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DIABETES MELLITUS (DM), TYPE 2

Population

  • Persons with pre-diabetes or impaired glucose tolerance (IGT).a

Recommendations

ADA 2019

  • Structured behavioral weight loss therapy with a reduced calorie meal plan such as the Mediterranean or low-calorie, low-fat eating plan. Quality of the food is important; avoid refined and processed foods.

  • Intensive lifestyle modification with a goal of sustained 7% weight loss.

  • Moderate physical activity such as brisk walking at least 150 min/wk.

  • Consider metformin for patients at highest risk for developing diabetes (eg, BMI 35 kg/m2 or greater, those age 60 y or younger, and women with prior gestational diabetes mellitus [GDM]).

  • Based on patient preference, technology-assisted diabetes prevention interventions (eg, SBGM) may be effective in preventing type 2 diabetes and should be considered.

  • At least annual monitoring for the development of type 2 diabetes.

  • Screening for and treatment of modifiable risk factors for cardiovascular disease.

Source

  • Diabetes Care. 2018;41(suppl 1):S1-S159.

Comments

  1. Recommendations for disease prevention:

    1. Annual influenza vaccine.

    2. Pneumococcal polysaccharide vaccine if 2 y or older with one-time revaccination when over 64 y.

    3. Hepatitis B vaccine series if unvaccinated and 19–59 y of age.

    4. Aspirin 81 mg daily for primary prevention if 10-y risk of significant CAD is at least 10% (by Framingham Risk Score); includes most men over 50 y and most women over 60 y.

Population

  • Persons with abnormal blood glucose or BMI >25.

Recommendation

USPSTF 2015

  • Intensive behavioral intervention to promote healthy diet and physical activity.

Source

  • Ann Intern Med. 2015;163(11):861-868.

Population

  • Children of ethnicities with higher prevalence of diabetes, such as American Indian, Alaskan Native, Mexican-American, and African-American.

Recommendations

AAP 2009

  • Counsel children with BMI >85th percentile on weight control, physical activity, and nutrition.

  • Do not use medications to prevent diabetes.

  • Nutritional interventions require familiarity with family and community culture and rely on the entire family making changes.

Source

  • Pediatrics. 2003;112(4):e328-e347.

aIGT, or pre-diabetes, if fasting glucose 100–125 mg/dL, 2-h glucose after 75-g anhydrous glucose load 140–199 mg/dL, or HgbA1c 5.7%–6.4%.

HORMONE REPLACEMENT THERAPY TO PREVENT CHRONIC CONDITIONS

Population

  • Postmenopausal women.

Recommendation

USPSTF 2017

  • Do not use combined estrogen and progestin to prevent chronic conditions, including osteoporosis, coronary artery disease, breast cancer, and cognitive impairment.

Source

  • JAMA. 2017;318(22):2224-2233.

Population

  • Postmenopausal women who have had a ...

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