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DIABETES MELLITUS (DM), TYPE 2

Population

  • –Persons with impaired glucose tolerance (IGT).a

Recommendations

ADA 2017

  • –Nutrition therapy emphasizing portion control and foods higher in fiber with lower glycemic index.

  • –Intensive lifestyle modification with a goal of sustained 7% weight loss.

  • –Moderate physical activity such as brisk walking at least 150 min/wk.

  • –Consider metformin for patients at highest risk for developing diabetes (eg, BMI 35 kg/m2 or greater, those age 60 y or younger, and those with prior gestational diabetes mellitus [GDM]).

Source

  • Diabetes Care. 2018;41(suppl 1):S1–S159.

Comments

  1. Recommendations for disease prevention:

    1. Annual influenza vaccine.

    2. Pneumococcal polysaccharide vaccine if 2 y or older with one-time revaccination when over 64 y.

    3. Hepatitis B vaccine series if unvaccinated and 19–59 y of age.

    4. Aspirin 81 mg daily for primary prevention if 10-y risk of significant CAD is at least 10% (by Framingham Risk Score); includes most men over 50 y and most women over 60 y.

Population

  • –Persons with abnormal blood glucose or BMI >25.

Recommendation

USPSTF 2016

  • –Intensive behavioral intervention to promote healthy diet and physical activity.

Source

  • Ann Intern Med. 2015;163(11):861-868.

Population

  • –Children of ethnicities with higher prevalence of diabetes, such as American Indian, Alaskan Native, Mexican-American, and African-American.

Recommendations

AAP 2009

  • –Counsel children with BMI >85th percentile on weight control, physical activity, and nutrition.

  • –Do not use medications to prevent diabetes.

  • –Nutritional interventions require familiarity with family and community culture and rely on the entire family making changes.

Source

  • Pediatrics. 2003;112(4):e328-347.

aIGT if fasting glucose 110–125 mg/dL, 2-h glucose after 75-g anhydrous glucose load 140–199 mg/dL, or HgbA1c 5.7%–6.4%.

HORMONE REPLACEMENT THERAPY TO PREVENT CHRONIC CONDITIONS

Population

  • –Postmenopausal women.

Recommendation

USPSTF 2017

  • –Do not use combined estrogen and progestin to prevent chronic conditions, including osteoporosis, coronary artery disease, breast cancer, and cognitive impairment.

Source

  • JAMA. 2017;318(22):2224-2233.

Population

  • –Postmenopausal women who have had a hysterectomy.

Recommendation

USPSTF 2017

  • –Do not use estrogen to prevent chronic conditions, including osteoporosis, coronary artery disease, breast cancer, and cognitive impairment.

Source

  • JAMA. 2017;318(22):2224-2233.

Comment

  1. This recommendation does not apply to women under the age of 50 y who have undergone a surgical menopause ...

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