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Ada Gestational Diabetes Guidelines 2016

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Pocket chart in the format of a Z-card with information for health professionals to identify, assess and treat diabetic foot patients earlier in the "window of presentation" between when neuropathy is diagnosed and prior to developing an ulcer. The content is derived from the IDF Clinical Practice Recommendations on the Diabetic Foot 2017. Available to download and to order in print format. The IDF Clinical Practice Recommendations on the Diabetic Foot are simplified, easy to digest guidelines to prioritize health care practitioner's early intervention of the diabetic foot with a sense of urgency through education. The main aims of the guidelines are to promote early detection and intervention; provide the criteria for Continue reading >>

Current Management Of Gestational Diabetes Mellitus

Current Management Of Gestational Diabetes Mellitus

Current Management of Gestational Diabetes Mellitus Guido Menato; Simona Bo; Anna Signorile; Marie-Laure Gallo; Ilenia Cotrino; Chiara Botto Poala; Marco Massobrio Expert Rev of Obstet Gynecol.2008;3(1):73-91. Treatment of Gestational Diabetes Mellitus Diet is the mainstay of treatment in GDM whether or not pharmacologic therapy is introduced. Dietary control with a reduction in fat intake and the substitution of complex carbohydrates for refined carbohydrates seeks to achieve and maintain the maternal blood glucose profile essential during gestation. Two approaches are recommended: decreasing the proportion of carbohydrates to 40% in a daily regimen of three meals and three or four snacks, or lowering the glycemic index so that carbohydrates make up approximately 60% of the daily intake.[ 9 , 10 , 11 , 12 ] The ADA also recommends nutritional counseling, if possible by a registered dietitian, with individualization of the nutrition plan based on height and weight.[ 13 ] For normal-weight women (BMI: 20-25 kg/m2) 30 kcal/kg should be prescribed; for overweight and obese women (BMI > 24-34 kg/m2) calories should be restricted to 25 kcal/kg, and for morbidly obese women (BMI > 34 kg/m2) calories should be restricted to 20 kcal/kg or less.[ 12 ] In normal pregnancy expected weight gain varies according to the prepregnancy weight. The Fifth International Workshop-Conference on GDM recommends a relatively small gain during pregnancy of 7 kg (15 lb) or more for obese women (BMI 30 kg/m2) and a proportionally greater weight gain (up to 18 kg or 40 lb) for underweight women (BMI < 18.5 kg/m2) at the onset of pregnancy. However, there are no data on optimal weight gain for women with GDM.[ 14 ] Caloric composition includes 40-50% from complex, high-fiber carbohydrates, 20% from Continue reading >>

Ada Issues New Diabetes Guidelines For Physical Activity And Exercise

Ada Issues New Diabetes Guidelines For Physical Activity And Exercise

ADA issues new diabetes guidelines for physical activity and exercise ADA issues new diabetes guidelines for physical activity and exercise The ADA releases its first independent recommendations on physical activity and exercise for all patients with diabetes. The American Diabetes Association (ADA) has issued updated guidelines for all patients with diabetes regarding regular, structured physical exercise. The report, published in Diabetes Care, includes a recommendation of 3 or more minutes of light activity, such as walking, leg extensions, or overhead arm stretches, every 30 minutes during prolonged sedentary activities to improve bloodsugarmanagement, particularly for patients withtype 2 diabetes. The new guidelines are the first time that the ADA has issued independent, comprehensive recommendations on physical activity and exercise for all patients with diabetes , including type 1, type 2, and gestational diabetes, as well asprediabetes. These updated guidelines are intended to ensure everyone continues to physically move around throughout the dayat least every 30 minutesto improveblood glucosemanagement, stated Sheri R. Colberg-Ochs, PhD, FACSM, consultant/director of physical fitness for the ADA and lead author of the guidelines. This movement should be in addition to regular exercise, as it is highly recommended for people with diabetes to be active. Since incorporating more daily physical activity can mean different things to different people with diabetes, these guidelines offer excellent suggestions on what to do, why to do it, and how to do it safely. The ADA's position statement is based on a review of more than 180 papers of the most recent diabetes research and includes input from leaders in diabetes and exercise physiology from the United States, Cana Continue reading >>

Gestational Diabetes Mellitus - Guidelines

Gestational Diabetes Mellitus - Guidelines

Abstract The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the Continue reading >>

12. Management Of Diabetes In Pregnancy

12. Management Of Diabetes In Pregnancy

For guidelines related to the diagnosis of gestational diabetes mellitus, please refer to Section 2 “Classification and Diagnosis of Diabetes.” Pregestational Diabetes Provide preconception counseling that addresses the importance of glycemic control as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies. B Family planning should be discussed and effective contraception should be prescribed and used until a woman is prepared and ready to become pregnant. A Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester and then be monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy. B Lifestyle change is an essential component of management of gestational diabetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets. A Preferred medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied. Most oral agents cross the placenta, and all lack long-term safety data. A General Principles for Management of Diabetes in Pregnancy Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestati Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106. Available here. Refer to source document for full recommendations, including class of recommendation and level of evidence. Jump to a topic or click back/next at the bottom of each page Diabetes in Pregnancy (Gestational Diabetes) Glycemic Targets in Pregnancy Pregestational diabetes Gestational diabetes mellitus (GDM) Fasting ≤90 mg/dL (5.0 mmol/L) ≤95 mg/dL (5.3 mmol/L) 1-hr postprandial ≤130-140 mg/dL (7.2-7.8 mmol/L) ≤140 mg/dL (7.8 mmol/L) 2-hr postprandial ≤120 mg/dL (6.7 mmol/L) ≤120 mg/dL (6.7 mmol/L) A1C 6.0-6.5% (42-48 mmol/L) recommended <6.0% may be optimal as pregnancy progresses Achieve without hypoglycemia Recommendations for Pregestational Diabetes Pregestational type 1 and type 2 diabetes confer greater maternal and fetal risk than GDM Spontaneous abortion Fetal anomalies Preeclampsia Intrauterine fetal demise Macrosomia Neonatal hypoglycemia Neonatal hyperbilirubinemia Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life Maintain A1C levels as close to normal as is safely possible Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia Discuss family planning Prescribe effective contraception until woman is prepared to become pregnant Women with preexisting type 1 or type 2 diabetes Counsel on the risk of development and/or progression of diabetic retinopathy Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum Management of Pregestational Diabetes Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet, exercise, and metformin Insulin* management during pre Continue reading >>

New Ada 2017 Standards Of Medical Care In Diabetes

New Ada 2017 Standards Of Medical Care In Diabetes

Psychological health, access to care, expanded and personalized treatment options and the tracking of hypoglycemia emphasized. The ADA Standards of Medical Care in Diabetes are established and revised annually by a Professional Practice Committee. The committee is a multi-disciplinary team of 12 leading experts in the field of diabetes care, and includes physicians, diabetes educators, registered dietitians and others who have experience in areas that include adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. Members of the committee must disclose potential conflicts of interest with industry and/or other relevant organizations. Psychological health, access to care, expanded and personalized treatment options, and the tracking of hypoglycemia in people with diabetes are key areas emphasized in the American Diabetes Association’s (Association) new 2017 Standards of Medical Care in Diabetes (Standards). Produced annually by the Association, the guidelines focus on screening, diagnosis and treatment to provide better health outcomes for children, adults and older people with type 1, type 2 or gestational diabetes, and to improve the prevention and delay of type 2 diabetes. The Standards were published as a supplement to the January 2017 issue of Diabetes Care. The Standards also include the findings of a new report on diabetes staging, titled “Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis” (Differentiation), which is being published at the same time in Diabetes. Produced by a joint symposium of the Association, JDRF, the European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists, the Differentiation report Continue reading >>

Management Of Pregnancy Complicated By Diabetes

Management Of Pregnancy Complicated By Diabetes

Preconception Care AACE guidelines specify that preconception care is important for all women with preexisting type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or previous gestational diabetes mellitus (GDM). One of the primary goals of preconception care is to educate patients about strategies to maintain adequate nutrition and glucose control before conception, during pregnancy, and in the postpartum period.1 Intensive glycemic management of women with diabetes prior to conception and throughout pregnancy has been shown to confer significant health benefits to both mother and child.2 When women with diabetes establish normoglycemia before pregnancy and maintain it through the first trimester, the risk of complications (eg, congenital anomalies and spontaneous abortion) is comparable to levels for women without diabetes.3 Glycemic Targets Glycemic targets during pregnancy are defined in the 2011 AACE guidelines, shown in the table below. For all glucose management protocols, AACE recommendations stress that patient safety must be the first priority.1,4 Table 1. AACE and ADA Glycemic Target Guidelines for Pregnant Women With GMD, T1DM, or T2DM1,5 Glucose Increment Patients With GDM Patients With Preexisting T1DM or T2DM Preprandial, premeal ≤95 mg/dL (5.3 mmol/L) Premeal, bedtime, and overnight glucose: 60-99 mg/dL (3.4-5.5 mmol/L) Postprandial, post-meal 1-hour post-meal: ≤140 mg/dL (7.8 mmol/L) or 2-hour post-meal: ≤120 mg/dL (6.7 mmol/L) Peak postprandial glucose 100-129 mg/dL (5.5-7.1 mmol/L) A1C ≤6.0% ≤6.0% Table 2. Expert Recommendations for Glycemic Target Guidelines for Pregnant Women With GMD, T1DM, or T2DM*1,5,6 Some experts recommend more stringent goals, in particular, for patients on insulin therapy, to prevent maternal and fetal Continue reading >>

American Diabetes Association Issues 2016 Treatment Guidelines

American Diabetes Association Issues 2016 Treatment Guidelines

The American Diabetes Association has issued its Standards of Medical Care in Diabetes 2016. The following is a summary of the recently published guidelines. You can read the entire article in Diabetes Care 2016;39(Suppl. 1):S4–S5. General Changes In alignment with the American Diabetes Association’s (ADA’s) position that diabetes does not define people, the word “diabetic” will no longer be used when referring to individuals with diabetes in the “Standards of Medical Care in Diabetes.” The ADA will continue to use the term “diabetic” as an adjective for complications related to diabetes (e.g., diabetic retinopathy). Although levels of evidence for several recommendations have been updated, these changes are not included below as the clinical recommendations have remained the same. Changes in evidence level from, for example, C to E are not noted below. The “Standards of Medical Care in Diabetes 2016” contains, in addition to many minor changes that clarify recommendations or reflect new evidence, the following are the more substantive revisions. Section Changes Section 1. Strategies for Improving Care This section was revised to include recommendations on tailoring treatment to vulnerable populations with diabetes, including recommendations for those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, and a discussion on disparities related to ethnicity, culture, sex, socioeconomic differences, and disparities. Section 2. Classification and Diagnosis of Diabetes The order and discussion of diagnostic tests (fasting plasma glucose, 2-h plasma glucose after a 75-g oral glucose tolerance test, and A1C criteria) were revised to make it clear that no one test is preferred over another for diagnosis. To clarify the relationship b Continue reading >>

Acog Releases Updated Guidance On Gestational Diabetes

Acog Releases Updated Guidance On Gestational Diabetes

SUMMARY: ACOG has released updated guidance on gestational diabetes (GDM), which has become increasingly prevalent worldwide. Highlights and changes from the previous practice bulletin include the following: Fetal Monitoring Screening for GDM – One or Two Step? ACOG (based on NIH consensus panel findings) still supports the ‘2 step’ approach (24 – 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 3 hour oral glucose tolerance test (OGTT) if positive Note: While the diagnosis of GDM is based on 2 abnormal values on the 3 hour OGTT, ACOG states, due to known adverse events, one abnormal value may be sufficient to make the diagnosis 1 step approach (75 g OGTT) on all women will increase the diagnosis of GDM but sufficient prospective studies demonstrating improved outcomes still lacking ACOG does acknowledge that some centers may opt for ‘1 step’ if warranted based on their population Who Should be Screened Early? ACOG has adopted the NIDDK / ADA guidance on screening for diabetes and prediabetes which takes in to account not only previous pregnancy history but also risk factors associated with type 2 diabetes. Screen early in pregnancy if: Patient is overweight with BMI of 25 (23 in Asian Americans), and one of the following: Physical inactivity Known impaired glucose metabolism Previous pregnancy history of: GDM Macrosomia (≥ 4000 g) Stillbirth Hypertension (140/90 mm Hg or being treated for hypertension) HDL cholesterol ≤ 35 mg/dl (0.90 mmol/L) Fasting triglyceride ≥ 250 mg/dL (2.82 mmol/L) PCOS, acanthosis nigricans, nonalcoholic steatohepatitis, morbid obesity and other conditions associated with insulin resistance Hgb A1C ≥ 5.7%, impaired glucose tolerance or impaired fasting glucose Cardiovascular disea Continue reading >>

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

INTRODUCTION Insulin is a hormone whose job is to enable glucose (sugar) in the bloodstream to enter the cells of the body, where sugar is the source of energy. All fetuses (babies) and placentas (afterbirths) produce hormones that make the mother resistant to her own insulin. Most pregnant women produce more insulin to compensate and keep their blood sugar level normal. Some pregnant women cannot produce enough extra insulin and their blood sugar level rises, a condition called gestational diabetes. Gestational diabetes affects between 5 and 18 percent of women during pregnancy, and usually goes away after delivery. It is important to recognize and treat gestational diabetes to minimize the risk of complications to mother and baby. In addition, it is important for women with a history of gestational diabetes to be tested for diabetes after pregnancy because of an increased risk of developing type 2 diabetes in the years following delivery. More detailed information about gestational diabetes is available by subscription. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) GESTATIONAL DIABETES TESTING We recommend that all pregnant women be tested for gestational diabetes. Identifying and treating gestational diabetes can reduce the risk of pregnancy complications. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) Complications of gestational diabetes can include: Having a large baby (weighing more than 9 lbs or 4.1 kg), which can increase the risk of injury to the mother or baby during delivery and increase the chance of needing a cesarean section. Stillbirth (a baby who dies before being born), a complication which fortunately is now rare in women with gestational diabetes because of good control of blood sugars and careful monitoring of mo Continue reading >>

An Evaluation Of Two Different Screening Criteria In Gestational Diabetes Mellitus

An Evaluation Of Two Different Screening Criteria In Gestational Diabetes Mellitus

An evaluation of two different screening criteria in gestational diabetes mellitus Accepted author version posted online: 24 Mar 2017 Get access/doi/full/10.1080/14767058.2017.1311858?needAccess=true Background: The objective of this study was to identify the gestational diabetes mellitus (GDM) prevalence difference according to American Diabetes Association (ADA) criteria and International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for 75 g oral glucose tolerance test (OGTT). Methods: This study was conducted at Erciyes University Department of Obstetrics and Gynecology. A total of 320 pregnant who met the criteria were included in the study and 75 g OGTT was applied. Irrespective of the first results, the test was applied to most participants 2 weeks later. Results: The GDM prevalence was found to be 9.1% according to the ADA criteria and 19.4% according to the IADPSG criteria. According to the ADA criteria, GDM prevalence was found to be statistically significantly high (p < .05) in patients with risk factors. According to the IADPSG criteria no relationship was found between GDM prevalence and any of the risk factors (p > .05). The patients diagnosed with GDM were observed not to reach the threshold levels for HbA1c. Conclusion: According to the IADPSG criteria, GDM prevalence doubles and leads to an increase in healthcare costs and workloads. HbA1c has no role in the diagnosis of GDM. Continue reading >>

Updated Guidelines For Diabetes Released By The American Diabetes Association

Updated Guidelines For Diabetes Released By The American Diabetes Association

New recommendations concerning cholesterol lowering drugs for all patients with diabetes, a lower BMI cut point for screening Asian Americans for diabetes, and new blood sugar targets for children and adolescents are among the many the updates in the American Diabetes Association’s (ADA’s) annual revised Standards of Medical Care, which was published in the January issue of Diabetes Care. Managing the Risk for Heart Disease The ADA now recommends that all people with type 2 diabetes take the cholesterol lowering drugs—statins in addition to lifestyle therapy (meal planning changes and exercise) to reduce the likelihood of developing heart disease (eg, heart attack and stroke). The dose of statin therapy should be based on a person’s risk for cardiovascular disease. In addition, the ADA recommended a less strict goal for diastolic blood pressure—80 mmHg compared with 90 mmHg in the past. Diastolic blood pressure is the bottom number in a blood pressure measurement, and measures the pressure in your arteries in between heartbeats when your heart is at rest. Lower Diabetes Screening Cutoff for Asian Americans Many Asian Americans develop diabetes at a lower body weight because they tend to gain weight around their waist, which is linked to a greater risk for diabetes and cardiovascular disease compared with weight gain in thighs and other parts of the body. Because of this difference in weight gain, the ADA has lowered the recommended body mass index (BMI) for screening Asian Americans for diabetes from ≥25 kg/m2 (the cutoff for the general public) to ≥23 kg/m2. Body mass index is a measure of body fat based on a person’s weight and height. Blood Sugar Goals for Children and Adolescents All children and adolescents with diabetes should aim to reach a target Continue reading >>

Updated Guidelines On Screening For Gestational Diabetes

Updated Guidelines On Screening For Gestational Diabetes

1Department of Medicine, Government Medical College and Hospital, Chandigarh, India; 2Bharti Hospital, Karnal, Haryana, India; 3Excel Center, Guwahati, Assam, India; 4Saket City Hospital, New Delhi, India Abstract: Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject. Keywords: pregnancy, guidelines, IADPSG, GDM, Carpenter and Coustan criteria Gestational diabetes mellitus (GDM) has classically been defined as any glucose intolerance first identified during pregnancy.1 Recently, the American Diabetes Association (ADA) defined it as “Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes”.2 However, as per IADPSG (International association of diabete Continue reading >>

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at www.annals.org on 1 March 2016. From St. Mark's Hospital and St. Mark's Diabetes Center, Salt Lake City, Utah; Glytec, Greenville, South Carolina; and University Physicians Primary Care, Augusta, Georgia. Acknowledgment: The authors thank Sarah Bradley; Jane Chiang, MD; Matt Petersen; and Jay Shubrook, DO, for their invaluable assistance in the writing of this manuscript. Disclosures: Dr. Chamberlain reports personal fees (speakers bureau) from Merck, Sanofi Aventis, and Janssen during the conduct of the study. Dr. Rhinehart reports personal fees from Sanofi, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Forest, and Glytec outside the submitted work. Dr. Shaefer reports personal fees from Sanofi, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Janssen, Forest Pharmaceuticals, and Vivus; and nonfinancial support from Sanofi outside the submitted work. Ms. Neuman has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3016 . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relations Continue reading >>

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