Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + DIABETES MELLITUS (DM), TYPE 2 Download Section PDF Listen +++ +++ 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 ++ 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 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 Download Section PDF Listen +++ +++ 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 to women under the age of 50 y who have undergone a surgical menopause and require estrogen for hot flashes and vasomotor symptoms. + OBESITY Download Section PDF Listen +++ +++ Population ++ Adolescents and adults. +++ Recommendations +++ ICSI 2013, CDC 2011 ++ Recommends a team approach for weight management in all persons of normal weight (BMI 18.5–24.9) or overweight (BMI 25–29.9), including: Nutrition. Physical activity. 150 minutes of moderate-intensity aerobic exercise/wk. Lifestyle changes. Avoid inactivity. Screen for depression. Screen for eating disorders. Review medication list and assess if any medications can interfere with weight loss. Recommends regular follow-up to reinforce principles of weight management. +++ Source ++ Fitch A, Everling L, Fox C, et al. Prevention and Management of Obesity for Adults. Bloomington (MN): ICSI; 2013. +++ Comments ++ Recommend 30–60 min of moderate physical activity on most days of the week. Nutrition education focused on decreased caloric intake, encouraging healthy food choices, and managing restaurant and social eating situations. Eat 5–6 servings of fruits and vegetables daily. Weekly weight checks. Encourage nonfood rewards for positive reinforcement. Stress management techniques. 5%–10% weight loss can produce a clinically significant reduction in heart disease risk. +++ Population ++ Children. +++ Recommendations +++ Endocrine Society 2017, AAP 2015, CDC 2011 ++ Educate children and parents about healthy diets and the importance of regular physical activity. 60 minutes or more/d of aerobic activity of a moderate or vigorous intensity. Encourage school systems to promote healthy eating habits and provide health education courses. Foster healthy sleep patterns. Children should sleep 9 h or more/night. Balance screen time with opportunities for physical activity. Avoid using food as a reward or withholding food as punishment. Breast-feed infants 6 months or longer. +++ Sources ++ J Clin Endocrinol Metab. 2017;102(3):709-757. Stanford Health Care. +++ Comments ++ Avoid the consumption of calorie-dense, nutrient-poor foods (eg, juices, soft drinks, “fast food” items, and calorie-dense snacks). Consume whole fruits rather than juices. Control calorie intake by portion control. Reduce saturated dietary fat intake for children age >2 y. Increase dietary fiber, fruits, and vegetables to 5 servings daily. Eat regular, scheduled meals and avoid snacking. Limit television, video games, and computer time to 2 h daily.