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Cited by 545Diabetes Treatment and ManagementClinical practice guidelines implementationDiabetes Management and Research

Japanese clinical practice guideline for diabetes 2019

Open access
Araki, Eiichi, Goto, Atsushi, Kondo, Tatsuya, Noda, Mitsuhiko, Noto, Hiroshi, Origasa, Hideki, Osawa, Haruhiko, Taguchi, Akihiko +3 more·2020·Diabetology International
DOI 10.1007/s13340-020-00439-5PMC PMC7378414
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Written from the paper’s full text.

TL;DR

This is the 6th edition of the Japanese Clinical Practice Guideline for Diabetes 2019, developed by the Japan Diabetes Society to promote evidence-based, rational, efficient and consistent diabetes care. It presents graded recommendations (Grade A/B) across diagnosis, management, complications, and special populations using a clinical question (CQ)/question (Q) format.

Key findings

  • Diagnosis is confirmed by two assessments of diabetic type (one blood glucose mandatory), one assessment plus typical hyperglycemia symptoms, or evidence of prior diagnosis; fasting glucose 100–109 mg/dL is classified as "high normal" within the normal type.
  • Glycemic target is generally HbA1c <7.0% (corresponding to fasting glucose <130 mg/dL and 2-h postprandial <180 mg/dL), set individually by age, duration, organ damage, hypoglycemia risk, and support.
  • Numerous Grade A recommendations with stated agreement: MNT effective (100%), MNT education by registered dieticians (95%), physical activity/exercise (100%), organized self-management education (100%), intensive insulin therapy for microangiopathy in type 1 (100%) and type 2 (94%) diabetes, routine ophthalmologic check-up (95%), glycemic control for nephropathy (100%), and glycemic control for neuropathy (90%).
  • For elderly patients, appropriate glycemic control focused on safety rather than tight control is recommended (Grade A), with a J-curve noted between HbA1c and macroangiopathy/mortality.

Methods

  • Guideline development used general questions (Qs) and clinical questions (CQs); recommendation statements were developed solely for CQs.
  • Clinical Guideline Committee members conducted systematic reviews, with a support team assisting literature retrieval and evidence-level confirmation; abstract tables used PICO, study design, and evidence level (1+ highest to 3 lowest).
  • Grades were determined considering certainty of overall evidence, balance of benefits and harms, patient preferences/values, and costs; Grade A = strongly recommended, Grade B = weakly recommended; a 75% agreement among eligible committee members was required to approve each recommendation.

Limitations

  • The paper states a paucity of evidence in several areas, including routine foot examinations for preventing diabetic foot, protein restriction for diabetic nephropathy, behavioral therapy for glycemic control in type 2 diabetes with obesity, and increased physical activity/exercise in pregnancy.
  • It states no clear evidence exists for ideal energy-producing nutrient ratios, and that no evidence supports long-term safety of protein intake ≥20% of total energy.
  • Evident from the text: several recommendations rest on consensus rather than trial evidence (e.g., routine foot examination graded "A by consensus," foot care education "B by consensus"), and the document is a guideline synthesis rather than a primary study generating new data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s13340-020-00439-5

Cites

451 of 451 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 281 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    In the management of diabetes, lifestyle modification centered on MNT is effective.

    “In the management of diabetes, lifestyle modification centered on MNT is shown to be effective 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 (grade A: 100% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

    • cites [3] Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee of Japan Diabetes Society on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1999;42:385–404 (in Japanese).

      Not checked in the free run.

  • Premisecitation

    Diabetes management aimed at ensuring continued smoking cessation and control of blood pressure and lipid levels prevents chronic diabetic complications or delays their progression.

    “Diabetes management is aimed not merely at glycemic control 1 but also at ensuring continued smoking cessation and control of blood pressure and lipid levels, thereby preventing chronic diabetic complications or delaying their progression 2 , 3 , 4 , 5 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

    • cites [3] Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee of Japan Diabetes Society on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1999;42:385–404 (in Japanese).

      Not checked in the free run.

    • cites [4] Seino Y, Nanjo K, Tajima N. et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus: the Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus. Diabetol Int. 2010;1:2. source

      Not checked in the free run.

  • Premisecitation

    Individual patients may have multiple etiological factors.

    “Individual patients may have multiple etiological factors 4 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Seino Y, Nanjo K, Tajima N. et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus: the Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus. Diabetol Int. 2010;1:2. source

      Not checked in the free run.

  • Premisecitation

    Achieving and maintaining favorable glycemic control early after initiation of treatment is likely to lead to favorable long-term outcomes in these individuals.

    “Achieving and maintaining favorable glycemic control early after initiation of treatment is likely to lead to favorable long‐term outcomes in these individuals 1 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

  • Premisenone given

    No evidence is available to support the benefits of n-3 fatty acids in diabetes management.

    “No evidence is available to support the benefits of n‐3 fatty acids in diabetes management.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 58
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Patients with fulminant type 1 diabetes frequently develop ketosis or ketoacidosis within 1 week of the onset of hyperglycemia, require insulin therapy immediately, and are characterized as having lower HbA1c values relative to their glucose values.

    “Patients with fulminant type 1 diabetes frequently develop ketosis or ketoacidosis within 1 week of the onset of hyperglycemia, require insulin therapy immediately, and are characterized as having lower HbA1c values relative to their glucose values 9 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: New Diagnostic Criteria of Fulminant Type 1 Diabetes Mellitus (2012). Diabetol Int. 2012;3:179–83. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with slowly-progressive (insulin-dependent) type 1 diabetes do not develop ketosis or ketoacidosis and do not require insulin therapy immediately, although their diagnosis is established by a positive test for anti-GAD antibodies or islet cell antibodies (ICA).

    “Patients with slowly‐progressive (insulin‐dependent) type 1 diabetes do not develop ketosis or ketoacidosis and do not require insulin therapy immediately, although their diagnosis is established by a positive test for anti‐GAD antibodies or islet cell antibodies (ICA) 8 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Tanaka S, Ohmori M, Awata T, et al. Erratum to: Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the Committee on Slowly Progressive Insulin-Dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society. Diabetol Int. 2012;2015(6):149.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with acute type 1 diabetes are generally likely to develop ketosis or ketoacidosis within 3 months of the onset of hyperglycemia and require insulin therapy immediately.

    “Patients with acute type 1 diabetes are generally likely to develop ketosis or ketoacidosis within 3 months of the onset of hyperglycemia and require insulin therapy immediately 7 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus. Diabetol Int. 2012;2013(4):221. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sucrose-rich sweets and juices are thought likely to worsen glycemic control and promote the metabolic syndrome.

    “However, they should abstain from sucrose‐rich sweets and juices, which are thought likely to worsen glycemic control and promote the metabolic syndrome 15 , 16 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50 [level 1] source

      Not checked in the free run.

    • cites [16] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403 [level 1] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A 75% agreement among eligible CGC members was required to approve each recommendation and its strength.

    “A 75% agreement among eligible CGC members was required to approve each recommendation and its strength.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Regularly eating three meals a day is shown to be effective in preventing the onset of diabetes.

    “Regularly eating three meals a day is shown to be effective in preventing the onset of diabetes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Long-term exercise is shown to reduce risk factors for cardiovascular disease and improve quality of life (QOL) in patients with type 1 diabetes.

    “Despite lack of consensus on its role in improving glycemic control in patients with type 1 diabetes, long‐term exercise is shown to reduce risk factors for cardiovascular disease and improve quality of life (QOL) 15 , 16 , 17 , 18 (grade B: 100% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50 [level 1] source

      Not checked in the free run.

    • cites [16] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403 [level 1] source

      Not checked in the free run.

    • cites [17] The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54 [level 1] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Patients receiving insulin therapy are not always in an insulin-dependent state.

    “Thus, it should be noted that patients receiving insulin therapy are not always in an insulin‐dependent state.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The influence of artificial sweeteners on the risk of diabetes and glycemic control has not been sufficiently elucidated.

    “While sucrose intake is a risk factor for diabetes, the influence of artificial sweeteners on the risk of diabetes and glycemic control has not been sufficiently elucidated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Sucrose intake is a risk factor for diabetes.

    “While sucrose intake is a risk factor for diabetes, the influence of artificial sweeteners on the risk of diabetes and glycemic control has not been sufficiently elucidated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The grade of recommendation was determined by each CGC member with consideration given to certainty of overall evidence, balance of benefits and harms, patient preferences/values, and costs.

    “The grade of recommendation was determined by each CGC member with consideration given to certainty of overall evidence, balance of benefits and harms, patient preferences/values, and costs (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Aerobic exercise and resistance exercise are shown to be effective individually, and more in combination in improving glycemic control in patients with type 2 diabetes.

    “Aerobic exercise and resistance exercise are shown to be effective individually, and more in combination in improving glycemic control in patients with type 2 diabetes 1 , 6 , 8 , 14 (grade A 100% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [6] Kadowaki T, Haneda M, Tominaga M, et al. Report of the Japan Diabetes Society’s Committee on the diagnostic criteria for diabetes mellitus and glucose metabolism disorder—a new category of fasting plasma glucose values: “high-normal”. J Jpn Diabetes Soc. 2008;51:281–3 (in Japanese).

      Not checked in the free run.

    • cites [8] Tanaka S, Ohmori M, Awata T, et al. Erratum to: Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the Committee on Slowly Progressive Insulin-Dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society. Diabetol Int. 2012;2015(6):149.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Clinical guideline committee members conducted systematic review of evidence from several resources to develop a statement of recommendation for CQs.

    “Clinical guideline committee (CGC) members conducted systematic review (SR) of evidence from several resources to develop a statement of recommendation for CQs and presented a strength of recommendation rated as a grade.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In general, screening for cardiovascular disease is not necessary in asymptomatic patients implementing light- to moderate-intensity exercise.

    “In general, screening for cardiovascular disease is not necessary in asymptomatic patients implementing light‐ to moderate‐intensity exercise (e.g., one that can be implemented as a daily activity, e.g., brisk walking) 19 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Chen L, Pei JH, Kuang J, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64:338–47 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity/exercise involving aerobic exercise, resistance exercise or their combination is shown to improve glycemic control and risk factors for cardiovascular disease.

    “Physical activity/exercise involving aerobic exercise, resistance exercise or their combination is shown to improve glycemic control 1 , 2 , 3 , 4 , 5 , 6 and risk factors for cardiovascular disease 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

    • cites [3] Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee of Japan Diabetes Society on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1999;42:385–404 (in Japanese).

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Etiology and pathophysiological states represent dimensions distinct from each other.

    “Their etiology (mechanism) and pathophysiological states (stages) represent dimensions distinct from each other and both should be used to describe the condition in each individual patient.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Strict glycemic control with intensive insulin therapy is effective in preventing the onset of microangiopathy and suppressing its progression in type 2 diabetes.

    “Strict glycemic control with intensive insulin therapy has been shown to be effective in preventing the onset of microangiopathy (retinopathy, nephropathy, and neuropathy) as well as in suppressing the progression of microangiopathy 8 , 9 (grade A: 94% agreement).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] Tanaka S, Ohmori M, Awata T, et al. Erratum to: Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the Committee on Slowly Progressive Insulin-Dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society. Diabetol Int. 2012;2015(6):149.

      Not checked in the free run.

    • cites [9] Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: New Diagnostic Criteria of Fulminant Type 1 Diabetes Mellitus (2012). Diabetol Int. 2012;3:179–83. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Insulin therapy may be associated with hypoglycemia and a transient worsening of retinopathy or neuropathy in some patients.

    “Insulin therapy may be associated with hypoglycemia as well as a transient worsening of retinopathy or neuropathy in some patients 1 , 2 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Intensive insulin therapy is effective in preventing the onset of microangiopathy and suppressing its progression in type 1 diabetes.

    “Intensive insulin therapy, which combines multiple insulin injections or CSII and self‐monitoring of blood glucose (SMBG) has been shown to be effective in preventing the onset of microangiopathy (retinopathy, nephropathy and neuropathy) and in suppressing their progression 4 , 5 (grade A: 100% agreement).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Seino Y, Nanjo K, Tajima N. et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus: the Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus. Diabetol Int. 2010;1:2. source

      Not checked in the free run.

    • cites [5] American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S13–27. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Combination therapy with insulin and oral glucose-lowering agents improves glycemic control and reduces the insulin dose in patients with type 2 diabetes.

    “Combination therapy with insulin and oral glucose‐lowering agents (SUs 13 , 14 , fast‐acting insulin secretagogues [glinides] 15 , 16 , 17 ), biguanides 18 , 19 , 20 , 21 , α‐glucosidase inhibitors 22 , 23 , insulin sensitizers 24 , 25 , 26 , 27 , and, DPP‐4 inhibitors 28 , and SGLT2 inhibitors 29 or GLP‐1 receptor agonists 30 are shown to improve glycemic control and reduce the insulin dose being”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Sone H, Tanaka S, Tanaka S, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448–56. source

      Not checked in the free run.

    • cites [14] Ueki K, Sasako T, Okazaki Y, Group JDS, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5:951–64. source

      Not checked in the free run.

    • cites [15] Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Both group and individualized education are useful for diabetes management.

    “Both group and individualized education has been shown to be useful for diabetes management 5 , 6 , 7 , 8 (grade A: 95% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S13–27. source

      Not checked in the free run.

    • cites [6] Kadowaki T, Haneda M, Tominaga M, et al. Report of the Japan Diabetes Society’s Committee on the diagnostic criteria for diabetes mellitus and glucose metabolism disorder—a new category of fasting plasma glucose values: “high-normal”. J Jpn Diabetes Soc. 2008;51:281–3 (in Japanese).

      Not checked in the free run.

    • cites [7] Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus. Diabetol Int. 2012;2013(4):221. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Depressive symptoms and anxiety disorders in diabetes lead to suboptimal self-care, worsening glycemic control, increased risk of diabetic complications, impaired QOL, and adversely affect prognosis.

    “Diabetes is often associated with depressive symptoms and anxiety disorders specific to the disease 18 , 19 , 20 , leading to suboptimal self‐care, worsening of glycemic control, an increased risk of diabetic complications, and an impaired QOL, thus adversely affecting the prognosis of affected patients 21 , 22 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Zhang X, Devlin HM, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. PLoS One. 2017;12:e0176436 [level 1] source

      Not checked in the free run.

    • cites [22] Franz MJ, Boucher JL, Rutten-Ramos S, et al. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115:1447–63 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Risk factors for the onset/progression of diabetic neuropathy include poor glycemic control, duration of diabetes, hypertension, dyslipidemia, smoking, and obesity.

    “The risk factors for the onset/progression of diabetic neuropathy include: ① poor glycemic control, ② duration of diabetes, ③ hypertension, ④ dyslipidemia, ⑤ smoking, and ⑥ obesity 3 , 4 , 5 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee of Japan Diabetes Society on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1999;42:385–404 (in Japanese).

      Not checked in the free run.

    • cites [4] Seino Y, Nanjo K, Tajima N. et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus: the Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus. Diabetol Int. 2010;1:2. source

      Not checked in the free run.

    • cites [5] American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S13–27. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    When diabetic foot is complicated by infection, it is likely to become severe, leading to lower limb amputation and a worse prognosis.

    “When diabetic foot is complicated by infection, it is likely to become severe, leading not only to lower limb amputation, but also to a worse prognosis 1 , 2 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Glycemic control is effective in inhibiting the onset of diabetic nephropathy and in inhibiting the progression of early-stage nephropathy.

    “Glycemic control is shown to be effective in inhibiting the onset of diabetic nephropathy as well as in inhibiting the progression of early‐stage nephropathy 5 , 6 , 7 , 8 , 9 , 10 (grade A: 100% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Suppl 1):S13–27. source

      Not checked in the free run.

    • cites [6] Kadowaki T, Haneda M, Tominaga M, et al. Report of the Japan Diabetes Society’s Committee on the diagnostic criteria for diabetes mellitus and glucose metabolism disorder—a new category of fasting plasma glucose values: “high-normal”. J Jpn Diabetes Soc. 2008;51:281–3 (in Japanese).

      Not checked in the free run.

    • cites [7] Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus. Diabetol Int. 2012;2013(4):221. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Team-based care is effective for prevention of foot lesions and treatment of foot ulcers.

    “Team‐based care is shown to be effective for prevention of foot lesions and treatment of foot ulcers 12 , 13 (grade B: 90% agreement).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Look ARG, Gregg EW, Jakicic JM, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016;4:913–21. source

      Not checked in the free run.

    • cites [13] Sone H, Tanaka S, Tanaka S, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448–56. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Diabetic retinopathy is a risk factor for diabetic nephropathy and macroangiopathy.

    “Diabetic retinopathy is a risk factor for diabetic nephropathy and macroangiopathy 15 , 16 , 17 , 18 , 19 , 20 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50 [level 1] source

      Not checked in the free run.

    • cites [16] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403 [level 1] source

      Not checked in the free run.

    • cites [17] The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    A decreased GFR and the occurrence of albuminuria are independent risk factors for cardiovascular disease.

    “A decreased GFR and the occurrence of albuminuria are independent risk factors for cardiovascular disease 24 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Møller G, Andersen HK, Snorgaard O. A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes. Am J Clin Nutr. 2017;106:1394–400 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Glycemic control is effective for preventing the onset of foot lesions and sparing lower limb amputation, and for preventing neuropathy as a risk factor for foot lesions.

    “Glycemic control is shown to be effective not only for preventing the onset of foot lesions and sparing lower limb amputation 6 , 7 but also for preventing neuropathy as a risk factor for foot lesions 7 (grade A: 85% agreement).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Kadowaki T, Haneda M, Tominaga M, et al. Report of the Japan Diabetes Society’s Committee on the diagnostic criteria for diabetes mellitus and glucose metabolism disorder—a new category of fasting plasma glucose values: “high-normal”. J Jpn Diabetes Soc. 2008;51:281–3 (in Japanese).

      Not checked in the free run.

    • cites [7] Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus. Diabetol Int. 2012;2013(4):221. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    SGLT2 inhibitor monotherapy may be effective for glycemic control while being less likely associated with hypoglycemia in patients with type 2 diabetes and obesity.

    “SGLT2 inhibitor monotherapy may be effective for glycemic control while being less likely associated with hypoglycemia 10 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] United Kingdom 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. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Patients with diabetic foot are significantly associated with high all-cause mortality, high incidence of cardiovascular/cerebrovascular diseases, depression, and cognitive impairment.

    “Patients with diabetic foot are significantly associated with high all‐cause mortality 16 , as well as a high incidence of cardiovascular/cerebrovascular diseases, depression 17 , and cognitive impairment 18 , suggesting that diabetic foot lesions likely represent a risk factor for mortality and these diseases.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [16] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403 [level 1] source

      Not checked in the free run.

    • cites [17] The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54 [level 1] source

      Not checked in the free run.

    • cites [18] Terranova CO, Brakenridge CL, Lawler SP, et al. Effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2015;17:371–8 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with diabetes and hypertension have a higher incidence of macroangiopathy and a poorer prognosis.

    “Both diabetes and hypertension are established risk factors for atherosclerosis‐associated macroangiopathy; patients with diabetes and hypertension have a higher incidence of macroangiopathy and a poorer prognosis 1 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Elderly patients with diabetes are susceptible to postprandial hyperglycemia and hypoglycemia and are vulnerable to hypoglycemia.

    “Elderly patients with diabetes are mainly characterized as: ① Being susceptible to postprandial hyperglycemia and hypoglycemia (see II‐CQ‐2) and as being vulnerable to hypoglycemia (see II‐CQ‐4);”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Patients with diabetes 75 years old or older are particularly highly likely to be associated with geriatric syndrome, e.g., dementia, decreased ADL, sarcopenia, falls/fractures, frailty, urinary incontinence, and undernutrition.

    “Patients with diabetes 75 years old or older are particularly highly likely to be associated with geriatric syndrome, e.g., dementia, decreased ADL, sarcopenia, falls/fractures, frailty, urinary incontinence, and undernutrition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Elderly patients with diabetes are susceptible to depression and decreased quality of life.

    “Elderly patients with diabetes need to be watched for depression (depressive tendency or depression) and decreased quality of life (QOL) to which they are susceptible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Glucose tolerance deteriorates with aging, and the frequency of occurrence of diabetes increases with aging.

    “Glucose tolerance deteriorates, and the frequency of occurrence of diabetes increases with aging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increased physical activity/exercise may have a role in promoting health by improving maternal glycemic control and suppressing excessive weight gain in pregnant women with hyperglycemic disorders, though evidence is sparse.

    “While there is a paucity of evidence to support the usefulness of increased physical activity/exercise in the management of hyperglycemic disorders in pregnancy, increased physical activity/exercise may have a role to promote health with improving maternal glycemic control, and suppressing excessive weight gain 12 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Look ARG, Gregg EW, Jakicic JM, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016;4:913–21. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sulfonylureas are effective in treating patients with KCNJ11/ABCCB8 gene mutations and allow these patients to discontinue insulin therapy.

    “Sulfonylureas (SUs) have been shown to be effective in treating patients with KCNJ11/ABCCB8 gene mutations and to allow these patients to discontinue insulin therapy 12 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Look ARG, Gregg EW, Jakicic JM, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016;4:913–21. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Diabetes in the elderly is associated with many complications that result from atherosclerosis as an underlying disease and may remain asymptomatic in many cases.

    “Diabetes in the elderly is associated with many complications which result from atherosclerosis as an underlying disease and may remain asymptomatic in many cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Elderly patients with diabetes are likely to develop hypoglycemia unawareness (asymptomatic hypoglycemia) and severe hypoglycemia.

    “They are likely to develop into hypoglycemia unawareness (asymptomatic hypoglycemia) and severe hypoglycemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Medical nutrition therapy in pregnant women with hyperglycemic disorders provides necessary and sufficient nutrition for healthy fetal development and ensures strict glycemic control and appropriate weight gain.

    “MNT in pregnant women with hyperglycemic disorders not only provides necessary and sufficient nutrition for healthy fetal development, but also ensures strict glycemic control and appropriate weight gain 11 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13. source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisereasoning

    Hypoglycemia is likely to adversely affect elderly patients with diabetes.

    “Thus, hypoglycemia is likely to adversely affect the elderly.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Institutionalized elderly patients with diabetes frequently require emergency room visits or hospital admissions and are frequently associated with bedsore and hypoglycemia.

    “Institutionalized elderly patients with diabetes are characterized as frequently requiring emergency room visits or hospital admissions and as being frequently associated with bedsore and hypoglycemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Lactic acidosis occurs only very rarely in elderly patients receiving metformin, with incidence not significantly higher than in those not receiving metformin.

    “The Cochrane reviews demonstrate that lactic acidosis occurs only very rarely in elderly patients receiving metformin, with its incidence shown to be not significantly higher than that in those not receiving metformin.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Alpha-glucosidase inhibitors are associated with gastrointestinal symptoms and dosing frequency burden.

    “Attention needs to be given to gastrointestinal symptoms and dosing frequency with α‐glucosidase inhibitors (α‐GIs), the risk of cardiac failure and fracture with thiazolidinediones (TZDs), and dehydration and urogenital infections with SGLT2 inhibitors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Glinides are suitable for improving postprandial hyperglycemia characteristic of diabetes in the elderly, but their risk of hypoglycemia and dosing frequency/timings likely increase patient burden.

    “While glinides are suitable for use in improving postprandial hyperglycemia characteristic of diabetes in the elderly, the risk of hypoglycemia associated with their use, as well as their dosing frequency and timings, is likely to increase the patient’s burden.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Elderly patients with diabetes are susceptible to pneumonia, urinary tract infections, septicemia, and tuberculosis.

    “Elderly patients with diabetes are susceptible to such infections as pneumonia, urinary tract infections, septicemia and tuberculosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Diabetes in elderly patients is a likely risk factor for nursing home institutionalization.

    “Diabetes in elderly patients is a likely risk factor for nursing home institutionalization.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Cognitive impairment in elderly patients with diabetes leads to decreased adherence to self-management, resulting in an increased risk of severe hypoglycemia.

    “Elderly patients with diabetes need to be assessed for cognitive function, as cognitive impairment in these patients leads to decreased adherence to their self‐management (self‐care) resulting in an increased risk of severe hypoglycemia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    DPP-4 inhibitors are less likely to cause hypoglycemia as monotherapy but may cause severe hypoglycemia in combination with sulfonylureas.

    “DPP‐4 inhibitors are less likely to cause hypoglycemia when used as monotherapy but may cause severe hypoglycemia when used in combination with SU.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    GLP-1 receptor agonists are associated with gastrointestinal symptoms (e.g., nausea and vomiting) and weight loss.

    “Attention needs to be given to gastrointestinal symptoms (e.g., nausea and vomiting) and weight loss with GLP‐1 receptor agonists.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Vibratory sensation becomes attenuated with aging.

    “While diabetic neuropathy is usually diagnosed based on the bilateral absence of Achilles tendon reflex, decreased vibratory sensation in the lower extremities and subjective symptoms, it should be kept in mind that vibratory sensation becomes attenuated with aging.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Typical autonomic symptoms of hypoglycemia are likely to become attenuated, and atypical symptoms are likely to become more frequent, with advancing years.

    “It should be noted that typical autonomic symptoms of hypoglycemia (e.g., palpitation, perspiration and tremor) are likely to become attenuated, and atypical symptoms (e.g., dizziness and shakiness) are likely to become more frequent, with advancing years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Resistance training improves glycemic control and increases lean body mass and muscle strength in elderly patients with type 2 diabetes.

    “Resistance training improves glycemic control and increases lean body mass and muscle strength in elderly patients with type 2 diabetes (grade B).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Physical activity/exercise is effective in correcting metabolic derangement, maintaining life prognosis and ADL, and reducing cognitive impairment in elderly patients with diabetes.

    “Physical activity/exercise, e.g., regular physical activity and walking, is effective not only in correcting metabolic derangement but also in maintaining life prognosis and ADL and reducing cognitive impairment in elderly patients with diabetes as well (grade A)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Hyperglycemia is a likely risk factor for cognitive impairment or onset of dementia in the elderly, but its association with dementia requires further examination.

    “Hyperglycemia, too, is a likely risk factor but requires to be examined in greater detail for its association with dementia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Comprehensive geriatric assessment (CGA) has proven efficacy in decreasing the number of institutionalized patients and in decreasing mortality.

    “Given its proven efficacy in decreasing the number of institutionalized patients and in decreasing mortality, multidisciplinary CGA is to be implemented in elderly patients with diabetes (grade of recommendation: A)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Risk factors for hypoglycemia in elderly patients with diabetes include insulin therapy, use of sulfonylureas, low/high HbA1c values, prolonged duration of diabetes, history of coronary artery disease or stroke, advanced age (75-80 years), cognitive impairment or dementia, depression, decreased ADL, renal impairment, liver disease, decreased dietary intake, infections, multi-drug combinationrapy,

    “Risk factors for hypoglycemia in elderly patients with diabetes include: insulin therapy; use of SUs; low/high HbA1c values; prolonged duration of diabetes; history of coronary artery disease or stroke; advanced age (75–80 years); cognitive impairment or dementia; depression; decreased ADL; renal impairment; liver disease; decreased dietary intake; infections; multi‐drug combination therapy; early”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Hyperglycemia is a risk factor for diabetic microangiopathy, macroangiopathy, infections, mortality, cognitive impairment, decreased ADL, sarcopenia, frailty, and falls/fractures in elderly patients with diabetes.

    “Favorable and appropriate glycemic control should be ensured for elderly patients with diabetes, given that hyperglycemia is a risk factor for diabetic microangiopathy, macroangiopathy, infections (see VII‐CQ‐2), mortality, cognitive impairment (see V‐CQ‐1), decreased ADL, sarcopenia, frailty, and falls/fractures (see VI‐CQ‐1) in elderly patients with diabetes (grade A).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Various risk factors have been identified for type 2 diabetes, and a risk model (risk scores) is currently being developed for type 2 diabetes in Japanese.

    “Various risk factors have been identified for type 2 diabetes, and a risk model (risk scores) is currently being developed for type 2 diabetes in Japanese 1 , 2 , 3 .”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Kosaka K, Akanuma Y, Goto Y, et al. Report of Committee on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1982;25:859–66 (in Japanese).

      Not checked in the free run.

    • cites [2] World Health Organization. Report of a WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization Department of Noncommunicable Disease Surveillance. 1999. http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm.

      Not checked in the free run.

    • cites [3] Kuzuya T, Nakagawa S, Satoh J, et al. Report of the Committee of Japan Diabetes Society on the classification and diagnostic criteria of diabetes mellitus. J Jpn Diabetes Soc. 1999;42:385–404 (in Japanese).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is a negative dose-response relationship between physical activity level and risk of type 2 diabetes, while overexercise is not associated with the risk of type 2 diabetes.

    “There is a negative dose‐response relationship between physical activity level and risk of type 2 diabetes, while overexercise is not associated with the risk of type 2 diabetes 12 , 13 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Look ARG, Gregg EW, Jakicic JM, et al. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2016;4:913–21. source

      Not checked in the free run.

    • cites [13] Sone H, Tanaka S, Tanaka S, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448–56. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Not only aerobic exercise but muscle training is associated with a reduced risk of type 2 diabetes, with their combination markedly decreasing the risk further.

    “Not only aerobic exercise but muscle training is associated with a reduced risk of type 2 diabetes, with their combination shown to markedly decrease the risk further 14 , 15 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] Ueki K, Sasako T, Okazaki Y, Group JDS, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5:951–64. source

      Not checked in the free run.

    • cites [15] Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Overweight during childhood to early adulthood increases the future risk of type 2 diabetes, with overweight during early adulthood particularly important.

    “Overweight during childhood to early adulthood is shown to increase the future risk of type 2 diabetes. Overweight during early adulthood is particularly important 7 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Kawasaki E, Maruyama T, Imagawa A, et al. Diagnostic criteria for acute-onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus. Diabetol Int. 2012;2013(4):221. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both short and long sleeping hours are associated with an increased risk of type 2 diabetes.

    “Sleeping hours are associated with the risk of type 2 diabetes. Both short and long sleeping hours are associated with an increased risk 29 , 30 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [29] Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001. source

      Not checked in the free run.

    • cites [30] Bazzano LA, Li TY, Joshipura KJ, et al. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care. 2008;31:1311–7. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mental stress and depressive tendencies are associated with an increased risk of diabetes.

    “Mental stress 32 and depressive tendencies (depression) 33 , 34 are associated with an increased risk of diabetes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [32] Pedersen AN, Kondrup J, Børsheim E. Health effects of protein intake in healthy adults: a systematic literature review. Food Nutr Res. 2013;57:21245. source

      Not checked in the free run.

    • cites [33] Guasch-Ferré M, Becerra-Tomás N, Ruiz-Canela M, et al. Total and subtypes of dietary fat intake and risk of type 2 diabetes mellitus in the Prevencio´ n con Dieta Mediterra´ nea (PREDIMED) study. Am J Clin Nutr. 2017;105:723–35. source

      Not checked in the free run.

    • cites [34] Tobias DK, Chen M, Hu FB, et al. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3:968–79. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Biguanides, alpha-glucosidase inhibitors, thiazolidinediones, basal insulin formulations, and GLP-1 receptor agonists have inhibitory effects on the onset of type 2 diabetes.

    “Biguanides 45 , α‐glucosidase inhibitors 46 , 47 , 48 , thiazolidinediones (TZDs) 49 , basal insulin formulations 50 , and GLP‐1 receptor agonists (GLP‐1RA) 51 are shown to have inhibitory effects on the onset of type 2 diabetes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [45] Schwingshackl L, Missbach B, Dias S, et al. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia. 2014;57:1789–97 [level 1+] source

      Not checked in the free run.

    • cites [46] Figueira FR, Umpierre D, Cureau FV, et al. Association between physical activity advice only or structured exercise training with blood pressure levels in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med. 2014;44:1557–72 [level 1+] source

      Not checked in the free run.

    • cites [47] Boulé NG, Kenny GP, Haddad E, et al. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus. Diabetologia. 2003;46:1071–81 (level 1+) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Intake of dietary fibers and dietary magnesium is associated with a reduced risk of type 2 diabetes.

    “Intake of dietary fibers 20 , 21 and dietary magnesium 20 , 22 , 23 is associated with a reduced risk of type 2 diabetes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Huang XL, Pan JH, Chen D, et al. Efficacy of lifestyle interventions in patients with type 2 diabetes: , systematic review and meta-analysis. Eur J Intern Med. 2016;27:37–47 [level 1] source

      Not checked in the free run.

    • cites [21] Zhang X, Devlin HM, Smith B, et al. Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. PLoS One. 2017;12:e0176436 [level 1] source

      Not checked in the free run.

    • cites [22] Franz MJ, Boucher JL, Rutten-Ramos S, et al. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115:1447–63 [level 1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Statins are associated with an increased risk of type 2 diabetes, but this disadvantage does not outweigh the benefits of their cardiovascular event-inhibitory effects.

    “While statins are shown to be associated with an increased risk of type 2 diabetes 54 , this disadvantage does not outweigh the benefits of their cardiovascular event‐inhibitory effects 54 , 55 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [54] Tonoli C, Heyman E, Roelands B, et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med. 2012;42:1059–80 [level 2] source

      Not checked in the free run.

    • cites [55] Kennedy A, Nirantharakumar K, Chimen M, et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS One. 2013;8:e58861 [level 2] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Decreased quality of sleep and excessive daytime naps are associated with an increased risk of type 2 diabetes.

    “Decreased quality of sleep 30 and excessive daytime naps 31 are associated with an increased risk of type 2 diabetes.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [30] Bazzano LA, Li TY, Joshipura KJ, et al. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care. 2008;31:1311–7. source

      Not checked in the free run.

    • cites [31] Halbesma N, Bakker SJ, Jansen DF, et al. High protein intake associates with cardiovascular events but not with loss of renal function. J Am Soc Nephrol. 2009;20:1797–804. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smoking cessation is temporarily associated with increased risk of diabetes due to weight gain, but is associated with a decreased risk of diabetes over the long term.

    “Smoking cessation is temporarily associated with increased risk of diabetes due to associated weight gain, but is associated with a decreased risk of diabetes over the long term 28 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Noto H, Goto A, Tsujimoto T, et al. Long-term low-carbohydrate diets and type 2 diabetes risk: a systematic review and meta-analysis of observational studies. J Gen Fam Med. 2016;17:60–70. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors decrease, and thiazide diuretics increase, the risk of type 2 diabetes.

    “It is shown that angiotensin II receptor blockers (ARBs) and angiotensin‐converting enzyme (ACE) inhibitors decrease, and thiazide diuretics increase, the risk of type 2 diabetes 52 , 53 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [52] Ostman C, Jewiss D, King N, et al. Clinical outcomes to exercise training in Type 1 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;139:380–91 [level 2] source

      Not checked in the free run.

    • cites [53] Yardley JE, Hay J, Abou-Setta AM, et al. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014;106:393–400 [level 2] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Lifestyle intervention focused on dietary and/or exercise modification delays the onset of type 2 diabetes, with effects lasting after completion of the intervention.

    “Lifestyle intervention focused on dietary and/or exercise modification is shown to delay the onset of type 2 diabetes 8 , 9 , 10 , with its effects shown to last even after completion of the intervention 42 , 43 , 44 (grade A: 100% agreement).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Tanaka S, Ohmori M, Awata T, et al. Erratum to: Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) (2012): report by the Committee on Slowly Progressive Insulin-Dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society. Diabetol Int. 2012;2015(6):149.

      Not checked in the free run.

    • cites [9] Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: New Diagnostic Criteria of Fulminant Type 1 Diabetes Mellitus (2012). Diabetol Int. 2012;3:179–83. source

      Not checked in the free run.

    • cites [10] United Kingdom 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. source

      Not checked in the free run.

72 of 72

  • The paper relies on this without support.

    The BMI value least associated with all-cause mortality varies with age and falls within a certain range.

    “Given that the body mass index (BMI) value least associated with all‐cause mortality is expected to vary with age and fall within a certain range, the target body weight is to be calculated for each patient by the following formula:”

  • The paper relies on this without support.

    Insulin has a wide-ranging action affecting not only glucose metabolism but lipid and protein metabolism, all of which are closely linked.

    “Given that insulin is shown to have a wide‐ranging action affecting not only glucose metabolism but lipid and protein metabolism, all of which are closely linked, energy‐producing nutrients as components of MNT must be assessed for their balance and validity against each patient’s disease condition, as well as associated risks including hyperglycemia.”

  • The paper relies on this without support.

    The treatment strategy for diabetes varies depending on disease type, disease condition, patient age, metabolic abnormalities, and status of diabetic complications.

    “The treatment strategy for diabetes may vary depending on the disease type, disease condition, patient age, metabolic abnormalities, and status of diabetic complications.”

  • The paper relies on this without support.

    Obesity is associated with abnormal eating behavior, such as speed eating, impulse eating, and eating between meals from post-lunch to nighttime, which can be problematic in many patients with type 2 diabetes and obesity.

    “Obesity is associated with abnormal eating behavior, such as speed eating characterized by an excessive intake of energy over a short time, impulse eating, and eating between meals from post‐lunch to nighttime, can be problematic in many of these patients.”

  • The paper relies on this without support.

    Behavioral enhancement through routine motivation measures is effective in maintaining desired behavioral changes.

    “Behavioral enhancement through routine motivation measures is thought to be effective in maintaining desired behavioral changes.”

  • The paper relies on this without support.

    SGLT2 inhibitor is associated with a weight loss of about 3 kg in obese patients with type 2 diabetes.

    “SGLT2 inhibitor is shown to be associated with a weight loss of about 3 kg in obese patients with type 2 diabetes.”

  • The paper relies on this without support.

    Concomitant hypertension in patients with diabetes is a risk factor for microangiopathy, such as diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy.

    “Concomitant hypertension in patients with diabetes is a risk factor for microangiopathy, such as diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy (see also relevant pages for diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy).”

  • The paper relies on this without support.

    Hypoglycemia is likely to be associated with cognitive impairment.

    “Hypoglycemia is likely to be associated with cognitive impairment.”

  • The paper relies on this without support.

    Hypoglycemia may not be recognized in patients below 6–7 years of age and may therefore become severe.

    “Hypoglycemia may not be recognized in patients below 6–7 years of age and may therefore become severe.”

  • The paper relies on this without support.

    Persistent hyperglycemia is associated with cognitive impairment.

    “It is also to be noted that persistent hyperglycemia is associated with cognitive impairment.”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Slowly progressive type 1 diabetes is described both with and without ketosis at onset

    Major

    The text says patients with slowly progressive type 1 diabetes do not develop ketosis or ketoacidosis, but Table 4 says they are expected to present with ketosis or ketoacidosis at disease onset or diagnosis. This changes the stated diagnostic presentation.

  • Visceral fat area threshold uses conflicting area units

    Minor

    The diagnostic threshold for visceral fat area is given as 100 cm2 in Q14‐2 but as 100 m2 in Q14‐7. These units differ by a factor of 10,000 for the same stated threshold.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. Kaku K, Tajima N, Kawamori R, et al. Melbin Observational Research (MORE) study of metformin therapy in patients with type 2 diabetes mellitus. J Jpn Diabetes Soc. 2006;49:325–31 (in Japanese).
  2. Iwakura T, Fujimoto K, Tahara Y, et al. A case of severe hypoglycemia induced by sitagliptin added to ongoing glimepiride therapy in patients with type 2 diabetes. J Jpn Diabetes Soc. 2010;53:505–8 (in Japanese).
  3. Han A, Katoh S, Nemoto M, et al. Effect of combination therapy of premixtured 50 R and voglibose in patients with type 2 diabetes. J Jpn Diabetes Soc. 2004;47:137–40 (in Japanese).
  4. Diabetes Control Complications Trial Research Group, Nathan DM, Genuth S, et al. 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;329:977–86 [level 1] · DOI · Paper page
  5. 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;329:977–86 [level 1] · DOI · Paper page
  6. United Kingdom 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;352:837–53 [level 1] · DOI · Paper page
  7. Diabetes C, Complications Trial Research G, Nathan DM, et al. 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;329:977–86 [level 1] · DOI · Paper page
  8. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–53 [level 1] · DOI · Paper page
  9. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103–17 [level 1] · DOI · Paper page
  10. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary, P et al. 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;329:977–86 [level 1] · DOI · Paper page
  11. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103–17 [level 2] · DOI · Paper page
  12. Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376:419–30 [level 1] · DOI · Paper page
  13. Stratton IM, Adler A, Meil HAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. 2000;321:405–2 [level 2] · DOI · Paper page
  14. Ueki K, Sasako T, Okazaki Y, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5:951–64. · DOI · Paper page
  15. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405–12 [level 2] · DOI · Paper page
  16. Matsuzawa Y, Sakata T, Ikeda Y, et al. Guidelines for the management of obesity disease. 2006;2006:1–91 (in Japanese).
  17. Saito Y, Shirai A, Nakamura M, et al. Diagnostic criteria for obesity disease. 2011;2011:1–78 (in Japanese).
  18. Ueki K, Sasako T, Okazaki Y, Kato M, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endcrinol. 2017;5:951–64 [level 1]
  19. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–860 [level 1] · DOI · Paper page
  20. Huang XL, Pan JH, Chen D, et al. Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. Eur J Intern Med. 2016;27:37–47 [level 1+] · DOI · Paper page
  21. Hayashino Y, Jackson JL, Fukumori N, et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60 [level 2] · DOI
  22. Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006;CD002968 [level 1+] · DOI · Paper page
  23. Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358:580–91 [level 2] · DOI · Paper page
  24. Ueki K, Sasako T, Okazaki Y, et al.; J-DOIT3 Study Group. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5:951–64 [level 1]
  25. Hiramatsu Y. Workshop “Gestational diabetes mellitus and self monitoring of blood glucose (SMBG)”. Diabetes Pregnancy. 2015;15:89–90 (in Japanese).
  26. Hiramatsu Y, Haneda M, et al. The joint committee with the Japan Society of Diabetes and Pregnancy and the Japan Diabetes Society “An abnormal glucose metabolism during pregnancy and the standardization of its diagnostic criteria.”. J Jpn Diabetes Soc. 2015;58:801–3 (in Japanese).
  27. Matsuura N, Takeuchi M, Amemiya S, et al. Trial of metformin clinical trial of metformin monotherapy in children and adolescents with type 2 diabetes mellitus in Japan. J Jpn Diabet Soc. 2008;51(5):427–34.
  28. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403. · DOI · Paper page
  29. Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180:32–9. · DOI

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Authors
Araki, E., Goto, A., Kondo, T., Noda, M., Noto, H., Origasa, H., Osawa, H., Taguchi, A., Tanizawa, Y., Tobe, K., & Yoshioka, N.
Affiliations
  • Kumamoto University (JP)
  • Yokohama City University (JP)
  • Kumamoto University Hospital (JP)
  • International University of Health and Welfare Ichikawa Medical Center (JP)
  • St. Luke's International Hospital (JP)
  • University of Toyama (JP)
  • Ehime University (JP)
  • Yamaguchi University (JP)
  • NTT Medical Center Sapporo (JP)
Corresponding author
Araki, Eiichi
ORCID
Venue
Diabetology International
Publisher
Springer Science and Business Media LLC
Published
2020-07
Volume
11
Issue
3
Pages
165-223
ISSN
  • 2190-1678 (ISSN-L)
  • 2190-1686
DOI
10.1007/s13340-020-00439-5
PMC
PMC7378414
OpenAlex
W3044697752
Cited by
545
References
451
Citations by year
2026: 27 · 2025: 86 · 2024: 116 · 2023: 123 · 2022: 107 · 2021: 71 · 2020: 11 · 2019: 1 · 2018: 1
FWCI
11.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetology International (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science (18K08482)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes mellitus, diabetes management, glycemic control, diabetes complications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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