending in health care in the United States, according to the National Academy of Medicine. While there are many factors that drive overuse, the authors propose that applying the principles of EBM -- which includes balancing absolute benefits and harms with the physician's judgment and the patient's values and preferences -- helps to avoid overtreatment. The review is intended to be a call to action for physicians, medical educators, researchers, and policy leaders to apply EBM principles to individualize treatment decisions and to improve the health and well-being of patients. "Evidence-based medicine is a powerful tool to provide person-centered care to individuals with type 2 diabetes, as well as for patients with other diseases," said Dr. Anil Makam, Assistant Professor of Internal Medicine at UT Southwestern and lead author of the article. "When applied to type 2 diabetes, EBM calls for a paradigm shift in our treatment approach." To prevent overtreatment, the researchers propose that intensive blood-sugar treatment should not be a universal goal of patient care for those with type 2 diabetes, which according to the Centers for Disease Control and Prevention affects more than 29 million people in the United State Continue reading >>

Evidence Based Review Of Type 2 Diabetes Prevention And Management In Low And Middle Income Countries

Evidence Based Review Of Type 2 Diabetes Prevention And Management In Low And Middle Income Countries

Evidence based review of type 2 diabetes prevention and management in low and middle income countries Aimee Afable, Nidhi Shree Karingula, Department of Community Health Sciences, SUNY Downstate School of Public Health, New York, NY 11203, United States Author contributions: Afable A conceptualized the design of the study and led writing of paper; under the guidance of Afable A and Karingula NS conducted the literature review and documented the process; Karingula NS also assisted in the synthesis, analysis and writing up of findings. Correspondence to: Aimee Afable, PhD, MPH, Assistant Professor, Department of Community Health Sciences, SUNY Downstate School of Public Health, 450 Clarkson Avenue, Box 43, Brooklyn, New York, NY 11203, United States. [email protected] Telephone: +1-718-2706397 Fax: +1-718-2215157 Received 2014 Dec 11; Revised 2016 Jan 28; Accepted 2016 Mar 7. Copyright The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved. This article has been cited by other articles in PMC. AIM: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context. METHODS: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes. RESULTS: A total of 66 studies from 20 developing countries were gathered with publication dates through September Continue reading >>

Incretin Based Treatments And Mortality In Patients With Type 2 Diabetes: Systematic Review And Meta-analysis

Incretin Based Treatments And Mortality In Patients With Type 2 Diabetes: Systematic Review And Meta-analysis

Incretin based treatments and mortality in patients with type 2 diabetes: systematic review and meta-analysis Incretin based treatments and mortality in patients with type 2 diabetes: systematic review and meta-analysis BMJ 2017; 357 doi: (Published 08 June 2017) Cite this as: BMJ 2017;357:j2499 Jason W Busse, associate professor 2 3 4 , Per Olav Vandvik, associate professor 5 6 , Gordon H Guyatt, distinguished professor 2 8 , 1Chinese Evidence-based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, 610041, Sichuan, China 2Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada 3Department of Anesthesia, McMaster University, Hamilton, ON L8S 4K1, Canada 4Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada 5Norwegian Knowledge Centre for the Health Services, N-0130 Oslo, Norway 6Department of Medicine, Innlandet Hospital Trust, 2819 Gjvik, Norway 7Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China 8Department of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada Correspondence to: X Sun sunx26{at}gmail.com ObjectiveTo assess the impact of incretin based treatment on all cause mortality in patients with type 2 diabetes. DesignSystematic review and meta-analysis of randomised trials. Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Eligibility criteriaRandomised controlled trials that compared glucagon-like peptide-1 (GLP-1) receptor agonists or dipeptidyl peptidase-4 (DPP-4) inhibitors with placebo or active anti-diabetic Continue reading >>

Berberine In The Treatment Of Type 2 Diabetes Mellitus: A Systemic Review And Meta-analysis

Berberine In The Treatment Of Type 2 Diabetes Mellitus: A Systemic Review And Meta-analysis

Berberine in the Treatment of Type 2 Diabetes Mellitus: A Systemic Review and Meta-Analysis Hui Dong ,1 Nan Wang ,2 Li Zhao ,1and Fuer Lu 1 1Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China 2Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China Received 23 May 2012; Accepted 23 July 2012 Copyright 2012 Hui Dong 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. Objectives. To assess the efficacy and safety of berberine in the treatment of type 2 diabetes mellitus (T2DM). Methods. Randomized trials of berberine compared with lifestyle modification, placebo, and/or oral hypoglycaemics intervention on treating T2DM were included. Study population characteristics and outcome results were extracted independently by two reviewers. Meta-analyses were performed for data available. Results. Fourteen randomized trials, involving 1068 participants, were included in this study. Methodological quality was generally low. Compared with lifestyle modification with or without placebo, the cointervention of berberine and lifestyle modification showed significantly hypoglycaemic and antidyslipidemic response. Compared with oral hypoglycaemics including metformin, glipizide, or rosiglitazone, berberine did not demonstrate a significantly better glycaemic control but showed a mild antidyslipidemic effect. Compared with oral hypoglycaemic drugs, cointerventions with berberine and the same oral hypoglycaemics Continue reading >>

Canagliflozin In The Treatment Of Type 2 Diabetes: An Evidence-based Review Of Its Place In Therapy

Canagliflozin In The Treatment Of Type 2 Diabetes: An Evidence-based Review Of Its Place In Therapy

Editor who approved publication: Professor Garry Walsh Thomas Karagiannis,1 Eleni Bekiari,1 Apostolos Tsapas1,2 1Clinical Research and EvidenceBased Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Harris Manchester College, University of Oxford, Oxford, UnitedKingdom Introduction: Deciding on an optimal medication choice for type 2 diabetes is often challenging, due to the increasing number of treatment options. Canagliflozin is a novel glucose-lowering agent belonging to sodiumglucose co-transporter 2 (SGLT2) inhibitors. Aim: The aim of this study was to examine and summarize the evidence based on the efficacy, safety, and cost-effectiveness of canagliflozin for type 2 diabetes. Evidence review: Compared to placebo, canagliflozin 100 and 300 mg lower glycated hemoglobin (HbA1c) by ~0.6%0.8%, respectively. Canagliflozin appears to be slightly more effective than dipeptidyl peptidase-4 (DPP-4) inhibitors in reducing HbA1c. It also has a favorable effect on body weight and blood pressure, both versus placebo and most active comparators. However, treatment with canagliflozin is associated with increased incidence of genital tract infections and osmotic diuresis-related adverse events. Based on short-term data, canagliflozin is not associated with increased risk for all-cause mortality and cardiovascular outcomes. Economic evaluation studies from various countries indicate that canagliflozin is a cost-effective option in dual- or triple-agent regimens. Place in therapy: As monotherapy, canagliflozin could be used in patients for whom metformin is contraindicated or not tolerated. For patients on background treatment with metformin, canagliflozin appears to be superior to sulfonylureas with respect to body weight, blood Continue reading >>

Oral Pharmacologic Treatment Of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From The American College Of Physicians Free

Oral Pharmacologic Treatment Of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From The American College Of Physicians Free

Abstract Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on oral pharmacologic treatment of type 2 diabetes in adults. This guideline serves as an update to the 2012 ACP guideline on the same topic. This guideline is endorsed by the American Academy of Family Physicians. Methods: This guideline is based on a systematic review of randomized, controlled trials and observational studies published through December 2015 on the comparative effectiveness of oral medications for type 2 diabetes. Evaluated interventions included metformin, thiazolidinediones, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. Study quality was assessed, data were extracted, and results were summarized qualitatively on the basis of the totality of evidence identified by using several databases. Evaluated outcomes included intermediate outcomes of hemoglobin A1c, weight, systolic blood pressure, and heart rate; all-cause mortality; cardiovascular and cerebrovascular morbidity and mortality; retinopathy, nephropathy, and neuropathy; and harms. This guideline grades the recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with type 2 diabetes. Recommendation 1: ACP recommends that clinicians prescribe metformin to patients with type 2 diabetes when pharmacologic therapy is needed to improve glycemic control. (Grade: strong recommendation; moderate-quality evidence) Recommendation 2: ACP recommends that clinicians consider adding either a Continue reading >>

American College Of Physicians Updates Recommendations For Treatment Of Type 2 Diabetes

American College Of Physicians Updates Recommendations For Treatment Of Type 2 Diabetes

Newer oral medications are now available since ACP’s 2012 clinical practice guideline Philadelphia, January 3, 2017 – Physicians should prescribe metformin to patients with type 2 diabetes when medication is needed to improve high blood sugar, the American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine. If a second oral medication is needed to improve high blood sugar, ACP recommends that physicians consider adding either a sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or DPP-4 inhibitor to metformin. The American Academy of Family Physicians has endorsed the guideline. “Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications,” said Nitin S. Damle, MD, MS, MACP, president. ACP. “The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss.” ACP updated its 2012 guideline on the comparative effectiveness and safety of oral medications for the treatment of type 2 diabetes because of several new studies evaluating medications for type 2 diabetes as well as recent FDA approvals of several new medications. “Adding a second medication to metformin may provide additional benefits,” Dr. Damle said. “However, the increased cost may not always support the added benefit, particularly for the more expensive, newer medications. ACP recommends that clinicians and patients discuss the benefits, adverse effects, and costs of additional medications.” Diabetes is a leading cause of death in the U.S. The disease can af Continue reading >>

Biphasic Insulin Aspart In Type 2 Diabetes Mellitus: An Evidence-based Medicine Review.

Biphasic Insulin Aspart In Type 2 Diabetes Mellitus: An Evidence-based Medicine Review.

Biphasic insulin aspart in type 2 diabetes mellitus: an evidence-based medicine review. Department of Medicine, Division of Medical Sciences, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham, UK. More 1.Department of Medicine, Division of Medical Sciences, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham, UK. Clinical Drug Investigation [01 Jan 2007, 27(5):299-324] The efficacy benefits of biphasic insulin aspart formulation (BIAsp 30) in patients with diabetes mellitus have been reported in several studies. BIAsp 30 has been shown to be more effective in terms of glycaemic control than standard biphasic human insulin 30 (BHI 30). In addition to gauging the treatment in terms of clinical evidence of benefits provided, it is also important to evaluate the strength of the evidence supporting the therapeutic improvements offered by BIAsp 30. In this paper, we evaluated the strength of the available data that relate to the use of BIAsp 30 in the treatment of patients with type 2 diabetes based on a comprehensive literature review. Selected publications that provided relevant data were obtained via a literature search and from the manufacturer, Novo Nordisk. These were graded in terms of the strength of the evidence they provided using the Oxford Centre for Evidence-Based Medicine (CEBM) system in the following categories: (i) twice-daily use versus basal insulin; (ii) twice-daily use versus other treatments; (iii) once-daily use; (iv) thrice-daily use; (v) use in combination with thiazolidinediones; and (vi) use in comparison with BHI 30. A total of 30 publications for BIAsp 30 were identified and graded. For the majority of categories (four out of six), the evidence supporting the use of BIAsp 30 was given Continue reading >>

Type 2 Diabetes | Virta Health

Type 2 Diabetes | Virta Health

Your form has been submitted.Thank you for your interest in Virta Health. Type 2 diabetes is a national health crisis If you are an adult living in the United States, you are now more likely than not to either have type 2 diabetes or be on your way to developing it. 14.3% of US adults have type 2 diabetes, and 38.0% of US adults have prediabetes, meaning that 52.3% of the adult population in the US is suffering from metabolic disease. At the most basic level, diabetes is a term used to describe a group of diseases that result in high blood sugar. Type 2 diabetes, (also called diabetes mellitus type 2) represents about 95% of what is generically called diabetes. Early in its course, type 2 diabetes is characterized by the combination of very high insulin levels and high blood sugar. In a person without diabetes, such high insulin levels would rapidly reduce blood sugar to normal, but in type 2 diabetes the body becomes resistant to the action of insulin (also known as insulin resistance), making blood glucose levels hard to control with insulin and other standard medications. Prediabetes is used to describe an earlier stage of insulin resistance where blood sugar that is elevated above normal, but not high enough to be called type 2 diabetes. An American Diabetes Association expert panel estimated that up to 70% of individuals with prediabetes will eventually develop diabetes.3But because prediabetes has few obvious symptoms, 90% of people with prediabetes dont know they have it.4 What are the symptoms of type2diabetes? Fasting blood sugar of 100-125 mg/dL on two separate occasions An oral glucose tolerance test that shows a blood sugar of 140 mg/dL or above after 2 hours. Everyone has glucose, a type of sugar, in their blood at all times. Sugar is a source of energyit Continue reading >>

The Early Treatment Of Type 2 Diabetes

The Early Treatment Of Type 2 Diabetes

Abstract The growing epidemic of type 2 diabetes is one of the leading causes of premature morbidity and mortality worldwide, mainly due to the micro- and macrovascular complications associated with the disease. A growing body of evidence suggests that although the risk of developing complications is greater with glucose levels beyond the established threshold for diagnosis – increasing in parallel with rising hyperglycemia—individuals with glucose levels in the prediabetic range are already at increased risk. Early intervention, ideally as soon as abnormalities in glucose homeostasis are detected, is of great importance to minimize the burden of the disease. However, as the early stages of the disease are asymptomatic, diagnosing prediabetes and early overt type 2 diabetes is challenging. The aim of this article is to discuss these challenges, the benefits of early intervention—with emphasis on the prevention trials showing that progression to type 2 diabetes can be delayed by addressing prediabetes—and the existing evidence-based guidelines that have been drawn to optimize the standards of care at the prediabetes and overt type 2 diabetes stages. Continue reading >>

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