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listlengths 384
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range.\nDCCT\n,\tDiabetes\tControl\tand\tComplications\tTrial;\t\nFPG\n,\tfasting\tplasma\tglucose;\t\n2-h\tPG\n,\t2-hour\tplasma\tglucose\tlevel\t(measured\t2\thours\tafter\tan\noral\tglucose\ttolerance\ttest\t[OGTT]\twith\tadministration\tof\t75\tg\tof\tglucose);\t\nNGSP\n,\tNational\tGlycohemoglobin\tStandardization\tProgram;\t\nWHO\n,\tWorld\nHealth\n\tOrganization.
|
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] |
WHO\n,\tWorld\nHealth\n\tOrganization.\nModified\tfrom\tAmerican\tDiabetes\tAssociation:\tClassification\tand\tof\tdiabetes:\tstandards\tof\tmedical\tcare\tin\tdiabetes—2018,\t\nDiabetes\tCare\n41(S1):S15-17,\t2018.\nOther\ttypes\tof\tdiabetes\nThis\tcategory\tincludes\tdiabetes\tassociated\twith\tspecific\tgenetic\tsyndromes\t(such\tas\tneonatal\ndiabetes\tand
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] |
diabetes\tand\t\nmaturity\tonset\tdiabetes\tof\tyouth\t(MODY)\n,\tgenetic\tdefects\tin\tinsulin\taction,\ndiseases\tof\tthe\n\texocrine\tpancreas\t(such\tas\tcystic\tfibrosis),\tendocrinopathies,\t(such\tas\tacromegaly\tor\nCushing’s\tsyndrome),\tdrug\tor\tchemical\tinduced\t(such\tas\tin\tthe\ttreatment\tof\tHIV/AIDS\tor\tafter\torgan
|
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] |
transplantation),\tinfections,\tand\tother\tillnesses.\tMonogenic\tdefects\tthat\tcause\tb-cell\tdysfunction,\nsuch\tas\tneonatal\tdiabetes\tand\tMODY,\trepresent\ta\tsmall\tfraction\tof\tpatients\twith\tdiabetes\t(<5%)\n(\nADA,\t2018\n).\nScreening\tand\tdiagnostic\tcriteria\nScreening\tfor\tdiabetes\n1.
|
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).\nScreening\tand\tdiagnostic\tcriteria\nScreening\tfor\tdiabetes\n1.\t\nTesting\tshould\tbe\tconsidered\tin\toverweight\tor\tobese\t(BMI\tgreater\tthan\tor\tequal\tto\t25\tkg/m\n2\nor\tgreater\tthan\tor\tequal\tto\t23\tkg/m2\tin\tAsian\tAmericans)\tadults\twho\thave\tone\tor\tmore\tof\tthe\nfollowing\trisk\tfactors:\n•\t\nFirst-degree\trelative\twith\tdiabetes\n•
|
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0.005190511234104633,
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0.0732397586107254,
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-0.02436661720275879,
0.12501204013824463,
-0.0409090593457222,
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0.01357433944940567,
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-0.027831722050905228,
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0.14399056136608124,
0.010121247731149197,
-0.022108430042862892,
-0.028275515884160995,
0.10700339823961258,
0.10341435670852661,
-0.039673663675785065,
-0.004886121489107609,
0.05146562680602074,
0.0008654402336105704,
-0.05381463095545769,
-0.004098920617252588,
0.04461962357163429,
0.0019940435886383057,
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0.043531134724617004,
0.06010010838508606,
0.06639335304498672,
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0.0416591502726078,
0.06669128686189651,
0.00883800070732832,
0.03724992647767067,
0.010434543713927269
] |
following\trisk\tfactors:\n•\t\nFirst-degree\trelative\twith\tdiabetes\n•\t\nHigh-risk\trace/ethnicity\t(e.g.,\tAfrican\tAmerican,\tLatino,\tNative\tAmerican,\tAsian\nAmerican,\tPacific\tIslander)\n•\t\nHistory\tof\tCVD\n•\t\nHypertension\t(greater\tthan\tor\tequal\tto\t140/90\tmm\tHg\tor\ton\ttherapy\tfor\thypertension)\n•
|
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0.008672896772623062,
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0.023374564945697784,
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0.007977121509611607,
0.124534972012043,
0.019709937274456024,
0.0896921157836914,
0.0046449583023786545
] |
•\t\nHigh-density\tlipoprotein\t(HDL)\tcholesterol\tlevel\t<35\tmg/dL\t(0.90\tmmol/L)\tand/or\ta\ntriglyceride\tlevel\t>250\tmg/dL\t(2.82\tmmol/L)\n•\t\nWomen\twith\tpolycystic\tovary\tsyndrome\t(PCOS)\n•\t\nPhysical\tinactivity\n•\t\nOther\tclinical\tconditions\tassociated\twith\tinsulin\tresistance\n\t(e.g.,\tsevere\tobesity;\nacanthosis\tnigricans
|
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(e.g.,\tsevere\tobesity;\nacanthosis\tnigricans\n,\ta\tcondition\tin\twhich\tdark\traised\tareas\tappear\ton\tthe\tsides\tof\nthe\tneck\tand\tin\tbody\tfolds\tand\tcreases).\n2.\t\nPatients\twith\tprediabetes\t(A1C\tgreater\tthan\tor\tequal\tto\t5.7%\t[39\tmmol/mol],\tIGT,\tor\tIFG)\nshould\tbe\ttested\tyearly.\n3.
|
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0.04071560129523277,
0.06265940517187119,
0.0408378541469574,
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] |
should\tbe\ttested\tyearly.\n3.\t\nWomen\twho\twere\tdiagnosed\twith\tGDM\tshould\thave\tlifelong\ttesting\tat\tleast\tevery\t3\tyears.\n4.\t\nFor\tall\tother\tpatients,\ttesting\n\tshould\tbegin\tat\tage\t45\tyears.\n5.\t\nIf\tresults\tare\tnormal,\ttesting\tshould\tbe\trepeated\tat\ta\tminimum\tof\t3-year\tintervals,\twith
|
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] |
consideration\tof\tmore\tfrequent\ttesting\tdepending\ton\tinitial\tresults\tand\trisk\tstatus.\nRisk-based\tscreening\tfor\tT2DM\tor\tprediabetes\tin\tasymptomatic\tchildren\tand\tadolescents\tin\ta\nclinical\tsetting\t(Persons\taged\t<18\tyears):\nCriteria\n•\t\nOverweight\t(BMI\t>85th\tpercentile\tfor\n\tage\tand\tsex,\tweight\tfor\theight\t>85th\tpercentile,\tor
|
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] |
Plus\tone\tor\tmore\tadditional\trisk\tfactors\tbased\ton\tthe\tstrength\tof\ttheir\tassociation\twith\tdiabetes\tas\nindicated\tby\tevidence\tgrades:\n•\t\nMaternal\thistory\tof\tdiabetes\tor\tGDM\tduring\tthe\tchild’s\tgestation\n•\t\nFamily\thistory\tof\tT2DM\tin\tfirst-\tor\tsecond-degree\trelative\n•\t\nRace/ethnicity\t(Native\tAmerican,\tAfrican\n\tAmerican,\tLatino,\tAsian\tAmerican,\tPacific
|
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] |
American,\tLatino,\tAsian\tAmerican,\tPacific\nIslander)\n•\t\nSigns\tof\tinsulin\tresistance\tor\tconditions\tassociated\twith\tinsulin\tresistance\t(acanthosis\nnigricans,\thypertension,\tdyslipidemia,\tPCOS,\tor\tsmall-for-gestational-age\tbirth\tweight)\n(\nADA,\t2018\n)\nDiagnostic\tcriteria
|
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0.03329712897539139,
-0.00564363319426775,
0.02491130866110325,
-0.005532475188374519,
-0.014934361912310123,
0.04264357313513756,
0.08505306392908096,
0.05841623619198799,
-0.008414162322878838,
0.038261767476797104,
-0.10154975205659866,
0.022551963105797768,
0.023352907970547676,
-4.450938817512906e-8,
0.09461884200572968,
0.051178716123104095,
0.0008376690093427896,
-0.061082981526851654,
-0.01719379983842373,
-0.004256477113813162,
0.021310189738869667,
0.04196425527334213,
0.02441656030714512,
0.0493701733648777,
-0.03271818906068802,
0.054435212165117264,
0.01381922047585249,
-0.07003625482320786,
0.052435509860515594,
-0.021278763189911842,
0.009685912169516087,
0.1594434380531311,
0.008981883525848389,
-0.06104066222906113,
-0.051229048520326614,
0.05522811785340309,
0.04230454936623573,
-0.024465816095471382,
-0.01659182272851467,
0.007762099150568247,
0.00686107762157917,
-0.04194201901555061,
-0.0005909703904762864,
0.016901591792702675,
0.012987857684493065,
-0.0036955764517188072,
-0.032518189400434494,
-0.05442621931433678,
-0.07710268348455429,
0.046477001160383224,
-0.06738822162151337,
-0.026038892567157745,
0.035274915397167206,
0.047793641686439514,
0.07086010277271271,
-0.021411107853055,
0.0063827731646597385,
0.05588466674089432,
0.05985024943947792,
-0.09471998363733292,
0.01950899139046669,
0.09359822422266006,
0.0423131100833416,
-0.05135554447770119,
-0.0031089785043150187,
0.04875008016824722,
-0.014196060597896576,
-0.03212142735719681,
-0.010993764735758305,
0.013295053504407406,
0.1332007795572281,
0.039659980684518814,
0.009385826997458935,
-0.0013907852116972208,
0.059935130178928375,
0.010824657045304775,
0.09897671639919281,
0.03157477080821991
] |
(\nADA,\t2018\n)\nDiagnostic\tcriteria\nThere\tare\tfour\tmethods\tused\tto\tdiagnose\tdiabetes.\tIn\tthe\tabsence\tof\tunequivocal\thyperglycemia,\nresults\tshould\tbe\tconfirmed\tby\n\trepeat\ttesting\t(\nADA,\t2018\n).\tDiagnostic\tcriteria\tfor\tdiabetes\tand\nprediabetes\tare\tsummarized\tin\t\nTable\t29.1\n.\n1.
|
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0.005917918868362904,
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0.006014893762767315,
0.08696974813938141,
0.05844617262482643,
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0.03985666483640671,
0.0351773276925087,
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0.03440855070948601,
0.018998080864548683,
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0.08765404671430588,
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0.03674347698688507,
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0.032721009105443954,
0.012855758890509605,
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0.03595514968037605,
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1.5394707481910543e-33,
0.033106498420238495,
0.03995495289564133,
0.00173917505890131,
0.046199239790439606,
0.048764150589704514,
0.04021931812167168,
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0.05350928381085396,
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0.012998046353459358,
0.00994343776255846,
0.028345992788672447,
0.0112144248560071,
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0.04990245774388313,
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0.11770059168338776,
0.04867483675479889,
0.00544683588668704,
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0.03480924293398857,
0.05090232938528061,
0.03144649416208267,
0.06558773666620255,
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0.0003583271463867277,
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0.003974457271397114,
0.04021831974387169,
0.046924516558647156,
0.03194341063499451,
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0.04858022555708885,
0.04954523593187332,
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0.07424356788396835,
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0.029419109225273132,
0.018202587962150574,
0.11921472102403641,
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0.13636022806167603,
0.019512930884957314,
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0.055537428706884384,
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0.07033361494541168,
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0.08607518672943115,
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0.10568386316299438,
0.015102429315447807,
0.06598305702209473,
0.02293974533677101,
0.0016485229134559631,
0.031699251383543015,
0.022855736315250397,
0.020792171359062195,
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0.0688973218202591,
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0.053279001265764236,
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0.019129397347569466,
0.051474012434482574,
0.014639086090028286,
0.08142045140266418,
0.0016861942131072283,
0.06809382140636444,
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0.03494666516780853,
0.029124828055500984,
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0.0572054497897625,
0.02763592079281807,
0.010967981070280075,
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0.08450314402580261,
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0.08901455253362656,
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0.04213707894086838,
0.016754498705267906,
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0.07738237082958221,
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0.02092200145125389,
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0.028983846306800842,
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0.003517475910484791,
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0.029382498934864998,
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0.027355343103408813,
0.06814950704574585,
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0.005883311852812767,
0.0528731495141983,
0.04365774989128113,
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0.06974507868289948,
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0.0023730318062007427,
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0.007901647128164768,
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0.04011073708534241,
-0.11380623281002045,
0.04095309600234032,
0.10369404405355453,
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-0.06339150667190552,
0.08385346829891205,
0.02864792011678219,
-0.07762357592582703,
0.13247299194335938,
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0.07530302554368973,
0.002402417128905654,
0.011134443804621696,
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0.008534148335456848,
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0.002867829753085971,
0.010061030276119709,
0.0007352581014856696,
-0.0010574636980891228,
0.045150257647037506,
-0.03743840381503105,
-0.03311212360858917,
0.03345683962106705,
-0.009718126617372036,
0.013664545491337776,
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0.1172579750418663,
0.02231067419052124,
-0.05649930238723755,
-0.057962797582149506,
0.05852443352341652,
0.029918285086750984,
-0.08981891721487045,
-0.0008681791950948536,
0.08147235214710236,
0.029749132692813873,
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-0.010025489144027233,
0.08938276022672653,
-0.004032633267343044,
-0.043651483952999115,
-0.06288623809814453,
0.03616969659924507,
0.015983659774065018,
0.012663041241466999,
-0.017197920009493828,
-0.005948297679424286,
0.07118554413318634,
0.05630401521921158,
0.08214376866817474,
0.0017189921345561743
] |
prediabetes\tare\tsummarized\tin\t\nTable\t29.1\n.\n1.\t\nFasting\tplasma\tglucose\t(FPG)\t126\tmg/dL\t(7.0\tmmol/L).\tFasting\tis\tdefined\tas\tno\tcaloric\nintake\tfor\tat\tleast\t8\thours.\t(In\tthe\tabsence\tof\tunequivocal\thyperglycemia,\tresults\tshould\tbe\nconfirmed\tby\trepeat\ttesting\t[\nADA,\t2018\n]).\n2.\t\nOR\t2-h\tplasma\tglucose\t200\tmg/dL\t(11.1\tmmol/L)\tduring\tOGTT.
|
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]).\n2.\t\nOR\t2-h\tplasma\tglucose\t200\tmg/dL\t(11.1\tmmol/L)\tduring\tOGTT.\n\tThe\ttest\tshould\tbe\tperformed\nas\tdescribed\tby\tthe\tWorld\tHealth\tOrganization\t(WHO),\tusing\ta\tglucose\tload\tcontaining\tthe\nequivalent\tof\t75-g\tanhydrous\tglucose\tdissolved\tin\twater.*\n3.\t\nOR\tA1C\t6.5%\t(48\tmmol/mol).\tThe\ttest\tshould\tbe\tperformed\tin\ta\tlaboratory\tusing\ta\tmethod
|
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0.06524822860956192,
0.049185771495103836,
0.06708584725856781,
-0.043994463980197906
] |
that\tis\tNational\tGlycohemoglobin\tStandardization\tProgram\t(NGSP)\tcertified\tand\nstandardized\tto\tthe\tDiabetes\tControl\tand\tComplications\n\tTrial\t(DCCT)\tassay.*\n4.\t\nOR\tin\ta\tpatient\twith\tclassic\tsymptoms\tof\thyperglycemia\tor\thyperglycemic\tcrisis,\ta\trandom\nplasma\tglucose\t<200\tmg/dL\t(11.1\tmmol/L).\nPlasma\tglucose\tcriteria,\teither\tthe
|
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] |
Plasma\tglucose\tcriteria,\teither\tthe\t\nfasting\tplasma\tglucose\t(FPG)\n\tor\tthe\t2-hr\tplasma\tglucose\nafter\ta\t75-g\tOGTT,\twas\tthe\tmethod\tusually\tused\tto\tdiagnosis\tdiabetes.\tHowever,\tthe\tA1C\tassay\tnow\nis\thighly\tstandardized\tand\tis\ta\treliable\tmeasure\n\tof\tchronic\tglucose\tlevels.\tThe\tA1C\ttest\treflects
|
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] |
of\tchronic\tglucose\tlevels.\tThe\tA1C\ttest\treflects\nlonger-term\tglucose\tconcentrations\tand\tis\tassessed\tfrom\tthe\tresults\tof\t\nglycosylated\themoglobin\n(A1C)\n\ttests.\tWhen\themoglobin\tand\tother\tproteins\tare\texposed\tto\tglucose,\tthe\tglucose\tbecomes\nattached\tto\tthe\tprotein\tin\ta\tslow,\tnonenzymatic,\tand\tconcentration-dependent\tfashion\t(\nFig.\t29.1\n).
|
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] |
Fig.\t29.1\n).\nMeasurements\tof\tA1C\ttherefore\treflect\ta\tweighted\taverage\tof\tplasma\n\tglucose\tconcentration\tover\tthe\npreceding\tweeks.\tIn\tnondiabetic\tpersons\tA1C\tvalues\tare\t4%\tto\t6%;\tthese\tvalues\tcorrespond\tto\tmean\nblood\tglucose\tlevels\tof\tabout\t70\tto\t126\tmg/dL\t(3.9\tto\t7.0\tmmol/L)\t(\nTable\t29.2\n).\tA1C\tvalues\tvary\tless
|
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] |
Table\t29.2\n).\tA1C\tvalues\tvary\tless\nthan\tFPG,\tand\ttesting\tis\tmore\tconvenient\tbecause\tpatients\tare\tnot\trequired\tto\tbe\tfasting\tor\tto\nundergo\tan\tOGTT.\tHowever,\tA1C\tlevels\tmay\tvary\twith\ta\tperson’s\trace/ethnicity\n\tas\tglycation\trates\nmay\tdiffer\tby\trace\t(\nADA,\t2018\n).\tIt\tis\talso\tunclear\tif\tthe\tsame\tA1C\tcutoff\tpoint\tshould\tbe\tused\tto
|
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).\tIt\tis\talso\tunclear\tif\tthe\tsame\tA1C\tcutoff\tpoint\tshould\tbe\tused\tto\ndiagnose\tchildren\tor\tadolescents\twith\tdiabetes\tbecause\tstudies\tused\tto\trecommend\tA1C\tto\tdiagnose\ndiabetes\thave\tall\tbeen\tperformed\tin\tadult\tpopulations.\tFor\tconditions\twith\tabnormal\tred\tcell\nturnover,\tsuch\tas\themolysis\t(blood\tloss),\tpregnancy,\tor\tiron\tdeficiency,\tthe\tdiagnosis\tof
|
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] |
diabetes\tmust\nuse\tglucose\tcriteria\texclusively\t(\nADA,\t2018\n).\tThe\tA1C\ttest\tshould\tbe\tperformed\tusing\ta\tmethod\ncertified\tby\tthe\tNGSP.
|
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] |
FIG.\t29.1\nGlycosylated\tHemoglobin:\tHemoglobin\tA1C.\tGlycosylated\themoglobin\tor\tA1C\tis\tthe\tamount\tof\nglucose\tattached\tto\tthe\themoglobin\tprotein\tin\ta\tred\tblood\tcell.\tAs\tblood\tsugar\tincreases,\tthe\tamount\tof\nglucose\tattached\tto\themoglobin\tincreases.\tBecause\tred\tblood\tcells\tlast\tfor\t3\tmonths\tin\tcirculation,\tthe\tA1C
|
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0.006260751746594906,
0.08752069622278214,
0.03574869781732559,
-0.07104415446519852
] |
test\tis\tused\tto\testimated\taverage\tblood\tglucose\tover\ta\t3-month\ttime\tframe.\nTABLE\n\t29.2\nA1C\tand\tEstimated\tAverage\tGlucose\nA1C\t(%)\nEstimated\tAverage\tGlucose\t(mg/dL)\n4\n68\n4.5\n82\n5.0\n97\n5.5\n111\n6.0\n126\n6.5\n140\n7.0\n154\n7.5\n169\n8.0\n183\n8.5\n197\n9.0\n212\n9.5\n226\n10.0\n240\n10.5\n255\n11.0\n269\n11.5\n283\n12.0\n298
|
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] |
8.5\n197\n9.0\n212\n9.5\n226\n10.0\n240\n10.5\n255\n11.0\n269\n11.5\n283\n12.0\n298\nThe\tA1C\ttest\tmeasures\tthe\tpercentage\tof\tred\tblood\tcells\tthat\thave\tglucose\tbound\tto\themoglobin.\tThis\tnumber\tcorrelates\tto\tblood\tglucose\n\tlevels\n(mg/dL).\nAmerican\tDiabetes\tAssociation.\t\neAG\t/\tA1C\tConversion\tCalculator\n\t(website)
|
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eAG\t/\tA1C\tConversion\tCalculator\n\t(website)\t\nhttps://professional.diabetes.org/diapro/glucose_calc\n.\nManagement\tof\tprediabetes\nIn\tno\tother\tdisease\tdoes\tlifestyle—healthy\tfood\tchoices\tand\tphysical\tactivity—play\ta\tmore\timportant\nrole\tin\tprevention\tand\ttreatment\tthan\tin\tdiabetes.\tStudies\tcomparing\tlifestyle\tmodifications\tto\nmedication\thave\tprovided
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medication\thave\tprovided\n\tsupport\tfor\tthe\tbenefit\tof\tweight\tloss\t(reduced\tenergy\tintake)\tand\tphysical\nactivity\tas\tthe\tfirst\tchoice\tto\tprevent\tor\tdelay\tdiabetes.\tClinical\ttrials\tcomparing\tlifestyle\ninterventions\tto\ta\tcontrol\tgroup\thave\treported\trisk\treduction\tfor\tT2DM\tfrom\tlifestyle\tinterventions\nranging\tfrom\t29%\tto\t67%\t(\nYoussef,\t2012
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ranging\tfrom\t29%\tto\t67%\t(\nYoussef,\t2012\n).\tTwo\tfrequently\tcited\tstudies\tare\tthe\tFinnish\tDiabetes\nPrevention\tStudy\t(FDPS)\tand\tthe\n\tDiabetes\tPrevention\tProgram\t(DPP),\tin\twhich\tlifestyle\ninterventions\tfocused\ton\ta\tweight\tloss\tof\t5%\tto\t10%,\tphysical\tactivity\tof\tat\tleast\t150\tmin/week\tof
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moderate\tactivity,\tand\tongoing\tcounseling\tand\tsupport.\tBoth\treported\ta\t58%\treduction\tin\tthe\nincidence\tof\tT2DM\tin\tthe\tintervention\tgroup\tcompared\twith\tthe\tcontrol\tgroup\tand\tpersistent
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reduction\tin\tthe\trate\tof\tconversion\tto\tT2DM\twithin\t3\tto\t14\tyears\n\tpostintervention\tfollow-up\t(\nDPP\nResearch\tGroup,\t2009\n;\t\nLi\tet\tal,\t2008\n;\t\nLindström\tet\tal,\t2006\n).\nMedical\tmanagement\nUse\tof\tthe\tpharmacologic\tagents\tmetformin,\talpha-glucosidase\tinhibitors,\torlistat,\tglucagon-like
|
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] |
peptide-1\t(GLP-1)\treceptor\tagonist,\tand\tthiazolidinediones\thas\tbeen\tshown\tto\tdecrease\tincidence\tof\ndiabetes\tby\tvarious\tdegrees.\tHowever,\tnone\tare\tapproved\tby\tthe\tU.S.\tFood\tand\tDrug\tAdministration\n(FDA)\tspecifically\tfor\tdiabetes\tprevention\t(\nADA,\t2018\n).\tMetformin\thas\tthe\tstrongest\tevidence\tbase
|
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ADA,\t2018\n).\tMetformin\thas\tthe\tstrongest\tevidence\tbase\nand\thas\talso\tdemonstrated\tlong-term\tsafety\tas\tpharmacologic\ttherapy\tfor\tdiabetes\tprevention.\tKeep\nin\tmind\tthat\tdiet\tand\tlifestyle\tmodifications\thave\tbeen\tshown\tto\tbe\tmore\teffective\tthan\tmetformin\nwhen\tit\tcomes\tto\tpreventing\tand/or\tdelaying\tdiabetes\t(\nADA,\t2018\n).\nPhysical\tactivity
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ADA,\t2018\n).\nPhysical\tactivity\nPhysical\tactivity\n\thelps\tto\timprove\tblood\tglucose\tcontrol\tin\tT2DM,\treduces\tcardiovascular\trisk\nfactors,\tand\tmay\tcontribute\tto\twell-being.\tIt\tis\talso\timportant\tto\tnote\tthat\tphysical\tactivity,\nindependent\tof\tweight\tloss,\timproves\tinsulin\tsensitivity\t(\nADA,\t2018\n).\tRecommendations\tinclude
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] |
ADA,\t2018\n).\tRecommendations\tinclude\nmoderate-intensity\taerobic\tphysical\tactivity\ta\tminimum\tof\t30\tminutes\t5\tdays\tper\tweek\t(150\nmin/week)\t(i.e.,\twalking\t3\tto\t4\tmiles/hr)\n\tor\tvigorous-intensity\taerobic\tphysical\tactivity\ta\tminimum\tof\n20\tminutes\t3\tdays\tper\tweek\t(90\tmin/week).\tMuscle-strengthening\tactivities\tinvolving\tall\tmajor
|
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] |
muscle\tgroups\ttwo\tor\tmore\tdays\tper\tweek\tare\talso\trecommended\t(\nU.S.\tDepartment\tof\tHealth\tand\nHuman\tServices\tand\tU.S.\tDepartment\tof\tAgriculture,\t2015\n).\nMedical\tnutrition\ttherapy\tfor\tprediabetes\nThere\tis\tno\tone-size-fits-all\tmeal\tplan\tfor\tpeople\n\tliving\twith\tprediabetes.\tOne\tof\tthe\tmost\timportant
|
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living\twith\tprediabetes.\tOne\tof\tthe\tmost\timportant\nconsiderations\tfor\tcreating\tdiabetes-centered\tgoals\taround\tMNT\tis\tan\temphasis\ton\tpatient-centered\ncare.\tThis\tmeans\tthe\tapproach\tshould\tbe\tindividualized\tand\ttake\tinto\taccount\ta\tpatient’s\thealth\nstatus,\tfood\tpreferences,\tfood\tsecurity,\tand\thousing\tsituation\t(\nADA,\t2018\n).\tThe\tADA\tstates\tthat\tit\tis
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] |
olive\toil,\thigh\tintake\tof\tplant-based\tfoods\t(vegetables,\tlegumes,\tfruits,\tand\tnuts),\tmoderate\tamounts\nof\tfish\tand\twine,\tand\ta\tlow\tintake\tof\tred\tand\tprocessed\tmeat\tand\twhole-fat\tdairy\tproducts\thas\tbeen\nassociated\twith\ta\tlower\tincidence\tof\tdiabetes\t(\nYoussef,\t2012\n;\t\nADA,\t2018\n).\nIn\taddition,
|
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0.01972050592303276
] |
Youssef,\t2012\n;\t\nADA,\t2018\n).\nIn\taddition,\n\twhole\tgrains\tand\tdietary\tfiber\tare\tassociated\twith\treduced\trisk\tof\tdiabetes.\tIncreased\nintake\tof\twhole\tgrain–containing\tfoods\timproves\tinsulin\tsensitivity\tindependent\tof\tbody\tweight,\tand\nincreased\tintake\tof\tdietary\tfiber\thas\tbeen\tassociated\twith\timproved\tinsulin\tsensitivity\tand\timproved
|
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] |
ability\tto\tsecrete\tinsulin\tadequately\tto\tovercome\tinsulin\tresistance.\tModerate\tconsumption\tof\nalcohol\t(1\tto\n\t3\tdrinks\tper\tday\t[15\tto\t45\tg\talcohol])\tis\tlinked\twith\tdecreased\trisk\tof\tT2DM,\tcoronary\nheart\tdisease,\tand\tstroke.\tBut\tthe\tdata\tdo\tnot\tsupport\trecommending\talcohol\tconsumption\tto\tpeople
|
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] |
at\trisk\tfor\tdiabetes\twho\tdo\tnot\talready\tdrink\talcoholic\tbeverages.\nHigh\tconsumption\tof\tsugar-sweetened\tbeverages,\twhich\tincludes\tsoft\tdrinks,\tfruit\tdrinks,\tand\nenergy\tand\tvitamin\twater-type\tdrinks\tcontaining\tsucrose,\n\thigh-fructose\tcorn\tsyrup,\tand/or\tfruit\tjuice\nconcentrates\tis\tassociated\twith\tthe\tdevelopment\tof\tT2DM\t(\nMalik\tet\tal,\t2010
|
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] |
Malik\tet\tal,\t2010\n).\tStudies\talso\thave\nreported\tthat\tan\teating\tpattern\thigh\tin\tsaturated\tfatty\tacids\tand\ttrans\tfatty\tacids\tis\tassociated\twith\nincreased\tmarkers\tof\tinsulin\tresistance\tand\trisk\tfor\tT2DM,\twhereas\tunsaturated\tfatty\tacid\tintake\tis\nassociated\tinversely\twith\trisk\tof\tdiabetes\t(\nYoussef,\t2012\n).\tTherefore\tindividuals\tat\tincreased\trisk\tfor
|
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] |
Youssef,\t2012\n).\tTherefore\tindividuals\tat\tincreased\trisk\tfor\nT2DM\tshould\tbe\tencouraged\tto\tlimit\ttheir\tintake\tof\tsugar-sweetened\tbeverages\tand\tdecrease\nsaturated\tfat\tintake\t(\nADA,\t2018\n).\nManagement\tof\tdiabetes\nAchieving\tglycemic\tcontrol\tis\tthe\tmost\timportant\tMNT\tgoal\tin\tpeople\twith\tdiabetes.\tTwo\tclassic
|
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clinical\ttrials\thave\tdemonstrated\tbeyond\ta\tdoubt\tthe\tclear\tlink\tbetween\tglycemic\tcontrol\tand\tthe\ndevelopment\n\tof\tcomplications\tin\tpeople\twith\tboth\tT1DM\tand\tT2DM.\tThe\tfirst\tis\tthe\tDCCT,\twhich\nstudied\tapproximately\t1400\tpeople\twith\tT1DM.\tEach\tindividual\tinvolved\tin\tthe\tstudy\twas\ttreated
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with\teither\tintensive\t(multiple\tinjections\tof\tinsulin\tor\tuse\tof\tinsulin\tinfusion\tpumps\tguided\tby\tblood\nglucose\tmonitoring\tresults)\tor\tconventional\t(one\tor\ttwo\tinsulin\tinjections\tper\tday)\tregimens.\tA\t30-\nyear\tfollow-up\tof\n\tthe\tDCCT\tdemonstrated\tthat\tan\tintervention\tthat\taimed\tto\tachieve\nnormoglycemia
|
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] |
normoglycemia\n,\tas\tclose\tto\tthe\tnondiabetic\trange\tas\tsafely\tpossible,\treduced\tall\tof\tthe\nmicrovascular\tand\tcardiovascular\tcomplications\tof\tdiabetes\tand\tshould\tbe\timplemented\tas\tearly\tas\npossible\tafter\tdiagnosis\t(\nNathan,\t2014\n).\tAnother\tstudy,\tknown\tas\tthe\tUnited\tKingdom\tProspective\nDiabetes\tStudy\t(UKPDS),\tdemonstrated\tconclusively
|
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0.09668726474046707,
0.0726163312792778,
0.05456011742353439,
0.013503284193575382
] |
Diabetes\tStudy\t(UKPDS),\tdemonstrated\tconclusively\n\tthat\tglucose\tand\tblood\tpressure\tcontrol\ndecreased\tthe\trisk\tof\tlong-term\tcomplications\tin\tT2DM\t(\nHolman\tet\tal,\t2008\n).\tBoth\tof\tthese\ttrials\nemphasize\timportance\tof\tnutrition\ttherapy\tin\tachieving\tcontinued\tglycemic\tcontrol.\nMedical\tmanagement
|
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] |
Medical\tmanagement\nThe\tmanagement\tof\tall\ttypes\tof\tdiabetes\tincludes\tMNT,\tphysical\tactivity,\tblood\tglucose\tmonitoring,\nmedications,\tand\tself-management\teducation\tand\tsupport.\n\tAn\timportant\tgoal\tof\tmedical\ttreatment\tis\nto\tprovide\tthe\tindividual\twith\tdiabetes\twith\tthe\tnecessary\ttools\tto\tachieve\tthe\tbest\tpossible\tcontrol
|
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] |
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|
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] |
nephropathy,\tneuropathy,\tand\tretinopathy)\tand\tmacrovascular\tcomplications\t(coronary\tartery\ndisease,\tperipheral\tarterial\tdisease,\tand\tstroke)\twhile\tminimizing\thypoglycemia\n\tand\texcess\tweight\ngain.\tInsulin,\tthe\tprimary\thormone\tin\tglucose\tcontrol\tis\talso\tanticatabolic\tand\tanabolic\tand\nfacilitates\tcellular\ttransport\t(\nTable\t29.3\n).\tIn\tgeneral,\tthe
|
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] |
facilitates\tcellular\ttransport\t(\nTable\t29.3\n).\tIn\tgeneral,\tthe\t\ncounterregulatory\t(stress)\thormones\n(glucagon,\tgrowth\thormone,\tcortisol,\tepinephrine,\tand\tnorepinephrine)\thave\tthe\topposite\teffect\tof\ninsulin.\nTABLE\t29.3\nAction\tof\tInsulin\ton\tCarbohydrate,\tProtein,\tand\tFat\tMetabolism\nEffect\nCarbohydrates\nProtein\nFat\nAnticatabolic\n(prevents\nbreakdown)
|
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0.018502358347177505,
-0.010670917108654976,
0.03459684178233147,
0.05234137922525406,
0.04820064455270767,
-0.020962677896022797,
0.03574036434292793,
-0.011057892814278603,
0.07342017441987991,
0.11099892854690552,
-4.939822417782125e-8,
0.0712272971868515,
-0.03910403326153755,
0.0013664180878549814,
-0.06440412253141403,
-0.05877559632062912,
0.01204912830144167,
0.0774179995059967,
0.03654206171631813,
-0.042125727981328964,
-0.026512352749705315,
-0.0050822291523218155,
0.0965629443526268,
0.0012681299122050405,
-0.02887900359928608,
0.05026508495211601,
0.04531233385205269,
-0.009148193523287773,
0.07265187799930573,
-0.006890192162245512,
-0.1293795108795166,
-0.012696532532572746,
-0.03051513060927391,
-0.007531787268817425,
0.04866950958967209,
0.056206826120615005,
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-0.014291475526988506,
0.04482298716902733,
0.04192941263318062,
0.031714700162410736,
0.0686684176325798,
-0.027921468019485474,
-0.0065076835453510284,
-0.029747439548373222,
-0.04253675043582916,
0.07796747982501984,
0.0016029507387429476,
-0.05766070634126663,
-0.06067371740937233,
0.09327584505081177,
0.005808042827993631,
0.010020548477768898,
-0.040542736649513245,
0.030455609783530235,
0.057879481464624405,
-0.061830244958400726,
-0.0022364079486578703,
0.08849700540304184,
0.013461381196975708,
-0.03624165430665016,
-0.031812623143196106,
0.10409893095493317,
-0.0174107626080513,
-0.023268356919288635,
-0.1179412230849266,
0.034839075058698654,
0.005849011708050966,
0.002461438998579979,
0.05559377744793892,
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-0.022838328033685684,
0.09625951945781708,
0.12477245181798935,
0.003258293028920889
] |
Effect\nCarbohydrates\nProtein\nFat\nAnticatabolic\n(prevents\nbreakdown)\nDecreases\tbreakdown\tand\nrelease\tof\tglucose\tfrom\nglycogen\tin\tthe\tliver\nInhibits\tprotein\ndegradation,\ndiminishes\ngluconeogenesis\nInhibits\tlipolysis,\tprevents\nexcessive\tproduction\tof\nketones\tand\tketoacidosis\nAnabolic\n(promotes\nstorage)\nFacilitates\tconversion\tof
|
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2.945314788329485e-33,
0.04604921117424965,
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0.03890113905072212,
0.09583106637001038,
0.0087727727368474,
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0.016554752364754677,
0.04218808934092522,
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0.11771151423454285,
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0.009180392138659954,
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0.011258880607783794,
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0.038349851965904236,
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0.09232833236455917,
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0.06962613016366959,
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0.0179081242531538,
0.032574743032455444,
0.04936493933200836,
0.007165998686105013,
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0.17427131533622742,
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0.005048426799476147,
0.018332071602344513,
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0.14106057584285736,
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] |
Anabolic\n(promotes\nstorage)\nFacilitates\tconversion\tof\nglucose\tto\tglycogen\tfor\nstorage\tin\tliver\tand\nmuscle\nStimulates\n\tprotein\nsynthesis\nFacilitates\tconversion\tof\npyruvate\tto\tfree\tfatty\tacids,\nstimulating\tlipogenesis\nTransport\nActivates\tthe\ttransport\nsystem\tof\tglucose\tinto\nmuscle\tand\tadipose\tcells\nLowers\tblood\tamino\nacids\tin\tparallel\twith
|
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] |
muscle\tand\tadipose\tcells\nLowers\tblood\tamino\nacids\tin\tparallel\twith\nblood\tglucose\tlevels\nActivates\tlipoprotein\tlipase,\nfacilitating\ttransport\tof\ntriglycerides\tinto\tadipose\ntissue\nThe\tADA’s\tglycemic\ttreatment\tgoals\tfor\tpeople\twith\tdiabetes\n\tare\tlisted\tin\t\nTable\t29.4\n.\tAchieving
|
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0.05175112187862396,
0.055988676846027374,
0.07664044946432114,
-0.002687535248696804
] |
are\tlisted\tin\t\nTable\t29.4\n.\tAchieving\ngoals\trequires\topen\tcommunication\tbetween\tthe\thealth\tcare\tprovider\tand\tthe\tindividual\twith\ndiabetes\tand\tappropriate\tself-management\teducation.\tPatients\tcan\tassess\tday-to-day\tglycemic\ncontrol\tby\t\nself-monitoring\tof\tblood\tglucose\t(SMBG)\n\tand\tmeasurement\tof\turine\tor\tblood\tketones.
|
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] |
and\tmeasurement\tof\turine\tor\tblood\tketones.\nLonger-term\tglycemic\tcontrol\t(3-month\taverage)\tis\tassessed\tby\tA1C\ttesting.\tCardiovascular\n\trisk\nfactors\tshould\tbe\tassessed\tat\tleast\tannually\tin\tall\tpatients\twith\tdiabetes.\tThese\trisk\tfactors\tinclude\nhypertension,\tdyslipidemia,\tsmoking,\ta\tfamily\thistory\tof\tpremature\tcoronary\tdisease,\tchronic\tkidney
|
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0.08471763879060745,
0.07395465672016144,
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0.10111456364393234,
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0.06544864922761917,
0.07231955975294113,
0.04331791028380394,
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0.09090688824653625,
0.04928620904684067,
0.06679271161556244,
-0.03701126575469971
] |
disease,\tand\tthe\tpresence\tof\talbuminuria\t(\nADA,\t2018\n).\nTABLE\t29.4\nRecommendations\tfor\tGlycemic\tControl\tfor\tMany\tNonpregnant\tAdults\tWith\tDiabetes\nGlycemic\tControl\nCriteria\nA1C\n<7.0%\n\t(<53\tmmol/mol)\n*\nPreprandial\tcapillary\tplasma\tglucose\n80-130\tmg/dL\n*\n\t(4.4-7.2\tmmol/L)\nPeak\tpostprandial\tcapillary\tplasma\tglucose\n†\n<180\tmg/dL\n*\n\t(<10.0\tmmol/L)\n*
|
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0.015764258801937103,
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0.019626928493380547,
0.046264369040727615,
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0.013639435172080994,
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0.05511479824781418,
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0.07477375119924545,
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0.02238011546432972,
0.035484086722135544,
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0.07427077740430832,
0.08890694379806519,
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0.07422150671482086,
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0.04723164066672325,
0.05581270903348923,
0.029085546731948853,
0.012536701746284962
] |
†\n<180\tmg/dL\n*\n\t(<10.0\tmmol/L)\n*\nMore\tor\tless\tstringent\tglycemic\tgoals\tmay\tbe\tappropriate\tfor\tindividual\tpatients.\tGoals\tshould\tbe\tindividualized\tbased\ton\tduration\tof\tdiabetes,\nage/life\texpectancy,\tcomorbid\tconditions,\tknown\tCVD\tor\tadvanced\tmicrovascular\tcomplications,\n\thypoglycemia\tunawareness,\tand\tindividual\tpatient\nconsiderations.\n†
|
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] |
hypoglycemia\tunawareness,\tand\tindividual\tpatient\nconsiderations.\n†\nPostprandial\tglucose\tmay\tbe\ttargeted\tif\tA1C\tgoals\tare\tnot\tmet\tdespite\treaching\tpreprandial\tglucose\tgoals.\tPostprandial\tglucose\tmeasurements\nshould\tbe\tmade\t1\tto\t2\th\tafter\tthe\tbeginning\tof\tthe\tmeal,\tgenerally\tpeak\tlevels\tin\tpatients\twith\tdiabetes.
|
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] |
Modified\tfrom\tAmerican\tDiabetes\tAssociation:\tGlycemic\tTargets:\tStandards\tof\tmedical\n\tcare\tin\tdiabetes—2018,\t\nDiabetes\tCare\n\t41(S1):S60,\t2018.\nPatients\twith\tT1DM\tor\tT2DM\twho\thave\thypertension\tshould\tbe\ttreated\tto\tachieve\tblood\tpressure\ntargets\tthat\tare\tgreater\tthan\tor\tequal\tto\t140/90\tmm\tHg\t(\nADA,\t2018\n).\tThe\tADA\tstates\tthat\tin\tadults
|
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] |
ADA,\t2018\n).\tThe\tADA\tstates\tthat\tin\tadults\nwith\tdiabetes,\tit\tis\treasonable\tto\tobtain\ta\tlipid\tprofile\t(total\tcholesterol,\tlow-density\tlipoprotein\n[LDL]\tcholesterol,\tHDL\tcholesterol,\tand\ttriglycerides)\n\tat\tthe\ttime\tof\tdiagnosis,\tat\tthe\tinitial\tmedical
|
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at\tthe\ttime\tof\tdiagnosis,\tat\tthe\tinitial\tmedical\nevaluation,\tand\tat\tleast\tevery\t5\tyears\tthereafter\tin\tpatients\tunder\tthe\tage\tof\t40\tyears.\tIn\tpatients\nwho\thave\thad\tthe\tdisease\tfor\ta\tlonger\tperiod\tof\ttime\t(typically\tyounger\tpatients\twith\tyouth-onset\nT1DM),\tmore\tfrequent\tlipid\tprofiles\tmay\tbe\tpreferred\t(\nADA,\t2018\n).\tProviders\tshould\tconsider
|
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] |
ADA,\t2018\n).\tProviders\tshould\tconsider\nintensifying\tlifestyle\ttherapy\tand\toptimizing\tglycemic\tcontrol\n\tfor\tpatients\twith\televated\ttriglyceride\nlevels\t(>=\t150\tmg/dL\t[1.7\tmmol/L])\tand/or\tlow\tHDL\tcholesterol\t(<40\tmg/dL\t[1.0\tmmol/L]\tfor\tmen,\n<50\tmg/dL\t[1.3\tmmol/L]\tfor\twomen)\t(\nADA,\t2018\n).
|
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] |
<50\tmg/dL\t[1.3\tmmol/L]\tfor\twomen)\t(\nADA,\t2018\n).\nOptimal\tcontrol\tof\tdiabetes\talso\trequires\tthe\trestoration\tof\tnormal\tcarbohydrate,\tprotein,\tand\tfat\nmetabolism.\tIt\tis\timportant\tthat\tpeople\twith\tdiabetes\treceive\tmedical\tcare\tfrom\ta\tteam\tthat\tideally\nincludes\tphysicians,\n\tdietitians,\tnurses,\tpharmacists,\tand\tmental\thealth\tprofessionals\twith\texpertise
|
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in\tdiabetes.\tIndividuals\twith\tdiabetes\talso\tmust\tassume\tan\tactive\trole\tin\ttheir\tcare.\tFor\tT1DM\ta\nflexible,\tindividualized\tmanagement\tprogram\tusing\tthe\tprinciples\tof\tintensive\tinsulin\ttherapy\tis\nessential.\tT2DM\tis\ta\tprogressive\tdisease.\tIn\tthis\tinstance\tit\tis\tnot\tthe\tdiet\tthat\tfails;\trather,\tthe\npancreas\tis\tno\tlonger
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] |
optimal\tblood\tglucose\tcontrol.\tThrough\tthe\tcollaborative\tdevelopment\tof\tindividualized\tnutrition\ninterventions\tand\tongoing\tsupport\n\tof\tbehavior\tchanges,\thealth\tcare\tprofessionals\tcan\tfacilitate\tthe\nachievement\tof\thealth\tgoals\tfor\tthe\tperson\twith\tdiabetes.\nMedical\tnutrition\ttherapy\tfor\tdiabetes
|
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experience\tin\tdiabetes\tmanagement\tand\tprevention.\nMNT\trequires\tan\tindividualized\tapproach\tand\teffective\tnutrition,\tself-management\teducation,\ncounseling,\tand\n\tsupport.\tMonitoring\tglucose,\tA1C\tand\tlipid\tlevels,\tblood\tpressure,\tweight,\tand\nquality-of-life\tissues\tis\tessential\tin\tevaluating\tthe\tsuccess\tof\tnutrition-related\trecommendations.
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Effective\tnutrition\ttherapy\tinterventions\tmay\tbe\timplemented\tin\tindividualized\tsessions\tor\tin\ta\ncomprehensive\tdiabetes\teducation\tprogram.\nSince\tT2DM\tis\ta\tprogressive\tdisease,\tnutrition\tand\tphysical\tactivity\tinterventions\n\talone\t(i.e.,\nwithout\tmedications)\tare\tgenerally\tnot\tadequate\tin\tmaintaining\tglycemic\tcontrol\tovertime.\tHowever,
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even\tafter\tmedications\tare\tinitiated,\tnutrition\ttherapy\tand\tproper\teducation\tshould\tcontinue\tto\tbe\tan\nimportant\tcomponent\tof\tthe\tindividualized\ttreatment\tplan.\tFor\texample,\tindividuals\twith\tT1DM\nusing\tmultiple\tdaily\tinjections\tor\tcontinuous\tsubcutaneous\tinsulin\tinfusion\tshould\tfocus\n\ton\thow\tto
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on\thow\tto\nadjust\tinsulin\tdoses\tbased\ton\tplanned\tcarbohydrate\tintake.\tFor\tindividuals\tusing\tfixed\tdaily\tinsulin\ndoses,\tcarbohydrate\tintake\ton\ta\tday-to-day\tbasis\tshould\tbe\tconsistent\twith\trespect\tto\ttime\tand\namount.\tRetrospective\tstudies\treveal\tdurable\tA1C\treductions\twith\tthese\ttypes\tof\tprograms,\twith\ta
|
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significant\timprovement\tin\tquality\tof\tlife\tover\ttime.\tFinally,\tnutritional\tapproaches\tfor\treducing\n\tCVD\nrisk,\tincluding\toptimizing\tserum\tlipids\tand\tblood\tpressure,\tcan\teffectively\treduce\tCVD\tevents\tand\nmortality\t(\nEvert\tet\tal,\t2014\n).\nThe\tAcademy\tof\tNutrition\tand\tDietetics\t(AND)\tpublished\tevidence-based\tnutrition\tpractice
|
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] |
guidelines\t(EBNPG)\tfor\tT1DM\tand\tT2DM\tin\tadults\tin\ttheir\tEvidence\tAnalysis\tLibrary\tand\tin\tprint\n(\nAND,\t2017\n;\t\nFranz\tet\tal,\t2017\n).\tThe\tADA\tnutrition\trecommendations\tare\tpublished\n\tin\ta\tposition\nstatement\tand\tare\tsummarized\tin\ttheir\tannual\tstandards\tof\tcare.\nGoals\tand\tdesired\toutcomes
|
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] |
Goals\tand\tdesired\toutcomes\nThe\tgoals\tfor\tMNT\tfor\tdiabetes\temphasize\tthe\trole\tof\tlifestyle\tin\timproving\tglucose\tcontrol,\tlipid\tand\nlipoprotein\tprofiles,\tand\tblood\tpressure.\tGoals\tof\tMNT\tare\tsummarized\tin\t\nBox\t29.1\n.\tMedicare\nreimburses\tqualified\tRDN\tproviders\tfor\tproviding\tevidence-based\tMNT\tfor\tdiabetes\tmanagement\tto
|
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] |
eligible\tparticipants.\tImproving\thealth\tthrough\tfood\tchoices\tand\tphysical\tactivity\tis\tthe\tbasis\tof\tall\nnutrition\trecommendations\tfor\tthe\ttreatment\tof\tdiabetes.\nBOX\t29.1\nGoals\tof\tMedical\tNutrition\tTherapy\tThat\tApply\tto\tAdults\tWith\nDiabetes\n1.\t\nTo\tpromote\tand\tsupport\thealthful\teating\tpatterns,\temphasizing\ta\tvariety\tof\tnutrient-dense
|
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] |
of\tadults\twith\ndiabetes,\t\nDiabetes\tCare\n\t36:3821,\t2013.\nBesides\tbeing\tskilled\tand\tknowledgeable\tin\tassessing\tand\timplementing\tMNT,\tRDNs\talso\tmust\tbe\naware\tof\texpected\toutcomes\tfrom\tMNT,\twhen\tto\tassess\toutcomes,\tand\twhat\tfeedback\t(including\nrecommendations)\tshould\tbe\tgiven\tto\treferral\tsources.\tFurthermore,\tthe\teffect\tof\tMNT\ton\tA1C\twill
|
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] |
be\tknown\tby\t6\tweeks\tto\t3\tmonths,\tat\twhich\ttime\tthe\tRDN\n\tmust\tassess\twhether\tthe\tgoals\tof\ttherapy\nhave\tbeen\tmet\tby\tchanges\tin\tlifestyle\tor\twhether\tchanges\tor\tadditional\tmedications\tare\tneeded\n(\nEvert\tet\tal,\t2014\n;\t\nAND,\t2017\n).\nMultiple\tresearch\tstudies\tsupport\tMNT\tas\tan\teffective\ttherapy\tin\treaching\tdiabetes\ttreatment
|
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goals.\tMNT\timplemented\tby\tRDNs\treduced\tA1C\tlevels\tby\t1.0%\tto\t1.9%\tfor\tpeople\twith\tT1DM\tand\n0.3%\tto\t2%\tfor\tpeople\twith\tT2DM\t(\nADA,\t2018\n).\nThese\toutcomes\tare\tsimilar\tor\tgreater\tto\tthose\tfrom\tglucose-lowering\tmedications.\tMNT\talso\tis\nreported\tto\timprove\tlipid\tprofiles,\tdecrease\tblood\tpressure,\tpromote\tweight\tloss,\tdecrease\tneed\tfor
|
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] |
medications,\tand\tdecrease\trisk\tof\tonset\tand\tprogression\tto\tdiabetes-related\tcomorbidities.\tA\tvariety\nof\tnutrition\ttherapy\tinterventions\tsuch\tas\tindividualized\tMNT,\tportion\tcontrol,\tsample\tmenus,\ncarbohydrate\n\tcounting,\texchange\tlists,\tsimple\tmeal\tplans,\tand\tlow-fat\tvegan\tdiets\tcan\tbe\nimplemented\t(\nFranz\tand\tMacLeod,\t2018
|
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] |
implemented\t(\nFranz\tand\tMacLeod,\t2018\n).\tIndividualized\tMNT,\timplemented\tin\tcollaboration\twith\nthe\tindividual\twith\tdiabetes,\tis\tessential\tbecause\ta\tvariety\tof\tnutrition\tinterventions\tare\teffective.\tA\ncommon\tfocus\tof\tMNT\tfor\tindividuals\twith\tT2DM\tis\treduced\tenergy\tintake.\tAdditionally,\tMNT\tmay\nencourage\tthe\tconsumption\tof
|
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] |
their\toverall\thealth\tbenefits.\tSodium\tmay\talso\tbe\ta\tnutrient\tof\tfocus.\tThe\trecommendation\tfor\tthe\ngeneral\tpublic\tto\treduce\tsodium\tto\t<2300\tmg/day\tis\talso\tappropriate\tfor\tpeople\twith\tdiabetes.\nHowever,\tif\tthe\tindividual\thas\tboth\tdiabetes\tand\thypertension,\tadditional\treductions\tin\tsodium\nintake\tmay\tbe\tindicated\t(\nFranz\tand\tMacLeod,\t2018
|
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] |
intake\tmay\tbe\tindicated\t(\nFranz\tand\tMacLeod,\t2018\n).\tFor\tindividuals\twith\tT1DM,\ta\tcommon\tfocus\tis\nusing\tcarbohydrate\tcounting\tto\tdetermine\tpremeal\tinsulin\tboluses\t(\nFranz\tet\tal,\t2017\n).\nEnergy\tbalance\tand\tweight\nChildren/adolescents\nHistorically,\tachieving\tand\tmaintaining\tbody\tweight\tgoals\thas\tbeen\ta\tfocus\tof\tMNT\tfor\tdiabetes.\tThis
|
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is\tparticularly\ttrue\tfor\tchildren\twith\tT1DM.\tProvision\tof\tadequate\tcalories\tfor\tnormal\tgrowth\tand\ndevelopment\n\tfor\tchildren\tand\tadolescents\twith\tT1DM\tis\ta\tkey\tcomponent\tof\tMNT.\tTherefore\theight\nand\tweight\tshould\tbe\tmeasured\tat\teach\tvisit\tand\ttracked\tvia\tappropriate\theight\tand\tweight\tgrowth\ncharts\t(\nChiang\tet\tal,\t2018\n)\t(See\t\nAppendix\t4\n).
|
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charts\t(\nChiang\tet\tal,\t2018\n)\t(See\t\nAppendix\t4\n).\nFor\tyouth\twith\tT2DM,\ttraditional\tnutrition\ttherapy\tgoals\tincluded\tprevention\tof\texcessive\tweight\ngain\twhile\tencouraging\tnormal\tlinear\tgrowth.\tHowever,\tthe\t2016\tAmerican\n\tAcademy\tof\tPediatrics\n(AAP)\tguidelines\trecommended\tshifting\tthe\tfocus\tfrom\tweight\tto\thealthy\tlifestyle\tbehaviors.\tThe
|
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guidelines\tstate\tthat\twhile\tobesity\tmay\tbe\ta\trisk\tfactor\tfor\tT2DM\tin\tyouth,\tobesity\tprevention\tefforts\nmay\tlead\tto\tthe\tdevelopment\tof\tan\teating\tdisorder\t(\nGolden\tet\tal,\t2016\n).\tFurthermore,\tlongitudinal\nresearch\tfound\tthat\tchildren\twhose\tparents\tused\trestrictive\tfeeding\thave\ta\thigher\n\tlikelihood\tof
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likelihood\tof\neating\tin\tthe\tabsence\tof\thunger\tand\tan\televated\tBMI\tlater\tin\tchildhood\t(\nBirch\tet\tal,\t2003\n).\nAdults\nOverweight\tand\tobesity\tare\tcommon\tin\tpeople\tboth\tat\trisk\tfor\tand\twith\tT2DM.\tSome\tresearch\nsuggests\tthat\treduced\tcalorie\tintake\tcan\tlead\tto\treductions\tin\tA1C\tof\t0.3%\tto\t2.0%\tin\tadults\twith
|
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] |
T2DM.\tIf\tappropriate\tfor\tthe\tindividual,\ta\treduction\tin\tcaloric\tintake\tmay\talso\tlead\tto\timprovements\nin\tmedication\tdoses\tand\tquality\tof\tlife\t(\nADA,\t2018\n).\tSimilarly,\tweight\tloss\tinterventions\timplemented\nin\tpeople\twith\tprediabetes\tand\tnewly\tdiagnosed\twith\tT2DM\thave\tbeen\tshown\tto\tbe\teffective\tin
|
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improving\tglycemic\tcontrol,\tbut\tthe\tbenefit\tof\tweight\tloss\tinterventions\tin\tT2DM\tof\tlonger\tduration\nis\tmixed\t(\nFranz\tet\tal,\t2017\n).\tSubstantial\tevidence\tsuggests\tthat\tweight\tloss\tdiets\tare\tnot\tsustainable.\nA\treview\tof\tover\t30\tlong-term\tstudies\tconcluded\tthat\tthe\tmore\tdiets\tan\tindividual\thas\ttried,\tthe\tmore\nweight\tthey\tregain\t(\nMann\tet\tal,\t2007\n).
|
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weight\tthey\tregain\t(\nMann\tet\tal,\t2007\n).\nFurthermore,\tthe\tAND\tEBNPG\treported\tthat\tapproximately\thalf\tof\tthe\tweight\tloss\tintervention\nstudies\tin\tpeople\twith\tT2DM\timproved\tA1C\tat\t1\tyear\tand\tone-half\tdid\tnot\t(\nAND,\t2008a\n).\tIn\tthe\nweight\tloss\tstudies\tlasting\t1\tyear\tor\tlonger\treviewed\tby\tthe\tADA,\tonly\n\t2\tstudy\tgroups\tachieved
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2\tstudy\tgroups\tachieved\nweight\tlosses\tof\t5%\tor\tgreater.\tThe\tfirst\twere\tpeople\tnewly\tdiagnosed\twith\tT2DM\twho\tfollowed\ta\nMediterranean-style\teating\tpattern\t(−6.2\tkg)\tand\tthe\tsecond\twere\tthose\twho\tparticipated\tin\tan\nintensive\tlifestyle\tintervention\tas\tpart\tof\tthe\tLook\tAHEAD\t(Action\tfor\tHealth\tin\tDiabetes)\tstudy\n(−8.4\tkg)\t(\nEsposito\tet\tal,\t2009\n;
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] |
(−8.4\tkg)\t(\nEsposito\tet\tal,\t2009\n;\t\nLook\tAHEAD\tResearch\tGroup,\t2010\n).\tOther\tweight\tloss\tinterventions\nresulted\tin\tweight\tlosses\tof\tless\tthan\t5%\t(4.8\tkg\tor\tless)\tat\t1\tyear\t(\nEvert\tet\tal,\t2013\n).\tWeight\tlosses\ngreater\tthan\t5%\tresulted\tin\tconsistent\timprovements\tin\tA1C,\tlipids,\tand\tblood\tpressure;\thowever,
|
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weight\tlosses\tless\tthan\t5%\tdid\tnot\tresult\tin\tconsistent\t1-year\timprovements\tin\tA1C,\tlipids,\tor\tblood\npressure\t(\nAND,\t2008a\n;\t\nFranz,\t2013\n).\tOne\tapproach\tthat\thas\trecently\tgained\tpopularity\twithin\tthe\ndietetics\tcommunity\tis\tthe\tHealth\tat\tEvery\tSize\t(HAES)\tweight\tneutral\tparadigm,\twhich\tfocuses\ton
|
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] |
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