Primary care
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There are many nonmodifiable and modifiable risk factors for type 2 diabetes. Nonmodifiable risk factors include age, genetics, epigenetics, and social determinants of health (including education level, socioeconomic status, and noise and arsenic exposure). ⋯ Weight loss is the lifestyle intervention with the largest benefit for both preventing and treating diabetes. Exercise, even without weight loss, significantly reduces the incidence of type 2 diabetes.
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Diabetes distress, disordered eating, and depression are common but often poorly recognized conditions that are often mutually self-sustaining and can confound a primary care physician's approach to the treatment of type 2 diabetes. There are validated screening instruments and evidence-based treatments for each of these. In devising a treatment plan for patients with these conditions, it is important for the primary care physician to target key issues, such as encouraging family support, instilling self-efficacy, understanding the value of a supportive physician-patient relationship, choosing medications that have evidence-based support, and making referrals to appropriate behavioral health providers.
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The incidence of all diabetes types are increasing, including the rate of women with diabetes in pregnancy. Preconception counseling continues to be an important part of visits with women who have diabetes and those at risk for gestational diabetes. Intensive control of blood sugar reduces the risk of negative outcomes in mother and baby. ⋯ Insulin dose adjustments are required to reach glycemic goals during pregnancy and tend to change throughout its course with higher doses needed with increasing insulin resistance in the second and third trimesters. Breastfeeding is encouraged for all women regardless of diabetes type. Insulin doses generally need adjustment after delivery due to placental delivery leading to decreased insulin and lactation increasing energy requirements.
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In the United States, diabetes has reached epidemic proportions. Thanks to science and technology, we are undergoing a rapid expansion of treatment tools including new drugs, continuous glucose monitoring devices as well as insulin pumps among other gadgets, aimed to help patients with diabetes take control over this disease. Unfortunately, people affected with diabetes face multiple barriers and cannot take advantage of these. This article uncovers multiple educational and financial resources that are often underutilized and not very well known by those providers responsible of taking care of this vulnerable population.
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Type of diabetes is not always straightforward at presentation. Misdiagnosis is common in all age groups and diagnosis becomes evident over time. ⋯ Patients with ketosis-prone diabetes mellitus are often misdiagnosed as having type 1 diabetes mellitus. Correct diagnosis helps wean patients off of insulin and use noninsulin agents if needed.