52 year old woman with well controlled type 2 diabetes mellitus is brought

πŸ”₯+ 52 year old woman with well controlled type 2 diabetes mellitus is brought 02 Jun 2020 Here are 12 foods to limit or skip altogether in a type 2 diabetic diet, ... According to the Mayo Clinic, foods that contain saturated fat include:.

52 year old woman with well controlled type 2 diabetes mellitus is brought Teens with type 2 diabetes have to pay close attention to what they eat and do. ... The glucose can't get into the cells normally, so the blood sugar level gets too ...

will lemon water lower blood sugar
From Wiki Journal Club
Jump to: navigation, search
Published
Knowler WC, et al. "". The New England Journal of Medicine. 2002. 346(6):393-403.
PubMed β€’ Full text β€’ PDF

Contents

Clinical Question

In patients at high risk of developing type 2 diabetes, do intensive lifestyle changes or metformin treatment prevent or delay the onset of diabetes?

Bottom the 1 last update 02 Jun 2020 LineBottom Line

In patients at high risk of developing type 2 diabetes, intensive lifestyle changes and metformin treatment both reduced the incidence of diabetes.

Major Points

Adults with prediabetes have a high incidence of developing overt T2DM. In the end of the 20th century, there was little evidence to guide prevention of progression to T2DM among prediabetics. Given the high incidence of obesity and low levels of exercise among prediabetics and diabetics, intensive lifestyle interventions promoting weight loss and exercise might be effective. Also, metformin is an oral diabetes medication associated with weight loss and reduced the 1 last update 02 Jun 2020 gluconeogenesis. Whether intensive lifestyle it may prevent progression of prediabetes to T2DM was also unknown. Adults with prediabetes have a high incidence of developing overt T2DM. In the end of the 20th century, there was little evidence to guide prevention of progression to T2DM among prediabetics. Given the high incidence of obesity and low levels of exercise among prediabetics and diabetics, intensive lifestyle interventions promoting weight loss and exercise might be effective. Also, metformin is an oral diabetes medication associated with weight loss and reduced gluconeogenesis. Whether intensive lifestyle it may prevent progression of prediabetes to T2DM was also unknown.

Published in 2002, the Diabetes Prevention Program (DPP) randomized 3,234 patients at high risk of T2DM (elevated BMI and prediabetes as defined by elevated fasting plasma glucose and elevated plasma glucose 2 hours after an OGTT) to receive standard lifestyle modification and placebo, standard lifestyle modification and metformin, or an intensive lifestyle intervention program. After 2.8 years of mean follow up, the study was closed early for efficacy of the active interventions. Intensive lifestyle intervention and metformin reduced the incidence of T2DM by 58% (95% CI 48-66%) and 31% (95% CI 17-43%) respectively, as compared to placebo. The interventions were generally well-tolerated, except for metformin, which had a higher rate of GI-related symptoms than placebo. This is consistent with the known GI side effect profile of metformin in T2DM.[1]

The DPP study was included in a 2008 meta-analysis of 8 studies (n=5,956 patients) to assess the effects of exercise and diet interventions for preventing T2DM.[2] Exercise and diet interventions reduced the risk of developing diabetes as compared to standard recommendations (RR 0.63, 95% CI 0.49-0.79) and showed favorable effects on weight reduction. Additionally, within-trial cost-effectiveness analysis concluded that the lifestyle and metformin interventions were cost-effective.[3]

52 year old woman with well controlled type 2 diabetes mellitus is brought herbs (πŸ‘ foot pain) | 52 year old woman with well controlled type 2 diabetes mellitus is brought recommendationshow to 52 year old woman with well controlled type 2 diabetes mellitus is brought for The core intervention of the intensive lifestyle arm targeting 150 min/week of moderate-intensity physical activity and 7% target weight loss is now referred to therapeutically as a '' and is an evidence-based intervention intended for adults with prediabetes. A CDC-approved curriculum of 16 classes is now covered by Medicare, with online and in-person courses available across the country.[4][5]

52 year old woman with well controlled type 2 diabetes mellitus is brought food choices (β˜‘ beta cells) | 52 year old woman with well controlled type 2 diabetes mellitus is brought glut4how to 52 year old woman with well controlled type 2 diabetes mellitus is brought for Guidelines

ADA Standards of Medical Care in Diabetes (2018, adapted)[6]

  • Prediabetics should be referred to a DPP targeting 7% weight loss and 150 min/week of moderate-intensity exercise (grade A)
  • Consider metformin in prediabetics, especially if BMI β‰₯35 kg/m2, age <60, and if prior GDM in women (grade A)

the 1 last update 02 Jun 2020 DesignDesign

  • Multicenter, double-blind, parallel-group, randomized, controlled trial
  • N=3,234
    • Placebo (n=1,082)
    • Metformin (n=1,073)
    • Intensive-lifestyle (n=1,079)
  • Setting: 27 centers in the United States
  • Enrollment: 1996-1999
  • Mean follow-up: 2.8 years (stopped early for benefit)
  • Analysis: Intention-to-treat
  • Primary outcome: Diabetes diagnosed according to the 1997 criteria of the American Diabetes Association[7]

Population

Inclusion Criteria

  • Age β‰₯25 years
  • BMI β‰₯24.0 kg/m2 (β‰₯22.0 in Asians)
  • Non-diabetic patients at high risk with both of the following:
    • Fasting plasma glucose of 95-125 mg/dL (5.3-6.9 mmol/L)
      • Note, there was no lower limit for American Indians due to their high risk of T2DM
    • 2-hour post OGTT plasma glucose of 140-199 mg/dL (7.8-11.0 mmol/L)

52 year old woman with well controlled type 2 diabetes mellitus is brought meal plan (πŸ‘ breakfast) | 52 year old woman with well controlled type 2 diabetes mellitus is brought treatment insulinhow to 52 year old woman with well controlled type 2 diabetes mellitus is brought for Exclusion for 1 last update 02 Jun 2020 CriteriaExclusion Criteria

  • Taking medications known to alter glucose tolerance (eg, thiazide and beta-blockers)
  • Significant illness that would limit life expectancy.

Baseline Characteristics

All patients

  • Demographics: Female sex 68%, age 51 years, white race 55%, black race 20%, hispanic 16%, American Indian 4%, asian 4%
  • BMI: 34 kg/m2, waist circumference 105 cm, waist:hip 0.92
  • Diabetes history: Family history of diabetes 69%, gestational diabetes in women 16%, fasting glucose 106 mg/dL, 2h OGTT 165 mg/dL, A1c 5.9%
  • Physical activity by the Modifiable Activity Questionnaire: 16 MET-hr/week

Interventions

  • Randomization to a group:
    • Intensive lifestyle - Intensive lifestyle modifications targeting 7% weight loss through diet (low calorie, low-fat diet) and exercise (β‰₯150 min/week) delivered through a 16 lesson curriculum, details are published elsewhere[8]
    • Metformin - 850 mg PO BID (uptitrated from daily), with standard lifestyle recommendations
    • Placebo - With standard lifestyle recommendations
    • Note, there was originally a troglitazone arm, which was discontinued given the medication's elevated incidence of liver damage.

for 1 last update 02 Jun 2020 OutcomesOutcomes

P-Y is person year.""mw-headline""Primary_Outcomes""mw-headline""Secondary_Outcomes""mw-headline""Adverse_Events""mw-headline""Criticisms""cite_ref-:0_9-0""reference""#cite_note-:0-9""cite_ref-:1_10-0""reference""#cite_note-:1-10""cite_ref-:2_11-0""reference""#cite_note-:2-11""mw-headline""Funding""mw-headline""Further_Reading""references""cite_note-1""mw-cite-backlink""#cite_ref-1""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pubmed/25510240""cite_note-2""mw-cite-backlink""#cite_ref-2""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pubmed/18646086""cite_note-3""mw-cite-backlink""#cite_ref-3""reference-text""nofollow""external text""http://care.diabetesjournals.org/content/26/9/2518""cite_note-4""mw-cite-backlink""#cite_ref-4""reference-text""nofollow""external text""https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/""cite_note-5""mw-cite-backlink""#cite_ref-5""reference-text""nofollow""external text""https://www.cdc.gov/diabetes/prevention/index.html""cite_note-6""mw-cite-backlink""#cite_ref-6""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pubmed/29222376""cite_note-7""mw-cite-backlink""#cite_ref-7""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pubmed/9203460""cite_note-8""mw-cite-backlink""#cite_ref-8""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pubmed/10189543""cite_note-:0-9""mw-cite-backlink""#cite_ref-:0_9-0""reference-text""nofollow""external text""http://www.nejm.org/doi/full/10.1056/NEJM200206063462316""cite_note-:1-10""mw-cite-backlink""#cite_ref-:1_10-0""reference-text""nofollow""external text""http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214566/""cite_note-:2-11""mw-cite-backlink""#cite_ref-:2_11-0""reference-text""nofollow""external text""http://ebn.bmj.com/content/5/4/109.full""printfooter""http://www.wikijournalclub.org/w/index.php?title=DPP&oldid=30196""mw-normal-catlinks""mw-normal-catlinks""/wiki/Special:Categories""Special:Categories""/wiki/Category:Usable_articles""Category:Usable articles""/wiki/Category:Endocrinology""Category:Endocrinology""visualClear""mw-navigation""mw-head""p-personal""navigation""""p-personal-label""p-personal-label""pt-createaccount""/w/index.php?title=Special:UserLogin&returnto=DPP&type=signup""You are encouraged to create an account and log in; however, it is not mandatory""pt-login""/w/index.php?title=Special:UserLogin&returnto=DPP""You are encouraged to log in; however, it is not mandatory [o]""o""left-navigation""p-namespaces""navigation""vectorTabs""p-namespaces-label""p-namespaces-label""ca-nstab-main""selected""/wiki/DPP""View the content page [c]""c""ca-talk""new""/w/index.php?title=Talk:DPP&action=edit&redlink=1""Discussion about the content page [t]""t""discussion""p-variants""navigation""vectorMenu emptyPortlet""p-variants-label""p-variants-label""#""menu""right-navigation""p-views""navigation""vectorTabs""p-views-label""p-views-label""ca-view""selected""/wiki/DPP""ca-viewsource""/w/index.php?title=DPP&action=edit""This page is protected. You can view its source [e]""e""ca-history""collapsible""/w/index.php?title=DPP&action=history""Past revisions of this page [h]""h""p-cactions""navigation""vectorMenu emptyPortlet""p-cactions-label""p-cactions-label""#""menu""p-search""search""searchInput""/w/index.php""searchform""simpleSearch""search""search""Search""Search Wiki Journal Club [f]""f""searchInput""hidden""Special:Search""title""submit""fulltext""Search""Search the pages for this text""mw-searchButton""searchButton mw-fallbackSearchButton""submit""go""Go""Go to a page with this exact name if it exists""searchButton""searchButton""mw-panel""p-logo""banner""mw-wiki-logo""/wiki/Main_Page""Visit the main page""portal""navigation""body""n-mainpage-description""/wiki/Main_Page""Visit the main page [z]""z""n-usablearticles""/wiki/WikiJournalClub:Usable_articles""n-recentchanges""/wiki/Special:RecentChanges""A list of recent changes in the wiki [r]""r""n-randompage""/wiki/Special:Random""Load a random page [x]""x""n-about""/wiki/WikiJournalClub:About""portal""navigation""body""t-whatlinkshere""/wiki/Special:WhatLinksHere/DPP""A list of all wiki pages that link here [j]""j""t-recentchangeslinked""/wiki/Special:RecentChangesLinked/DPP""Recent changes in pages linked from this page [k]""k""t-specialpages""/wiki/Special:SpecialPages""A list of all special pages [q]""q""t-print""/w/index.php?title=DPP&printable=yes""alternate""Printable version of this page [p]""p""t-permalink""/w/index.php?title=DPP&oldid=30196""Permanent link to this revision of the page""t-info""/w/index.php?title=DPP&action=info""More information about this page""footer""contentinfo""footer-info""footer-info-lastmod""footer-places""footer-places-privacy""/wiki/WikiJournalClub:Privacy_policy""WikiJournalClub:Privacy policy""footer-places-about""/wiki/WikiJournalClub:About""WikiJournalClub:About""footer-places-disclaimer""/wiki/WikiJournalClub:General_disclaimer""WikiJournalClub:General disclaimer""footer-places-mobileview""https://www.wikijournalclub.org/w/index.php?title=DPP&mobileaction=toggle_view_mobile""noprint stopMobileRedirectToggle""footer-icons""noprint""footer-poweredbyico""//www.mediawiki.org/""/w/resources/assets/poweredby_mediawiki_88x31.png""Powered by MediaWiki""/w/resources/assets/poweredby_mediawiki_132x47.png 1.5x, /w/resources/assets/poweredby_mediawiki_176x62.png 2x""88""31""clear:both""stylesheet""/w/load.php?debug=false&lang=en&modules=ext.cite.styles&only=styles&skin=vector" />