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Strategies such as explicit goal setting with patients (453); identifying and addressing language, numeracy, or cultural barriers to care (454-456); integrating evidence-based guidelines and clinical information tools into the process of care (457-459); and incorporating care management teams including nurses, pharmacists, and other providers (460-463) have each been shown to optimize provider and team behavior and thereby catalyze reduction in AlC, blood pressure, and LDL cholesterol. Support patient behavior change Successful diabetes care requires a systematic approach to supporting patients' behavior change efforts, including (a) healthy lifestyle changes (physical activity, healthy eating, nonuse of tobacco, weight management, effective coping), (b) disease self-management (medication taking and management, self-monitoring of glucose and blood pressure when clinically appropriate); and (c) prevention of diabetes complications (self-monitoring of foot health, active participation in screening for eye, foot, and renal complications, and immunizations).

\"Plan delicious, diabetes-friendly meals--easily! When you have diabetes, meal planning and preparation are important parts of caring for your health. Quick Diabetic Recipes for Dummies gives you everything you need to create healthy, diabetes-friendly meals in a snap. Find recipes for delicious soups and stews, appetizers, salads, veggies even the kids will eat, hearty breakfasts, satisfying entrâees, and even desserts! Tips on shopping, cooking, keeping a healthy kitchen, and more will make your healthy eating journey even easier! Inside... basics of diabetes nutrition and meal planning; nutritious foods to keep in stock; healthy cooking techniques; dishes your guests will love; portion control tips and tricks, diabetes choices/exchanges\"-- Page 4 of cover.

Standards of Medical Care in Diabetes—2007 American Diabetes Association ABI, ankle-brachial index AMI, acute myocardial infarction ARB, angiotensin receptor blocker CAD, coronary artery disease CBG, capillary blood glucose CHD, coronary heart disease CHF, congestive heart failure CKD, chronic kidney disease CMS, Centers for Medicare and Medicaid Services CSII, continuous subcutaneous insulin infusion CVD, cardiovascular disease DCCB, dihydropyridine calcium channel blocker DCCT, Diabetes Control and Complications Trial DKA, diabetic ketoacidosis DMMP, diabetes medical management plan DPN, distal symmetric polyneuropathy DPP, Diabetes Prevention Program DRI, dietary reference intake DRS, Diabetic Retinopathy Study DSME, diabetes self-management education DSMT, diabetes self-management training ECG, electrocardiogram ESRD, end-stage renal disease ETDRS, Early Treatment Diabetic Retinopathy Study FDA, Food and Drug Administration FPG, fasting plasma glucose GDM, gestational diabetes mellitus GFR, glomerular filtration rate HRC, high-risk characteristic ICU, intensive care unit IFG, impaired fasting glucose IGT, impaired glucose tolerance MNT, medical nutrition therapy NDEP, National Diabetes Education Program NPDR, nonproliferative diabetic retinopathy OGTT, oral glucose tolerance test PAD, peripheral arterial disease PDR, proliferative diabetic retinopathy PPG, postprandial plasma glucose RDA, recommended dietary allowance SMBG, self-monitoring of blood glucose TZD, thiazolidinedione UKPDS, U.K. Prospective Diabetes Study Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to refs. 1–3. The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. I. CLASSIFICATION AND DIAGNOSIS A. Classification In 1997, ADA issued new diagnostic and classification criteria (4); in 2003, modifications were made regarding the diagnosis of impaired fasting glucose (IFG) (5). The classification of diabetes includes four clinical classes: Type 1 diabetes (results from β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) Other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases … [Full Text of this Article]

Dapagliflozin, a highly selective inhibitor of the renal sodium-glucose cotransporter-2, increases urinary excretion of glucose and lowers plasma glucose levels in an insulin-independent manner. We evaluated the efficacy and safety of dapagliflozin in treatment-naive patients with type 2 diabetes. This was a 24-week parallel-group, double-blind, placebo-controlled phase 3 trial. Patients with A1C 7.0-10% (n = 485) were randomly assigned to one of seven arms to receive once-daily placebo or 2.5, 5, or 10 mg dapagliflozin once daily in the morning (main cohort) or evening (exploratory cohort). Patients with A1C 10.1-12% (high-A1C exploratory cohort; n = 73) were randomly assigned 1:1 to receive blinded treatment with a morning dose of 5 or 10 mg/day dapagliflozin. The primary end point was change from baseline in A1C in the main cohort, statistically tested using an ANCOVA. In the main cohort, mean A1C changes from baseline at week 24 were -0.23% with placebo and -0.58, -0.77 (P = 0.0005 vs. placebo), and -0.89% (P < 0.0001 vs. placebo) with 2.5, 5, and 10 mg dapagliflozin, respectively. Signs, symptoms, and other reports suggestive of urinary tract infections and genital infection were more frequently noted in the dapagliflozin arms. There were no major episodes of hypoglycemia. Data from exploratory cohorts were consistent with these results. Dapagliflozin lowered hyperglycemia in treatment-naive patients with newly diagnosed type 2 diabetes. The near absence of hypoglycemia and an insulin-independent mechanism of action make dapagliflozin a unique addition to existing treatment options for type 2 diabetes.

In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were –0·65% (95% CI –5·76 to 4·46; p=0·80) unadjusted and –0·60% (–5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were –0·37% (one-sided 95% CI –1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and –0·36% (–1·99 to 1·28; pnon-inferiority<0·0001 adjusted). In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. European Union Horizon 2020 and Global Alliance for Chronic Diseases.

Using this guide, you can design a low-carb, low-calorie diet that helps you shed weight while controlling your diabetes. --from publisher description.

AbstractObjectiveTo assess the effect of dapagliflozin plus calorie restriction on remission of type 2 diabetes.DesignMulticentre, double blind, randomised, placebo controlled trial.Setting16 centres in mainland China from 12 June 2020 to 31 January 2023.Participants328 patients with type 2 diabetes aged 20-70 years, with body mass index >25 and diabetes duration of <6 years.InterventionsCalorie restriction with dapagliflozin 10 mg/day or placebo.Main outcome measuresPrimary outcome: incidence of diabetes remission (defined as glycated haemoglobin <6.5% and fasting plasma glucose <126 mg/dL in the absence of all antidiabetic drugs for at least 2 months); secondary outcomes: changes in body weight, waist circumference, body fat, blood pressure, glucose homoeostasis parameters, and serum lipids over 12 months.ResultsRemission of diabetes was achieved in 44% (73/165) of patients in the dapagliflozin group and 28% (46/163) of patients in the placebo group (risk ratio 1.56, 95% confidence interval (CI) 1.17 to 2.09; P=0.002) over 12 months, meeting the predefined primary endpoint. Changes in body weight (difference −1.3 (95% CI −1.9 to −0.7) kg) and homoeostasis model assessment of insulin resistance (difference −0.8, −1.1 to −0.4) were significantly greater in the dapagliflozin group than in the placebo group. Likewise, body fat, systolic blood pressure, and metabolic risk factors were significantly more improved in the dapagliflozin group than in the placebo group. In addition, no significant differences were seen between the two groups in the occurrence of adverse events.ConclusionThe regimen of dapagliflozin plus regular calorie restriction achieved a much higher rate of remission of diabetes compared with calorie restriction alone in overweight or obese patients with type 2 diabetes.Trial registrationClinicalTrials.gov NCT04004793.