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Hyperglycemia In Type 2 Diabetes

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1 Richard M. Bergenstal , MD,2 John B. Buse , MD, PHD,3 Michaela Diamant , MD, PHD,4 Ele Ferrannini , MD,5 Michael Nauck , MD,6 Anne L. Peters , MD,7 Apostolos Tsapas , MD, PHD,8 Richard Wender , MD,9 and David R. Matthews , MD, DPHIL10,11,12 From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 10Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, U.K.; the 11National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.; and the 12Harris Manchester College, University of Oxford, Oxford, U.K From the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut; the 2International Diabetes Center at Park Nicollet, Minneapolis, Minnesota; the 3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; the 5Department of Medicine, University of Pisa School of Medicine, Pisa, Italy; 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; the 7Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California; the 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece; the 9Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the 10Oxford Centre for Diabetes, Endoc Continue reading >>

Individualizing Treatment Of Hyperglycemia In Type 2 Diabetes

Individualizing Treatment Of Hyperglycemia In Type 2 Diabetes

From the University of Arizona College of Pharmacy and the University of Arizona College of Medicine-Tucson, Tucson, AZ. ABSTRACT • Objective: To summarize key issues relevant to managing hyperglycemia in patients with type 2 diabetes mellitus (T2DM) and review a strategy for initiating and intensifying therapy. • Methods: Review of the literature. • Results: The 6 most widely used pharmacologic treatment options for hyperglycemia in T2DM are metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and insulin. Recent guidelines stress the importance of an individualized, patient-centered approach to managing hyperglycemia in T2DM, although sufficient guidance for nonspecialists on how to individualize treatment is often lacking. For patients with no contraindications, metformin should be recommended concurrent with lifestyle intervention at the time of diabetes diagnosis. Due to the progressive nature of T2DM, glycemic control on metformin monotherapy is likely to deteriorate over time, and there is no consensus as to what the second-line agent should be. A second agent should be selected based on glycemic goal and potential advantages and disadvantages of each agent for any given patient. If the patient progresses to the point where dual therapy does not provide adequate control, either a third non-insulin agent or insulin can be added. • Conclusion: Although research is increasingly focusing on what the ideal number and sequence of drugs should be when managing T2DM, investigating all possible combinations in diverse patient populations is not feasible. Physicians therefore must continue to rely on clinical judgment to determine how to apply trial data to the treatment o Continue reading >>

Medical Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Medical Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes 6Department of Internal Medicine and Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut 1Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts 2University of North Carolina School of Medicine, Chapel Hill, North Carolina 3Clinical Center for Research Excellence, Charles R. Drew University, Los Angeles, California 4Department of Internal Medicine, University of Pisa, Pisa, Italy 5Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University, Oxford, U.K. 6Department of Internal Medicine and Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut 7Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada Corresponding author: David. M. Nathan, [email protected] Author information Copyright and License information Disclaimer Copyright 2009, American Diabetes Association Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of Continue reading >>

Breakfast May Decrease Postprandial Hyperglycemia In Type 2 Diabetes

Breakfast May Decrease Postprandial Hyperglycemia In Type 2 Diabetes

Breakfast May Decrease Postprandial Hyperglycemia in Type 2 Diabetes Breakfast May Decrease Postprandial Hyperglycemia in Type 2 Diabetes Breakfast May Decrease Postprandial Hyperglycemia in Type 2 Diabetes (HealthDay News) Breakfast consumption influences glucose regulation throughout the day in patients with diabetes, according to a small study published in Diabetes Care. Daniela Jakubowicz, MD, from Tel Aviv University in Israel, and colleagues conducted a crossover study in which 22 patients with diabetes (mean age, 56.9 years; BMI, 28.2; and glycated hemoglobin, 7.7%) were randomly assigned to two test days: 1 day with breakfast, lunch and dinner (YesB) and another with lunch and dinner but no breakfast (NoB). Lunch area under the curves for 0 to 180 minutes (AUC0-180) for plasma glucose, free fatty acids (FFA) and glucagon were 36.8%, 41.1% and 14.8% higher, respectively, while the AUC0-180 for insulin and intact glucagon-like peptide-1 (iGLP-1) were 17% and 19% lower, respectively, on the NoB day compared with YesB (P<.0001). Dinner AUC0-180 for glucose, FFA and glucagon were 26.6%, 29.6% and 11.5% higher, respectively, while AUC0-180 for insulin and iGLP-1 were 7.9% and 16.5% lower, respectively, on the NoB day compared with the YesB day (P<.0001). On the NoB day, insulin peak was delayed 30 minutes after lunch and dinner, compared with the YesB day. "Breakfast consumption could be a successful strategy for reduction of postprandial hyperglycemia in type 2 diabetes ," the researchers wrote. Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Management Of Hyperglycemia In Type 2 Diabetes: A Consensus Algorithm For The Initiation And Adjustment Of Therapy

Injections, three times/day dosing, frequent GI side effects, expensive, little experience *Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal. 1)Begin with low-dose metformin (500 mg) taken once or twice per day with meals (breakfast and/or dinner). 2)After 57 days, if GI side effects have not occurred, advance dose to 850 or 1,000 mg before breakfast and dinner. 3)If GI side effects appear as doses advanced, can decrease to previous lower dose and try to advance dose at a later time. 4)The maximum effective dose is usually 850 mg twice per day, with modestly greater effectiveness with doses up to 3 g per day. GI side effects may limit the dose that can be used. 5)Based on cost considerations, generic metformin is the first choice of therapy. A longer-acting formulation is available in some countries and can be given once per day. Injections, three times/day dosing, frequent GI side effects, expensive, little experience *Severe hypoglycemia is relatively infrequent with sulfonylurea therapy. The longer-acting agents (e.g. chlorpropamide, glyburide [glibenclamide], and sustained-release glipizide) are more likely to cause hypoglycemia than glipizide, glimepiride, and gliclazide. Repaglinide is more effective at lowering A1C than nateglinide. GI, gastrointestinal. David M. Nathan, MD,1 John B. Buse, MD, PHD,2 Mayer B. Davidson, MD,3 Robert J. Heine, MD,4 Rury R. Holman, FRCP,5 Robert Sherwin, MD 6 and Bernard Zinman, MD 7 1 Diabetes Center, Massachusetts General Hospital and Harv Continue reading >>

Hyperglycemia And Type 2 Diabetes

Hyperglycemia And Type 2 Diabetes

Part 1 of 6 Highlights High blood glucose, or hyperglycemia, primarily affects those with diabetes. If left untreated it can lead to chronic complications, such as kidney disease or nerve damage. Good diabetes management and careful blood glucose monitoring are both effective ways of preventing hyperglycemia. High blood glucose, or hyperglycemia, can cause major health complications in people with diabetes over time. Several factors can contribute to hyperglycemia, including eating more carbohydrates than normal and being less physically active than normal. Regular blood sugar testing is crucial for people with diabetes, because many people do not feel the symptoms of high blood sugar. Part 2 of 6 Short-term symptoms of high blood sugar include: excessive thirst excessive urination increased urination at night blurry vision sores that won’t heal fatigue If you experience symptoms of hyperglycemia, it’s important that you check your blood glucose levels. Untreated high blood sugar can lead to chronic complications, such as eye, kidney, or heart disease or nerve damage. The symptoms listed above can develop over several days or weeks. The longer the condition is left untreated, the more severe the problem may become. Generally, blood glucose levels greater than 180 mg/dL after meals — or over 130 mg/dL before eating — are considered high. Be sure to check with your doctor to learn your blood sugar targets. Part 3 of 6 A number of conditions or factors can contribute to hyperglycemia, including: eating more carbohydrates than usual being less physically active than usual being ill or having an infection experiencing high levels of stress not getting the right dosage of glucose-lowering medication Part 4 of 6 There are several treatment methods available for hypergl Continue reading >>

How Are Hyperglycemia And Diabetes Connected?

How Are Hyperglycemia And Diabetes Connected?

The term used to describe high blood glucose or blood sugar is hyperglycemia. When we eat food, the carbohydrate in food breaks down into sugar and goes into the bloodstream. The pancreas releases insulin when this happens. Insulin is a hormone produced by the pancreas that "unlocks" the body's cells, allowing the sugar go from the blood and into the cells. The cells in the body use this sugar for energy. When the body does not make any or enough insulin, or when the cells are unable to use the insulin correctly, blood sugar levels go up. Contents of this article: Hyperglycemia and diabetes Hyperglycemia is common in people with diabetes. People with prediabetes are also at an increased risk. Prediabetes refers to blood sugar levels that are higher than normal but are not as high as they are for diabetes. Diabetes causes high blood sugar levels two main ways. Either there is a lack of insulin, as is the case with type 1 diabetes, or the body doesn't respond properly to insulin. In prediabetes, it is usually due to the cells not responding correctly. In type 2 diabetes, it is usually a combination. Causes of hyperglycemia There are several causes of hyperglycemia that are related to diabetes: Though many causes are related to diabetes, there are additional factors that can contribute to hyperglycemia: Certain medications such as steroids Other pancreatic diseases Illness and stress can trigger hyperglycemia because the hormones that are produced to combat illness or stress can also cause blood sugar to rise. People do not have to have full-blown diabetes to develop hyperglycemia due to a severe illness. People with diabetes may need to take extra diabetes medication to keep their blood sugar levels stable during illness or stress. Symptoms of hyperglycemia Hyperglycemia Continue reading >>

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

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 — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>

Diabetes And Hyperglycemia

Diabetes And Hyperglycemia

Tweet Hyperglycemia occurs when people with diabetes have too much sugar in their bloodstream. Hyperglycemia should not be confused with hypoglycemia, which is when blood sugar levels go too low. You should aim to avoid spending long periods of time with high blood glucose levels. What is hyperglycemia? Hyperglycemia, the term for expressing high blood sugar, has been defined by the World Health Organisation as: Blood glucose levels greater than 7.0 mmol/L (126 mg/dl) when fasting Blood glucose levels greater than 11.0 mmol/L (200 mg/dl) 2 hours after meals Although blood sugar levels exceeding 7 mmol/L for extended periods of time can start to cause damage to internal organs, symptoms may not develop until blood glucose levels exceed 11 mmol/L. What causes hyperglycemia? The underlying cause of hyperglycemia will usually be from loss of insulin producing cells in the pancreas or if the body develops resistance to insulin. More immediate reasons for hyperglycemia include: Missing a dose of diabetic medication, tablets or insulin Eating more carbohydrates than your body and/or medication can manage Being mentally or emotionally stressed (injury, surgery or anxiety) Contracting an infection What are the symptoms of hyperglycemia? The main 3 symptoms of high blood sugar levels are increased urination, increased thirst and increased hunger. High blood sugar levels can also contribute to the following symptoms: Regular/above-average urination Weakness or feeling tired Increased thirst Vision blurring Is hyperglycemia serious? Hyperglycemia can be serious if: Blood glucose levels stay high for extended periods of time - this can lead to the development of long term complications Blood glucose levels rise dangerously high - this can lead to short term complications In the shor Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available (1–5), mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications (6–9). Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations (10) and by other societies and federations (2,11–15). However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes (16,17), the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care (18,19). This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular risk factors (blood pressure and lipid therapy, antiplatelet treatment, and Continue reading >>

Hyperglycemia: When Your Blood Glucose Level Goes Too High

Hyperglycemia: When Your Blood Glucose Level Goes Too High

Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when the blood glucose level is too high because the body isn't properly using or doesn't make the hormone insulin. You get glucose from the foods you eat. Carbohydrates, such as fruit, milk, potatoes, bread, and rice, are the biggest source of glucose in a typical diet. Your body breaks down carbohydrates into glucose, and then transports the glucose to the cells via the bloodstream. Body Needs Insulin However, in order to use the glucose, your body needs insulin. This is a hormone produced by the pancreas. Insulin helps transport glucose into the cells, particularly the muscle cells. People with type 1 diabetes no longer make insulin to help their bodies use glucose, so they have to take insulin, which is injected under the skin. People with type 2 diabetes may have enough insulin, but their body doesn't use it well; they're insulin resistant. Some people with type 2 diabetes may not produce enough insulin. People with diabetes may become hyperglycemic if they don't keep their blood glucose level under control (by using insulin, medications, and appropriate meal planning). For example, if someone with type 1 diabetes doesn't take enough insulin before eating, the glucose their body makes from that food can build up in their blood and lead to hyperglycemia. Your endocrinologist will tell you what your target blood glucose levels are. Your levels may be different from what is usually considered as normal because of age, pregnancy, and/or other factors. Fasting hyperglycemia is defined as when you don't eat for at least eight hours. Recommended range without diabet Continue reading >>

High Blood Sugar And Diabetes

High Blood Sugar And Diabetes

Blood sugar control is at the center of any diabetes treatment plan. High blood sugar, or hyperglycemia, is a major concern, and can affect people with both type 1 and type 2 diabetes . There are two main kinds: Fasting hyperglycemia. This is blood sugar that's higher than 130 mg/dL (milligrams per deciliter) after not eating or drinking for at least 8 hours. Postprandial or after-meal hyperglycemia. This is blood sugar that's higher than 180 mg/dL 2 hours after you eat. People without diabetes rarely have blood sugar levels over 140 mg/dL after a meal, unless it’s really large. Frequent or ongoing high blood sugar can cause damage to your nerves, blood vessels, and organs. It can also lead to other serious conditions. People with type 1 diabetes are prone to a build-up of acids in the blood called ketoacidosis. If you have type 2 diabetes or if you’re at risk for it, extremely high blood sugar can lead to a potentially deadly condition in which your body can’t process sugar. It's called hyperglycemic hyperosmolar nonketotic syndrome (HHNS). You’ll pee more often at first, and then less often later on, but your urine may become dark and you could get severely dehydrated. It's important to treat symptoms of high blood sugar right away to help prevent complications. Your blood sugar may rise if you: Eat too many grams of carbohydrates for the amount of insulin you took, or eat too many carbs in general Have an infection Are ill Are under stress Become inactive or exercise less than usual Take part in strenuous physical activity, especially when your blood sugar levels are high and insulin levels are low Early signs include: Increased thirst Trouble concentrating Frequent peeing Fatigue (weak, tired feeling) Blood sugar more than 180 mg/dL Ongoing high blood sugar Continue reading >>

Hyperglycemia In Diabetes

Hyperglycemia In Diabetes

Print Overview High blood sugar (hyperglycemia) affects people who have diabetes. Several factors can contribute to hyperglycemia in people with diabetes, including food and physical activity choices, illness, nondiabetes medications, or skipping or not taking enough glucose-lowering medication. It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as a diabetic coma. In the long term, persistent hyperglycemia, even if not severe, can lead to complications affecting your eyes, kidneys, nerves and heart. Symptoms Hyperglycemia doesn't cause symptoms until glucose values are significantly elevated — above 200 milligrams per deciliter (mg/dL), or 11 millimoles per liter (mmol/L). Symptoms of hyperglycemia develop slowly over several days or weeks. The longer blood sugar levels stay high, the more serious the symptoms become. However, some people who've had type 2 diabetes for a long time may not show any symptoms despite elevated blood sugars. Early signs and symptoms Recognizing early symptoms of hyperglycemia can help you treat the condition promptly. Watch for: Frequent urination Increased thirst Blurred vision Fatigue Headache Later signs and symptoms If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include: Fruity-smelling breath Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Coma Abdominal pain When to see a doctor Call 911 or emergency medical assistance if: You're sick and can't keep any food or fluids down, and Your blood glucose levels are persistently above 240 mg/dL (13 mmol/L) and you have ketones in your urine Make an appointment with your Continue reading >>

Postprandial Hyperglycemia Is Highly Prevalent Throughout The Day In Type 2 Diabetes Patients

Postprandial Hyperglycemia Is Highly Prevalent Throughout The Day In Type 2 Diabetes Patients

Volume 93, Issue 1 , July 2011, Pages 31-37 Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients Although postprandial hyperglycemia is recognized as an important target in type 2 diabetes treatment, information on the prevalence of postprandial hyperglycemia throughout the day is limited. Therefore, we assessed the prevalence of hyperglycemia throughout the day in type 2 diabetes patients and healthy controls under standardized dietary, but otherwise free-living conditions. 60 male type 2 diabetes patients (HbA1c 7.50.1% [581mmol/mol]) and 24 age- and BMI-matched normal glucose tolerant controls were recruited to participate in a comparative study of daily glycemic control. During a 3-day experimental period, blood glucose concentrations throughout the day were assessed by continuous glucose monitoring. Type 2 diabetes patients experienced hyperglycemia (glucose concentrations >10mmol/L) 384% of the day. Even diabetes patients with an HbA1c level below 7.0% (53mmol/mol) experienced hyperglycemia for as much as 245% throughout the day. Hyperglycemia was negligible in the control group (31%). Hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients, even in those patients with a HbA1c level well below 7.0% (53mmol/mol). Standard medical care with prescription of oral blood glucose lowering medication does not provide ample protection against postprandial hyperglycemia. Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes: Evidence And Uncertainty

Management Of Hyperglycemia In Type 2 Diabetes: Evidence And Uncertainty

Abstract The panoply of treatment algorithms, periodically released to improve guidance, is one mean to face therapeutic uncertainty in pharmacological management of hyperglycemia in type 2 diabetes, especially after metformin failure. Failure of recent guidelines to give advice on the use of specific antidiabetic drugs in patients with co-morbidity may generate further uncertainty, given the frequent association of type 2 diabetes with common comorbidity, including, although not limited to obesity, cardiovascular disease, impaired renal function, and frailty. The Italian Association of Diabetologists (Associazione Medici Diabetologi, AMD) recognized the need to develop personalized treatment plans for people with type 2 diabetes, taking into account the patients' individual profile (phenotype), with the objective of the safest possible glycemic control. As not every subject with type 2 diabetes benefits from intensive glycemic control, flexible regimens of treatment with diabetes drugs (including insulin) are needed for reaching individualized glycemic goals. Whether personalized diabetology will improve the quality healthcare practice of diabetes management is unknown, but specific research has been launched. Introduction In 2011, there were 366 million people with diabetes worldwide, and this is expected to rise to 552 million by 2030, rendering previous estimates very conservative [1]. Diabetes increases the risk of disabling and life-threatening complications from micro and macrovascular disease. Diabetes is one of the first conditions for which disease-specific indicators based on practice guidelines have been used to “score” the quality of care and preventive services. Recent estimates in the US claim that about one half (48.7%) of persons with diabetes still Continue reading >>

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