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Position Statements| November 24 2017
Diabetes Care 2018;41(Supplement_1):S28–S37
The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the
components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for
ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. PATIENT-CENTERED COLLABORATIVE CARERecommendation
A successful medical evaluation depends on beneficial interactions between the patient and the care team. The Chronic Care Model (1–3) (see Section 1 “Improving Care and Promoting Health in Populations”) is a patient-centered approach to care that requires a close working relationship between the patient and clinicians involved in treatment planning. People with diabetes should receive health care from an interdisciplinary team that may include physicians, nurse practitioners, physician assistants, nurses, dietitians, exercise specialists, pharmacists, dentists, podiatrists, and mental health professionals. Individuals with diabetes must assume an active role in their care. The patient, family or support persons, physician, and health care team should together formulate the management plan, which includes lifestyle management (see Section 4 “Lifestyle Management”). Treatment goals and plans should be created with the patients based on their individual preferences, values, and goals. The management plan should take into account the patient’s age, cognitive abilities, school/work schedule and conditions, health beliefs, support systems, eating patterns, physical activity, social situation, financial concerns, cultural factors, literacy and numeracy (mathematical literacy), diabetes complications and duration of disease, comorbidities, health priorities, other medical conditions, preferences for care, and life expectancy. Various strategies and techniques should be used to support patients’ self-management efforts, including providing education on problem-solving skills for all aspects of diabetes management. Provider communications with patients/families should acknowledge that multiple factors impact glycemic management, but also emphasize that collaboratively developed treatment plans and a healthy lifestyle can significantly improve disease outcomes and well-being (4–7). Thus, the goal of provider-patient communication is to establish a collaborative relationship and to assess and address self-management barriers without blaming patients for “noncompliance” or “nonadherence” when the outcomes of self-management are not optimal (8). The familiar terms “noncompliance” and “nonadherence” denote a passive, obedient role for a person with diabetes in “following doctor’s orders” that is at odds with the active role people with diabetes take in directing the day-to-day decision-making, planning, monitoring, evaluation, and problem-solving involved in diabetes self-management. Using a nonjudgmental approach that normalizes periodic lapses in self-management may help minimize patients’ resistance to reporting problems with self-management. Empathizing and using active listening techniques, such as open-ended questions, reflective statements, and summarizing what the patient said, can help facilitate communication. Patients’ perceptions about their own ability, or self-efficacy, to self-manage diabetes are one important psychosocial factor related to improved diabetes self-management and treatment outcomes in diabetes (9–13) and should be a target of ongoing assessment, patient education, and treatment planning. COMPREHENSIVE MEDICAL EVALUATIONRecommendations
The comprehensive medical evaluation includes the initial and follow-up evaluations, assessment of complications, psychosocial assessment, management of comorbid conditions, and engagement of the patient throughout the process. While a comprehensive list is provided in Table 3.1 , in clinical practice, the provider may need to prioritize the components of the medical evaluation given the available resources and time. The goal is to provide the health care team information to optimally support a patient. In addition to the medical history, physical examination, and laboratory tests, providers should assess diabetes self-management behaviors, nutrition, and psychosocial health (see Section 4 “Lifestyle Management”) and give guidance on routine immunizations. The assessment of sleep pattern and duration should be considered; a recent meta-analysis found that poor sleep quality, short sleep, and long sleep were associated with higher A1C in people with type 2 diabetes (14). Interval follow-up visits should occur at least every 3–6 months, individualized to the patient, and then annually.  Continued on p. S31 Lifestyle management and psychosocial care are the cornerstones of diabetes management. Patients should be referred for diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), and psychosocial/emotional health concerns if indicated. Patients should receive recommended preventive care services (e.g., immunizations, cancer screening, etc.); smoking cessation counseling; and ophthalmological, dental, and podiatric referrals. Additional referrals should be arranged as necessary (Table 3.2). Clinicians should ensure that individuals with diabetes are appropriately screened for complications and comorbidities. Discussing and implementing an approach to glycemic control with the patient is a part, not the sole goal, of care. Table 3.2 Referrals for initial care management
ImmunizationRecommendations
Children and adults with diabetes should receive vaccinations according to age-specific recommendations (15,16). The child and adolescent vaccination schedule is available at www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html, and the adult vaccination schedule is available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. These immunization schedules include vaccination schedules specifically for children, adolescents, and adults with diabetes. People with diabetes are at higher risk for hepatitis B infection and are more likely to develop complications from influenza and pneumococcal disease. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommends influenza, pneumococcal, and hepatitis B vaccinations specifically for people with diabetes. Vaccination against tetanus-diphtheria-pertussis, measles-mumps-rubella, human papillomavirus, and shingles are also important for adults with diabetes, as they are for the general population. InfluenzaInfluenza is a common, preventable infectious disease associated with high mortality and morbidity in vulnerable populations including the young and the elderly and people with chronic diseases. Influenza vaccination in people with diabetes has been found to significantly reduce influenza and diabetes-related hospital admissions (17). Pneumococcal PneumoniaLike influenza, pneumococcal pneumonia is a common, preventable disease. People with diabetes may be at increased risk for the bacteremic form of pneumococcal infection and have been reported to have a high risk of nosocomial bacteremia, with a mortality rate as high as 50% (18). The American Diabetes Association (ADA) endorses recommendations from the CDC ACIP that adults age ≥65 years, who are at higher risk for pneumococcal disease, receive an additional 23-valent pneumococcal polysaccharide vaccine (PPSV23), regardless of prior pneumococcal vaccination history. See detailed recommendations at www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/pneumo.html. Hepatitis BCompared with the general population, people with type 1 or type 2 diabetes have higher rates of hepatitis B. This may be due to contact with infected blood or through improper equipment use (glucose monitoring devices or infected needles). Because of the higher likelihood of transmission, hepatitis B vaccine is recommended for adults with diabetes age <60 years. For adults age ≥60 years, hepatitis B vaccine may be administered at the discretion of the treating clinician based on the patient’s likelihood of acquiring hepatitis B infection. ASSESSMENT OF COMORBIDITIESBesides assessing diabetes-related complications, clinicians and their patients need to be aware of common comorbidities that affect people with diabetes and may complicate management (19–23). Diabetes comorbidities are conditions that affect people with diabetes more often than age-matched people without diabetes. The list below includes many of the common comorbidities observed in patients with diabetes but is not necessarily inclusive of all the conditions that have been reported. Autoimmune DiseasesRecommendation
People with type 1 diabetes are at increased risk for other autoimmune diseases including thyroid disease, primary adrenal insufficiency, celiac disease, autoimmune gastritis, autoimmune hepatitis, dermatomyositis, and myasthenia gravis (24–26). Type 1 diabetes may also occur with other autoimmune diseases in the context of specific genetic disorders or polyglandular autoimmune syndromes (27). In autoimmune diseases, the immune system fails to maintain self-tolerance to specific peptides within target organs. It is likely that many factors trigger autoimmune disease; however, common triggering factors are known for only some autoimmune conditions (i.e., gliadin peptides in celiac disease) (see Section 12 “Children and Adolescents”). CancerDiabetes is associated with increased risk of cancers of the liver, pancreas, endometrium, colon/rectum, breast, and bladder (28). The association may result from shared risk factors between type 2 diabetes and cancer (older age, obesity, and physical inactivity) but may also be due to diabetes-related factors (29), such as underlying disease physiology or diabetes treatments, although evidence for these links is scarce. Patients with diabetes should be encouraged to undergo recommended age- and sex-appropriate cancer screenings and to reduce their modifiable cancer risk factors (obesity, physical inactivity, and smoking). Cognitive Impairment/DementiaRecommendation
Diabetes is associated with a significantly increased risk and rate of cognitive decline and an increased risk of dementia (30,31). A recent meta-analysis of prospective observational studies in people with diabetes showed 73% increased risk of all types of dementia, 56% increased risk of Alzheimer dementia, and 127% increased risk of vascular dementia compared with individuals without diabetes (32). The reverse is also true: people with Alzheimer dementia are more likely to develop diabetes than people without Alzheimer dementia. In a 15-year prospective study of community-dwelling people >60 years of age, the presence of diabetes at baseline significantly increased the age- and sex-adjusted incidence of all-cause dementia, Alzheimer disease, and vascular dementia compared with rates in those with normal glucose tolerance (33). HyperglycemiaIn those with type 2 diabetes, the degree and duration of hyperglycemia are related to dementia. More rapid cognitive decline is associated with both increased A1C and longer duration of diabetes (34). The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study found that each 1% higher A1C level was associated with lower cognitive function in individuals with type 2 diabetes (35). However, the ACCORD study found no difference in cognitive outcomes in participants randomly assigned to intensive and standard glycemic control, supporting the recommendation that intensive glucose control should not be advised for the improvement of cognitive function in individuals with type 2 diabetes (36). HypoglycemiaIn type 2 diabetes, severe hypoglycemia is associated with reduced cognitive function, and those with poor cognitive function have more severe hypoglycemia. In a long-term study of older patients with type 2 diabetes, individuals with one or more recorded episode of severe hypoglycemia had a stepwise increase in risk of dementia (37). Likewise, the ACCORD trial found that as cognitive function decreased, the risk of severe hypoglycemia increased (38). Tailoring glycemic therapy may help to prevent hypoglycemia in individuals with cognitive dysfunction. NutritionIn one study, adherence to the Mediterranean diet correlated with improved cognitive function (39). However, a recent Cochrane review found insufficient evidence to recommend any dietary change for the prevention or treatment of cognitive dysfunction (40). StatinsA systematic review has reported that data do not support an adverse effect of statins on cognition (41). The U.S. Food and Drug Administration (FDA) postmarketing surveillance databases have also revealed a low reporting rate for cognitive-related adverse events, including cognitive dysfunction or dementia, with statin therapy, similar to rates seen with other commonly prescribed cardiovascular medications (41). Therefore, fear of cognitive decline should not be a barrier to statin use in individuals with diabetes and a high risk for cardiovascular disease. Fatty Liver DiseaseDiabetes is associated with the development of nonalcoholic chronic liver disease and with hepatocellular carcinoma (42). Elevations of hepatic transaminase concentrations are associated with higher BMI, waist circumference, and triglyceride levels and lower HDL cholesterol levels. Interventions that improve metabolic abnormalities in patients with diabetes (weight loss, glycemic control, and treatment with specific drugs for hyperglycemia or dyslipidemia) are also beneficial for fatty liver disease (43,44). PancreatitisRecommendation
Diabetes is linked to diseases of the exocrine pancreas such as pancreatitis, which may disrupt the global architecture or physiology of the pancreas, often resulting in both exocrine and endocrine dysfunction. Up to half of patients with diabetes may have impaired exocrine pancreas function (45). People with diabetes are at an approximately twofold higher risk of developing acute pancreatitis (46). Conversely, prediabetes and/or diabetes has been found to develop in approximately one-third of patients after an episode of acute pancreatitis (47), thus the relationship is likely bidirectional. Postpancreatitis diabetes may include either new-onset disease or previously unrecognized diabetes (48). Studies of patients treated with incretin-based therapies for diabetes have also reported that pancreatitis may occur more frequently with these medications, but results have been mixed (49,50). Islet autotransplantation should be considered for patients requiring total pancreatectomy for medically refractory chronic pancreatitis to prevent postsurgical diabetes. Approximately one-third of patients undergoing total pancreatectomy with islet autotransplantation are insulin free one year postoperatively, and observational studies from different centers have demonstrated islet graft function up to a decade after the surgery in some patients (51–55). Both patient and disease factors should be carefully considered when deciding the indications and timing of this surgery. Surgeries should be performed in skilled facilities that have demonstrated expertise in islet autotransplantation. FracturesAge-specific hip fracture risk is significantly increased in people with both type 1 (relative risk 6.3) and type 2 (relative risk 1.7) diabetes in both sexes (56). Type 1 diabetes is associated with osteoporosis, but in type 2 diabetes, an increased risk of hip fracture is seen despite higher bone mineral density (BMD) (57). In three large observational studies of older adults, femoral neck BMD T score and the World Health Organization Fracture Risk Assessment Tool (FRAX) score were associated with hip and nonspine fractures. Fracture risk was higher in participants with diabetes compared with those without diabetes for a given T score and age or for a given FRAX score (58). Providers should assess fracture history and risk factors in older patients with diabetes and recommend measurement of BMD if appropriate for the patient’s age and sex. Fracture prevention strategies for people with diabetes are the same as for the general population and include vitamin D supplementation. For patients with type 2 diabetes with fracture risk factors, thiazolidinediones (59) and sodium–glucose cotransporter 2 inhibitors (60) should be used with caution. Hearing ImpairmentHearing impairment, both in high-frequency and low/mid-frequency ranges, is more common in people with diabetes than in those without, perhaps due to neuropathy and/or vascular disease. In a National Health and Nutrition Examination Survey (NHANES) analysis, hearing impairment was about twice as prevalent in people with diabetes compared with those without, after adjusting for age and other risk factors for hearing impairment (61). HIVRecommendation
Diabetes risk is increased with certain protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs). New-onset diabetes is estimated to occur in more than 5% of patients infected with HIV on PIs, whereas more than 15% may have prediabetes (62). PIs are associated with insulin resistance and may also lead to apoptosis of pancreatic β-cells. NRTIs also affect fat distribution (both lipohypertrophy and lipoatrophy), which is associated with insulin resistance. Individuals with HIV are at higher risk for developing prediabetes and diabetes on antiretroviral (ARV) therapies, so a screening protocol is recommended (63). The A1C test underestimates glycemia in people with HIV and is not recommended for diagnosis and may present challenges for monitoring (64). In those with prediabetes, weight loss through healthy nutrition and physical activity may reduce the progression toward diabetes. Among patients with HIV and diabetes, preventive health care using an approach similar to that used in patients without HIV is critical to reduce the risks of microvascular and macrovascular complications. For patients with HIV and ARV-associated hyperglycemia, it may be appropriate to consider discontinuing the problematic ARV agents if safe and effective alternatives are available (65). Before making ARV substitutions, carefully consider the possible effect on HIV virological control and the potential adverse effects of new ARV agents. In some cases, antihyperglycemic agents may still be necessary. Low Testosterone in MenRecommendation
Mean levels of testosterone are lower in men with diabetes compared with age-matched men without diabetes, but obesity is a major confounder (66,67). Treatment in asymptomatic men is controversial. Testosterone replacement in men with symptomatic hypogonadism may have benefits including improved sexual function, well being, muscle mass and strength, and bone density. (68). In men with diabetes who have symptoms or signs of low testosterone (hypogonadism), a morning total testosterone should be measured using an accurate and reliable assay. Free or bioavailable testosterone levels should also be measured in men with diabetes who have total testosterone levels close to the lower limit, given expected decreases in sex hormone–binding globulin with diabetes. Further testing (such as luteinizing hormone and follicle-stimulating hormone levels) may be needed to distinguish between primary and secondary hypogonadism. Obstructive Sleep ApneaAge-adjusted rates of obstructive sleep apnea, a risk factor for cardiovascular disease, are significantly higher (4- to 10-fold) with obesity, especially with central obesity (69). The prevalence of obstructive sleep apnea in the population with type 2 diabetes may be as high as 23%, and the prevalence of any sleep disordered breathing may be as high as 58% (70,71). In obese participants enrolled in the Action for Health in Diabetes (Look AHEAD) trial, it exceeded 80% (72). Sleep apnea treatment (lifestyle modification, continuous positive airway pressure, oral appliances, and surgery) significantly improves quality of life and blood pressure control. The evidence for a treatment effect on glycemic control is mixed (73). Periodontal DiseasePeriodontal disease is more severe, and may be more prevalent, in patients with diabetes than in those without (74,75). Current evidence suggests that periodontal disease adversely affects diabetes outcomes, although evidence for treatment benefits remains controversial (23). Psychosocial/Emotional DisordersPrevalence of clinically significant psychopathology diagnoses are considerably more common in people with diabetes than in those without the disease (76). Symptoms, both clinical and subclinical, that interfere with the person’s ability to carry out daily diabetes self-management tasks must be addressed. Providers should consider an assessment of symptoms of depression, anxiety, and disordered eating, and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Including caregivers and family members in this assessment is recommended. Diabetes distress is addressed in Section 4 “Lifestyle Management,” as this state is very common and distinct from the psychological disorders discussed below (77). Anxiety DisordersRecommendations
Anxiety symptoms and diagnosable disorders (e.g., generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, specific phobias, and posttraumatic stress disorder) are common in people with diabetes (78). The Behavioral Risk Factor Surveillance System (BRFSS) estimated the lifetime prevalence of generalized anxiety disorder to be 19.5% in people with either type 1 or type 2 diabetes (79). Common diabetes-specific concerns include fears related to hypoglycemia (80,81), not meeting blood glucose targets (78), and insulin injections or infusion (82). Onset of complications presents another critical point when anxiety can occur (83). People with diabetes who exhibit excessive diabetes self-management behaviors well beyond what is prescribed or needed to achieve glycemic targets may be experiencing symptoms of obsessive-compulsive disorder (84). General anxiety is a predictor of injection-related anxiety and associated with fear of hypoglycemia (81,85). Fear of hypoglycemia and hypoglycemia unawareness often co-occur, and interventions aimed at treating one often benefit both (86). Fear of hypoglycemia may explain avoidance of behaviors associated with lowering glucose such as increasing insulin doses or frequency of monitoring. If fear of hypoglycemia is identified and a person does not have symptoms of hypoglycemia, a structured program, blood glucose awareness training, delivered in routine clinical practice, can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (87,88). DepressionRecommendations
History of depression, current depression, and antidepressant medication use are risk factors for the development of type 2 diabetes, especially if the individual has other risk factors such as obesity and family history of type 2 diabetes (89–91). Elevated depressive symptoms and depressive disorders affect one in four patients with type 1 or type 2 diabetes (92). Thus, routine screening for depressive symptoms is indicated in this high-risk population including people with type 1 or type 2 diabetes, gestational diabetes mellitus, and postpartum diabetes. Regardless of diabetes type, women have significantly higher rates of depression than men (93). Routine monitoring with patient-appropriate validated measures can help to identify if referral is warranted. Adult patients with a history of depressive symptoms or disorder need ongoing monitoring of depression recurrence within the context of routine care (88). Integrating mental and physical health care can improve outcomes. When a patient is in psychological therapy (talk therapy), the mental health provider should be incorporated into the diabetes treatment team (94). Disordered Eating BehaviorRecommendations
Estimated prevalence of disordered eating behaviors and diagnosable eating disorders in people with diabetes varies (95–97). For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior (98,99); in people with type 2 diabetes, bingeing (excessive food intake with an accompanying sense of loss of control) is most commonly reported. For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported (100). People with diabetes and diagnosable eating disorders have high rates of comorbid psychiatric disorders (101). People with type 1 diabetes and eating disorders have high rates of diabetes distress and fear of hypoglycemia (102). When evaluating symptoms of disordered or disrupted eating in people with diabetes, etiology and motivation for the behavior should be considered (97,103). Adjunctive medication such as glucagon-like peptide 1 receptor agonists (104) may help individuals not only to meet glycemic targets but also to regulate hunger and food intake, thus having the potential to reduce uncontrollable hunger and bulimic symptoms. Serious Mental IllnessRecommendations
Studies of individuals with serious mental illness, particularly schizophrenia and other thought disorders, show significantly increased rates of type 2 diabetes (105). People with schizophrenia should be monitored for type 2 diabetes because of the known comorbidity. Disordered thinking and judgment can be expected to make it difficult to engage in behaviors that reduce risk factors for type 2 diabetes, such as restrained eating for weight management. Coordinated management of diabetes or prediabetes and serious mental illness is recommended to achieve diabetes treatment targets. In addition, those taking second-generation (atypical) antipsychotics such as olanzapine require greater monitoring because of an increase in risk of type 2 diabetes associated with this medication (106). Suggested citation: American Diabetes Association. 3. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018;41(Suppl. 1):S28–S37 References1. Stellefson M ,Dipnarine K ,Stopka C .The Chronic Care Model and diabetes management in US primary care settings: a systematic review . Prev Chronic Dis 2013 ; 10 : E26 2. Coleman K ,Austin BT ,Brach C ,Wagner EH .Evidence on the Chronic Care Model in the new millennium . Health Aff (Millwood) 2009 ; 28 : 75 – 85 3. Gabbay RA ,Bailit MH ,Mauger DT ,Wagner EH ,Siminerio L .Multipayer patient-centered medical home implementation guided by the Chronic Care Model . Jt Comm J Qual Patient Saf 2011 ; 37 : 265 – 273 4. UK Prospective Diabetes Study (UKPDS) Group .Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) . Lancet 1998 ; 352 : 837 – 853 5. The Diabetes Control and Complications Trial Research Group .The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med 1993 ; 329 : 977 – 986 6. Lachin JM ,Genuth S ,Nathan DM ,Zinman B ,Rutledge BN ;DCCT/EDIC Research Group .Effect of glycemic exposure on the risk of microvascular complications in the Diabetes Control and Complications Trial—revisited . Diabetes 2008 ; 57 : 995 – 1001 7. White NH ,Cleary PA ,Dahms W ,Goldstein D ,Malone J ,Tamborlane WV ;Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group .Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT) . J Pediatr 2001 ; 139 : 804 – 812 8. Anderson RM ,Funnell MM .Compliance and adherence are dysfunctional concepts in diabetes care . Diabetes Educ 2000 ; 26 : 597 – 604 9. Sarkar U ,Fisher L ,Schillinger D .Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care 2006 ; 29 : 823 – 829 10. King DK ,Glasgow RE ,Toobert DJ , et al.Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors . Diabetes Care 2010 ; 33 : 751 – 753 11. Nouwen A ,Urquhart Law G ,Hussain S ,McGovern S ,Napier H .Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes . Psychol Health 2009 ; 24 : 1071 – 1084 12. Beckerle CM ,Lavin MA .Association of self-efficacy and self-care with glycemic control in diabetes . Diabetes Spectr 2013 ; 26 : 172 – 178 13. Iannotti RJ ,Schneider S ,Nansel TR , et al.Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes . J Dev Behav Pediatr 2006 ; 27 : 98 – 105 14. Lee SWH ,Ng KY ,Chin WK .The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: a systematic review and meta-analysis . Sleep Med Rev 2017 ; 31 : 91 – 101 15. Robinson CL ,Romero JR ,Kempe A ,Pellegrini C ;Advisory Committee on Immunization Practices (ACIP) Child/Adolescent Immunization Work Group .Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger—United States, 2017 . MMWR Morb Mortal Wkly Rep 2017 ; 66 : 134 – 135 16. Kim DK ,Riley LE ,Harriman KH ,Hunter P ,Bridges CB .Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older—United States, 2017 . MMWR Morb Mortal Wkly Rep 2017 ; 66 : 136 – 138 17. Goeijenbier M ,van Sloten TT ,Slobbe L , et al.Benefits of flu vaccination for persons with diabetes mellitus: a review . Vaccine 2017 ; 35 : 5095 – 5101 18. Smith SA ,Poland GA .Use of influenza and pneumococcal vaccines in people with diabetes . Diabetes Care 2000 ; 23 : 95 – 108 19. Selvin E ,Coresh J ,Brancati FL .The burden and treatment of diabetes in elderly individuals in the U.S . Diabetes Care 2006 ; 29 : 2415 – 2419 20. Grant RW ,Ashburner JM ,Hong CS ,Chang Y ,Barry MJ ,Atlas SJ .Defining patient complexity from the primary care physician’s perspective: a cohort study . Ann Intern Med 2011 ; 155 : 797 – 804 21. Tinetti ME ,Fried TR ,Boyd CM .Designing health care for the most common chronic condition—multimorbidity . JAMA 2012 ; 307 : 2493 – 2494 22. Sudore RL ,Karter AJ ,Huang ES , et al.Symptom burden of adults with type 2 diabetes across the disease course: Diabetes & Aging Study . J Gen Intern Med 2012 ; 27 : 1674 – 1681 23. Borgnakke WS ,Ylöstalo PV ,Taylor GW ,Genco RJ .Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence . J Periodontol 2013 ; 84 ( Suppl. ): S135 – S152 24. Triolo TM ,Armstrong TK ,McFann K , et al.Additional autoimmune disease found in 33% of patients at type 1 diabetes onset . Diabetes Care 2011 ; 34 : 1211 – 1213 25. Hughes JW ,Riddlesworth TD ,DiMeglio LA ,Miller KM ,Rickels MR ,McGill JB ;T1D Exchange Clinic Network .Autoimmune diseases in children and adults with type 1 diabetes from the T1D Exchange Clinic Registry . J Clin Endocrinol Metab 2016 ; 101 : 4931 – 4937 26. Kahaly GJ ,Hansen MP .Type 1 diabetes associated autoimmunity . Autoimmun Rev 2016 ; 15 : 644 – 648 27. Eisenbarth GS ,Gottlieb PA .Autoimmune polyendocrine syndromes . N Engl J Med 2004 ; 350 : 2068 – 2079 28. Suh S ,Kim K-W .Diabetes and cancer: is diabetes causally related to cancer? Diabetes Metab J 2011 ; 35 : 193 – 198 29. Giovannucci E ,Harlan DM ,Archer MC , et al.Diabetes and cancer: a consensus report . Diabetes Care 2010 ; 33 : 1674 – 1685 30. Cukierman T ,Gerstein HC ,Williamson JD .Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies . Diabetologia 2005 ; 48 : 2460 – 2469 31. Biessels GJ ,Staekenborg S ,Brunner E ,Brayne C ,Scheltens P .Risk of dementia in diabetes mellitus: a systematic review . Lancet Neurol 2006 ; 5 : 64 – 74 32. Gudala K ,Bansal D ,Schifano F ,Bhansali A .Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies . J Diabetes Investig 2013 ; 4 : 640 – 650 33. Ohara T ,Doi Y ,Ninomiya T , et al.Glucose tolerance status and risk of dementia in the community: the Hisayama study . Neurology 2011 ; 77 : 1126 – 1134 34. Rawlings AM ,Sharrett AR ,Schneider ALC , et al.Diabetes in midlife and cognitive change over 20 years: a cohort study . Ann Intern Med 2014 ; 161 : 785 – 793 35. Cukierman-Yaffe T ,Gerstein HC ,Williamson JD , et al.;Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators .Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial . Diabetes Care 2009 ; 32 : 221 – 226 36. Launer LJ ,Miller ME ,Williamson JD , et al.;ACCORD MIND Investigators .Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy . Lancet Neurol 2011 ; 10 : 969 – 977 37. Whitmer RA ,Karter AJ ,Yaffe K ,Quesenberry CP Jr,Selby JV .Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus . JAMA 2009 ; 301 : 1565 – 1572 38. Punthakee Z ,Miller ME ,Launer LJ , et al.;ACCORD Group of Investigators ;ACCORD-MIND Investigators .Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial . Diabetes Care 2012 ; 35 : 787 – 793 39. Scarmeas N ,Stern Y ,Mayeux R ,Manly JJ ,Schupf N ,Luchsinger JA .Mediterranean diet and mild cognitive impairment . Arch Neurol 2009 ; 66 : 216 – 225 40. Ooi CP ,Loke SC ,Yassin Z ,Hamid T-A .Carbohydrates for improving the cognitive performance of independent-living older adults with normal cognition or mild cognitive impairment . Cochrane Database Syst Rev 2011 ; 4 : CD007220 41. Richardson K ,Schoen M ,French B , et al.Statins and cognitive function: a systematic review . Ann Intern Med 2013 ; 159 : 688 – 697 42. El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460–468 43. American Gastroenterological Association .American Gastroenterological Association medical position statement: nonalcoholic fatty liver disease . Gastroenterology 2002 ; 123 : 1702 – 1704 44. Cusi K ,Orsak B ,Bril F , et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial . Ann Intern Med 2016 ; 165 : 305 – 315 45. Hardt PD ,Brendel MD ,Kloer HU ,Bretzel RG .Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed? Diabetes Care 2008 ; 31 ( Suppl. 2 ): S165 – S169 46. Lee Y-K ,Huang M-Y ,Hsu C-Y ,Su Y-C .Bidirectional relationship between diabetes and acute pancreatitis: a population-based cohort study in Taiwan . Medicine (Baltimore) 2016 ; 95 : e2448 47. Das SLM ,Singh PP ,Phillips ARJ ,Murphy R ,Windsor JA ,Petrov MS .Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis . Gut 2014 ; 63 : 818 – 831 48. Petrov MS .Diabetes of the exocrine pancreas: American Diabetes Association-compliant lexicon . Pancreatology 2017 ; 17 : 523 – 526 49. Thomsen RW ,Pedersen L ,Møller N ,Kahlert J ,Beck-Nielsen H ,Sørensen HT .Incretin-based therapy and risk of acute pancreatitis: a nationwide population-based case-control study . Diabetes Care 2015 ; 38 : 1089 – 1098 50. Tkáč I ,Raz I .Combined analysis of three large interventional trials with gliptins indicates increased incidence of acute pancreatitis in patients with type 2 diabetes . Diabetes Care 2017 ; 40 : 284 – 286 51. Bellin MD ,Gelrud A ,Arreaza-Rubin G , et al.Total pancreatectomy with islet autotransplantation: summary of an NIDDK workshop . Ann Surg 2015 ; 261 : 21 – 29 52. Sutherland DER ,Radosevich DM ,Bellin MD , et al.Total pancreatectomy and islet autotransplantation for chronic pancreatitis . J Am Coll Surg 2012 ; 214 : 409 – 424 53. Quartuccio M ,Hall E ,Singh V , et al.Glycemic predictors of insulin independence after total pancreatectomy with islet autotransplantation . J Clin Endocrinol Metab 2017 ; 102 : 801 – 809 54. Webb MA ,Illouz SC ,Pollard CA , et al.Islet auto transplantation following total pancreatectomy: a long-term assessment of graft function . Pancreas 2008 ; 37 : 282 – 287 55. Wu Q ,Zhang M ,Qin Y , et al.Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients . Endocr J 2015 ; 62 : 227 – 234 56. Janghorbani M ,Van Dam RM ,Willett WC ,Hu FB .Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture . Am J Epidemiol 2007 ; 166 : 495 – 505 57. Vestergaard P .Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis . Osteoporos Int 2007 ; 18 : 427 – 444 58. Schwartz AV ,Vittinghoff E ,Bauer DC , et al.;Study of Osteoporotic Fractures (SOF) Research Group ;Osteoporotic Fractures in Men (MrOS) Research Group ;Health, Aging, and Body Composition (Health ABC) Research Group .Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes . JAMA 2011 ; 305 : 2184 – 2192 59. Kahn SE ,Zinman B ,Lachin JM , et al.;Diabetes Outcome Progression Trial (ADOPT) Study Group .Rosiglitazone-associated fractures in type 2 diabetes: an analysis from A Diabetes Outcome Progression Trial (ADOPT) . Diabetes Care 2008 ; 31 : 845 – 851 60. Taylor SI ,Blau JE ,Rother KI .Possible adverse effects of SGLT2 inhibitors on bone . Lancet Diabetes Endocrinol 2015 ; 3 : 8 – 10 61. Bainbridge KE ,Hoffman HJ ,Cowie CC .Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004 . Ann Intern Med 2008 ; 149 : 1 – 10 62. Monroe AK ,Glesby MJ ,Brown TT .Diagnosing and managing diabetes in HIV-infected patients: current concepts . Clin Infect Dis 2015 ; 60 : 453 – 462 63.
Schambelan M ,Benson CA ,Carr A , et al.;International AIDS Society-USA .Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society-USA panel . J Acquir Immune Defic Syndr 2002 ; 31 : 257 – 275 . 64. Kim PS ,Woods C ,Georgoff P , et al.A1C underestimates glycemia in HIV infection . Diabetes Care 2009 ; 32 : 1591 – 1593 65. Wohl DA ,McComsey G ,Tebas P , et al.Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy . Clin Infect Dis 2006 ; 43 : 645 – 653 66. Dhindsa S ,Miller MG ,McWhirter CL , et al.Testosterone concentrations in diabetic and nondiabetic obese men . Diabetes Care 2010 ; 33 : 1186 – 1192 67. Grossmann M .Low testosterone in men with type 2 diabetes: significance and treatment . J Clin Endocrinol Metab 2011 ; 96 : 2341 – 2353 68. Bhasin S ,Cunningham GR ,Hayes FJ , et al.;Task Force, Endocrine Society .Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline . J Clin Endocrinol Metab 2010 ; 95 : 2536 – 2559 69. Li C ,Ford ES ,Zhao G ,Croft JB ,Balluz LS ,Mokdad AH .Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005–2006 . Prev Med 2010 ; 51 : 18 – 23 70. West SD ,Nicoll DJ ,Stradling JR .Prevalence of obstructive sleep apnoea in men with type 2 diabetes . Thorax 2006 ; 61 : 945 – 950 71. Resnick HE ,Redline S ,Shahar E , et al.;Sleep Heart Health Study .Diabetes and sleep disturbances: findings from the Sleep Heart Health Study . Diabetes Care 2003 ; 26 : 702 – 709 72. Foster GD ,Sanders MH ,Millman R , et al.;Sleep AHEAD Research Group .Obstructive sleep apnea among obese patients with type 2 diabetes . Diabetes Care 2009 ; 32 : 1017 – 1019 73. Shaw JE ,Punjabi NM ,Wilding JP ,Alberti KGMM ,Zimmet PZ ;International Diabetes Federation Taskforce on Epidemiology and Prevention .Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention . Diabetes Res Clin Pract 2008 ; 81 : 2 – 12 74. Khader YS ,Dauod AS ,El-Qaderi SS ,Alkafajei A ,Batayha WQ .Periodontal status of diabetics compared with nondiabetics: a meta-analysis . J Diabetes Complications 2006 ; 20 : 59 – 68 75. Casanova L ,Hughes FJ ,Preshaw PM .Diabetes and periodontal disease: a two-way relationship . Br Dent J 2014 ; 217 : 433 – 437 76. de Groot M ,Golden SH ,Wagner J .Psychological conditions in adults with diabetes . Am Psychol 2016 ; 71 : 552 – 562 77. Young-Hyman D ,de Groot M ,Hill-Briggs F ,Gonzalez JS ,Hood K ,Peyrot M .Psychosocial care for people with diabetes: a position statement of the American Diabetes Association . Diabetes Care 2016 ; 39 : 2126 – 2140 78. Smith KJ ,Béland M ,Clyde M , et al.Association of diabetes with anxiety: a systematic review and meta-analysis . J Psychosom Res 2013 ; 74 : 89 – 99 79. Li C ,Barker L ,Ford ES ,Zhang X ,Strine TW ,Mokdad AH .Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System . Diabet Med 2008 ; 25 : 878 – 881 80. Cox DJ ,Irvine A ,Gonder-Frederick L ,Nowacek G ,Butterfield J .Fear of hypoglycemia: quantification, validation, and utilization . Diabetes Care 1987 ; 10 : 617 – 621 81. Wild D ,von Maltzahn R ,Brohan E ,Christensen T ,Clauson P ,Gonder-Frederick L .A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education . Patient Educ Couns 2007 ; 68 : 10 – 15 82. Zambanini A ,Newson RB ,Maisey M ,Feher MD .Injection related anxiety in insulin-treated diabetes . Diabetes Res Clin Pract 1999 ; 46 : 239 – 246 83.
Young-Hyman D ,Peyrot M .Psychosocial Care for People with Diabetes . Alexandria, VA , American Diabetes Association , 2012 84. American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders [Internet] , 2013 . 5th ed. 85. Mitsonis C ,Dimopoulos N ,Psarra V .P01-138 Clinical implications of anxiety in diabetes: a critical review of the evidence base . Eur Psychiatry 2009 ; 24 ( Suppl. 1 ): S526 86. Yeoh E ,Choudhary P ,Nwokolo M ,Ayis S ,Amiel SA .Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis . Diabetes Care 2015 ; 38 : 1592 – 1609 87. Cox DJ ,Gonder-Frederick L ,Polonsky W ,Schlundt D ,Kovatchev B ,Clarke W .Blood glucose awareness training (BGAT-2): long-term benefits . Diabetes Care 2001 ; 24 : 637 – 642 88. Gonder-Frederick LA ,Schmidt KM ,Vajda KA , et al.Psychometric properties of the Hypoglycemia Fear Survey-II for adults with type 1 diabetes . Diabetes Care 2011 ; 34 : 801 – 806 89. Lustman PJ ,Griffith LS ,Clouse RE .Depression in adults with diabetes. Results of 5-yr follow-up study . Diabetes Care 1988 ; 11 : 605 – 612 90. de Groot M ,Crick KA ,Long M ,Saha C ,Shubrook JH .Lifetime duration of depressive disorders in patients with type 2 diabetes . Diabetes Care 2016 ; 39 : 2174 – 2181 91. Rubin RR ,Ma Y ,Marrero DG , et al.;Diabetes Prevention Program Research Group .Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the Diabetes Prevention Program . Diabetes Care 2008 ; 31 : 420 – 426 92. Anderson RJ ,Freedland KE ,Clouse RE ,Lustman PJ .The prevalence of comorbid depression in adults with diabetes: a meta-analysis . Diabetes Care 2001 ; 24 : 1069 – 1078 93. Clouse RE ,Lustman PJ ,Freedland KE ,Griffith LS ,McGill JB ,Carney RM .Depression and coronary heart disease in women with diabetes . Psychosom Med 2003 ; 65 : 376 – 383 94. Katon WJ ,Lin EHB ,Von Korff M , et al.Collaborative care for patients with depression and chronic illnesses . N Engl J Med 2010 ; 363 : 2611 – 2620 95. Pinhas-Hamiel O ,Hamiel U ,Levy-Shraga Y .Eating disorders in adolescents with type 1 diabetes: challenges in diagnosis and treatment . World J Diabetes 2015 ; 6 : 517 – 526 96. Papelbaum M ,Appolinário JC ,Moreira Rde O ,Ellinger VCM ,Kupfer R ,Coutinho WF .Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients . Rev Bras Psiquiatr 2005 ; 27 : 135 – 138 97. Young-Hyman DL ,Davis CL .Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification . Diabetes Care 2010 ; 33 : 683 – 689 98. Pinhas-Hamiel O ,Hamiel U ,Greenfield Y , et al.Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus . Int J Eat Disord 2013 ; 46 : 819 – 825 99. Goebel-Fabbri AE ,Fikkan J ,Franko DL ,Pearson K ,Anderson BJ ,Weinger K .Insulin restriction and associated morbidity and mortality in women with type 1 diabetes . Diabetes Care 2008 ; 31 : 415 – 419 100. Weinger K ,Beverly EA .Barriers to achieving glycemic targets: who omits insulin and why? Diabetes Care 2010 ; 33 : 450 – 452 101. Hudson JI ,Hiripi E ,Pope HG Jr,Kessler RC .The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication . Biol Psychiatry 2007 ; 61 : 348 – 358 102. Martyn-Nemeth P ,Quinn L ,Hacker E ,Park H ,Kujath AS .Diabetes distress may adversely affect the eating styles of women with type 1 diabetes . Acta Diabetol 2014 ; 51 : 683 – 686 103. Peterson CM ,Fischer S ,Young-Hyman D .Topical review: a comprehensive risk model for disordered eating in youth with type 1 diabetes . J Pediatr Psychol 2015 ; 40 : 385 – 390 104. Garber AJ .Novel GLP-1 receptor agonists for diabetes . Expert Opin Investig Drugs 2012 ; 21 : 45 – 57 105. Suvisaari J ,Perälä J ,Saarni SI , et al.Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey . Eur Arch Psychiatry Clin Neurosci 2008 ; 258 : 129 – 136 106. Koro CE ,Fedder DO ,L’Italien GJ , et al.Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study . BMJ 2002 ; 325 : 243 © 2017 by the American Diabetes Association. 2017 13,400 Views 56 Citations Email alertsWhich are clinical findings usually associated with type 1 diabetes?The most common symptoms of type 1 diabetes mellitus (DM) are polyuria, polydipsia, and polyphagia, along with lassitude, nausea, and blurred vision, all of which result from the hyperglycemia itself. Polyuria is caused by osmotic diuresis secondary to hyperglycemia.
What are the nursing assessment for diabetes?The nurse should assess the following for patients with Diabetes Mellitus:. Assess the patient's history. ... . Assess physical condition. ... . Assess the body mass index and visual acuity of the patient.. Perform examination of foot, skin, nervous system and mouth.. Laboratory examinations.. What are some nursing diagnosis for type 1 diabetes?Nursing Diagnoses
Risk for impaired skin integrity related to slow healing process and decreased circulation. Risk for infection related to elevated glucose levels. Deficient knowledge related to complications of hypoglycemia and hyperglycemia. Deficient knowledge related to appropriate exercise and activity.
What is type 1 diabetes characterized?Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, specialized cells in the pancreas called beta cells stop producing insulin . Insulin controls how much glucose (a type of sugar) is passed from the blood into cells for conversion to energy.
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What are the nursing assessment findings that could indicate a patient has type 1 diabetes?
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