Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ DIABETES MELLITUS (DM), TYPE 2 +++ Population ++ –Persons with impaired glucose tolerance (IGT).a +++ Recommendations ++ ADA 2017 ++ –Nutrition therapy emphasizing portion control and foods higher in fiber with lower glycemic index. –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 those with prior gestational diabetes mellitus [GDM]). ++ Source ++ –Diabetes Care. 2018;41(suppl 1):S1–S159. +++ Comments ++ Recommendations for disease prevention: Annual influenza vaccine. Pneumococcal polysaccharide vaccine if 2 y or older with one-time revaccination when over 64 y. Hepatitis B vaccine series if unvaccinated and 19–59 y of age. 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 2016 ++ –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):e328-347. + ++ aIGT if fasting glucose 110–125 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 hysterectomy. +++ Recommendation ++ USPSTF 2017 ++ –Do not use estrogen to prevent chronic conditions, including osteoporosis, coronary artery disease, breast cancer, and cognitive impairment. ++ Source ++ –JAMA. 2017;318(22):2224-2233. +++ Comment ++ This recommendation does not apply ... GET ACCESS TO THIS RESOURCE Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options