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5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

Open access
ElSayed, Nuha A., Aleppo, Grazia, Aroda, Vanita R., Bannuru, Raveendhara R., Brown, Florence M., Bruemmer, Dennis, Collins, Billy S., Hilliard, Marisa E. +13 more·2023·Diabetes Care
DOI 10.2337/dc23-s005PMC PMC9810478
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Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

AI snapshot

Written from the paper’s full text.

TL;DR

This ADA Standards of Care section provides clinical practice recommendations for facilitating positive health behaviors and well-being in diabetes, covering DSMES, medical nutrition therapy, physical activity, smoking cessation, behavioral strategies, and psychosocial care. It synthesizes evidence to recommend person-centered care, routine psychosocial screening, and individualized nutrition and activity plans, while noting low DSMES uptake and research gaps.

Key findings

  • DSMES is associated with improved diabetes knowledge and self-care, lower A1C, lower self-reported weight, improved quality of life, reduced all-cause mortality risk, and reduced health care costs; yet only 5–7% of individuals eligible through Medicare or private insurance actually receive it.
  • MNT delivered by an RDN is associated with A1C absolute decreases of 1.0–1.9% for type 1 diabetes and 0.3–2.0% for type 2 diabetes; weight loss goals are 7–10% for preventing progression from prediabetes and at least 5% for overweight/obesity with type 2 diabetes.
  • Physical activity recommendations include 150+ min/week of moderate-to-vigorous aerobic activity for most adults, spread over at least 3 days/week with no more than 2 consecutive days without activity, and 60+ min/day for children/adolescents; structured exercise interventions of at least 8 weeks lower A1C by an average of 0.66% in type 2 diabetes.
  • Diabetes distress prevalence is reported at 18–45%, with 38–48% incidence over 18 months in type 2 diabetes; in DAWN2, 45% reported significant diabetes distress but only 24% reported that their health care teams asked how diabetes affected their lives. Depression affects one in four people with type 1 or type 2 diabetes.

Methods

  • This is the ADA Standards of Care in Diabetes—2023, Section 5, a clinical practice guideline updated annually by the multidisciplinary ADA Professional Practice Committee; detailed methodology and evidence-grading system are referenced to the Introduction and Methodology.
  • The section narratively synthesizes cited literature and expert consensus into recommendations graded A, B, C, or E; no primary data collection, systematic review, or meta-analysis is conducted in this section.

Limitations

  • Stated: there is inadequate research in type 1 diabetes to support one eating pattern over another; there is a paucity of evidence and agreement on nutrition management among children and adolescents with type 1 diabetes; and a significant literature gap remains for young children with type 1 diabetes.
  • Stated: more data are needed to identify optimal long-term meal plans, the optimal degree of carbohydrate restriction, and long-term cardiovascular effects; little outcome data exist on long-term systematic treatment of diabetes distress integrated into routine care.
  • Evident: as a guideline section, the provided text does not report its own search strategy, inclusion criteria, or quality appraisal; many recommendations are expert opinion or grade C/E.

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Integrity signals

Registry

Crossref · 10.2337/dc23-s005

Cites

435 of 435 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 514 cited sources checked · 0 supported · 0 flagged

  • Premisecitation
    § Abstract

    Potentially judgmental words are associated with increased feelings of shame and guilt.

    “in response to the growing body of evidence that associates potentially judgmental words with increased feelings of shame and guilt”
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    • cites [4] Dickinson, 2017, The use of language in diabetes care and education, Diabetes Care source

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    • cites [12] Dickinson, 2017, Building therapeutic relationships: choosing words that put people first, Clin Diabetes source

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    § Abstract

    Digital coaching and digital self-management interventions can be effective methods to deliver diabetes self-management education and support.

    “Digital coaching and digital selfmanagement interventions can be effective methods to deliver diabetes self-management education and support.B”
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  • Premisecitation
    § Abstract

    Following a diabetes self-management education and support curriculum improves quality of care.

    “Furthermore, following a DSMES curriculum improves quality of care (11).”
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    • cites [11] Brunisholz, 2014, Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure, J Multidiscip Healthc source

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  • Premisecitation
    § Abstract

    A randomized controlled trial testing a decision-making education and skill-building program showed that addressing these targets improved health outcomes in a population in need of health care resources.

    “A randomized controlled trial (RCT) testing a decision-making education and skill-building program (10) showed that addressing these targets improved health outcomes in a population in need of health care resources.”
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    • cites [10] Fitzpatrick, 2016, Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) program delivery modalities on clinical and behavioral outcomes in urban African Americans with type 2 diabetes: a randomized trial, Diabetes Care source

      Not checked in the free run.

  • Premisecitation
    § Abstract

    Diabetes self-management education and support is associated with lower self-reported weight.

    “DSMES is associated with improved diabetes knowledge and self-care behaviors (17), lower A1C (17-21), lower selfreported weight (22), improved quality of life (19,23,24), reduced all-cause mortality risk (25), positive coping behaviors (5,26), and reduced health care costs (27)(28)(29).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Steinsbekk, 2012, Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis, BMC Health Serv Res source

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    Premisecitation
    § Abstract

    Building positive health behaviors and maintaining psychological well-being are foundational for achieving diabetes treatment goals and maximizing quality of life.

    “Building positive health behaviors and maintaining psychological well-being are foundational for achieving diabetes treatment goals and maximizing quality of life (1,2).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source

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    • cites [2] Powers, 2020, Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association, Diabetes Care source

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    § Abstract

    Diabetes self-management education and support can improve outcomes and reduce costs.

    “Reimbursement by third-party payers is recommended C because diabetes self-management education and support can improve outcomes and reduce costs.B”
    Quote in the paperNot a substantial claim

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    Premisecitation
    § Abstract

    Health system, programmatic, and payer barriers to diabetes self-management education and support include lack of administrative leadership support, limited numbers of DSMES professionals, not having referral to DSMES services effectively embedded in the health system service structure, and limited reimbursement rates.

    “Health system, programmatic, and payer barriers include lack of administrative leadership support, limited numbers of DSMES professionals, not having referral to DSMES services effectively embedded in the health system service structure, and limited reimbursement rates (82).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] Carey, 2019, Exploring organizational support for the provision of structured self-management education for people with type 2 diabetes: findings from a qualitative study, Diabet Med source

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    Interpretationcitation
    § Abstract

    Incorporating a systematic approach for technology assessment, adoption, and integration into the care plan may help ensure equity in access and standardized application of technology-enabled solutions.

    “Incorporating a systematic approach for technology assessment, adoption, and integration into the care plan may help ensure equity in access and standardized application of technology-enabled solutions (8,30,(65)(66)(67).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [8] Greenwood, 2020, A framework for optimizing technology-enabled diabetes and cardiometabolic care and education: the role of the diabetes care and education specialist, Diabetes Educ source

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    • cites [30] Johnson, 2010, Associations between self-management education and comprehensive diabetes clinical care, Diabetes Spectr source

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    • cites [65] Isaacs, 2020, Technology integration: the role of the diabetes care and education specialist in practice, Diabetes Educ source

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    • cites [66] Scalzo, 2021, From the Association of Diabetes Care & Education Specialists: the role of the diabetes care and education specialist as a champion of technology integration, Sci Diabetes Self Manag Care source

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    • cites [67] Greenwood, 2021, A new taxonomy for technology-enabled diabetes self-management interventions: results of an umbrella review, J Diabetes Sci Technol source

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    Premisecitation
    § Abstract

    Low participation in diabetes self-management education and support may be due to lack of referral or other identified barriers, such as logistical issues (accessibility, timing, costs) and the lack of a perceived benefit.

    “This low participation may be due to lack of referral or other identified barriers, such as logistical issues (accessibility, timing, costs) and the lack of a perceived benefit (81).”
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    • cites [81] Horigan, 2016, Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review, Diabet Med

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    Premisecitation
    § Abstract

    Certification as a diabetes care and education specialist and/or board certification in advanced diabetes management demonstrates an individual's specialized training in and understanding of diabetes management and support.

    “Certification as a DCES (cbdce.org/)and/or board certification in advanced diabetes management (diabeteseducator. org/education/certification/bc_adm) demonstrates an individual's specialized training in and understanding of diabetes management and support (43), and engagement with qualified professionals has been shown to improve disease-related outcomes.”
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    • cites [43] Davis, 2022, 2022 National standards for diabetes self-management education and support, Diabetes Care source

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    § Weight Management

    Diabetes medical nutrition therapy can result in cost savings and improved cardiometabolic outcomes.

    “Because diabetes medical nutrition therapy can result in cost savings B and improved cardiometabolic outcomes A, medical nutrition therapy should be adequately reimbursed by insurance and other payers.E”
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    Premisecitation
    § Weight Management

    Overweight and obesity are increasingly prevalent in people with type 1 diabetes and present clinical challenges regarding diabetes treatment and cardiovascular disease risk factors.

    “Overweight and obesity are also increasingly prevalent in people with type 1 diabetes and present clinical challenges regarding diabetes treatment and CVD risk factors (114,115).”
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    • cites [114] Prinz, 2018, Trajectories of body mass index from childhood to young adulthood among patients with type 1 diabetes—a longitudinal group-based modeling approach based on the DPV Registry, J Pediatr source

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    • cites [115] Lipman, 2013, Increasing incidence of type 1 diabetes in youth: twenty years of the Philadelphia Pediatric Diabetes Registry, Diabetes Care source

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    § Weight Management

    There is no ideal macronutrient pattern for people with diabetes.

    “There is no ideal macronutrient pattern for people with diabetes; meal plans should be individualized while keeping nutrient quality, total calorie, and metabolic goals in mind.E”
    Quote in the paperSubstantial claim

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    Interpretationcitation
    § Reimbursement

    During the COVID-19 pandemic, reimbursement policies were revised, and these changes may provide a new reimbursement paradigm for future provision of diabetes self-management education and support through telehealth channels.

    “During the time of the coronavirus disease 2019 (COVID-19) pandemic, reimbursement policies were revised (professional. diabetes.org/content-page/dsmes-and- mnt-during-covid-19-national-pandemic), and these changes may provide a new reimbursement paradigm for future provision of DSMES through telehealth channels.”
    Quote in the paperNot a substantial claim

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    Premisecitation
    § MEDICAL NUTRITION THERAPY

    After medication is initiated, nutrition therapy continues to be an important component.

    “However, after medication is initiated, nutrition therapy continues to be an important component, and RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan (70,94).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source

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    • cites [94] Davies, 2018, Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care source

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    Interpretationcitation
    § Weight Management

    Newer medications (beyond metabolic surgery) may have potential for sustainability, impact on cardiovascular outcomes, and weight reduction beyond 10-15%.

    “Long-term durability of weight loss remains a challenge; however, newer medications (beyond metabolic surgery) may have potential for sustainability, impact on cardiovascular outcomes, and weight reduction beyond 10-15% (108-111).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [108] Look AHEAD Research Group, 2021, Does lifestyle intervention improve health of adults with overweight/obesity and type 2 diabetes? Findings from the Look AHEAD randomized trial, Obesity (Silver Spring) source

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    • cites [109] Garvey, 2021, Long-term health benefits of intensive lifestyle intervention in the Look AHEAD study, Obesity (Silver Spring) source

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    • cites [110] Davies, 2021, Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial, Lancet source

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    • cites [111] Jastreboff, 2022, Tirzepatide once weekly for the treatment of obesity, N Engl J Med source

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    Premisecitation
    § Carbohydrates

    Monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose management.

    “Studies examining the ideal amount of carbohydrate intake for people with diabetes are inconclusive, although monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose management (156,157).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [156] DAFNE Study Group, 2002, Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial, BMJ source

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    • cites [157] Delahanty, 2009, Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial, Am J Clin Nutr source

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    Interpretationcitation
    § Eating Patterns and Meal Planning

    For individuals with type 2 diabetes not meeting glycemic targets or for whom reducing glucose-lowering drugs is a priority, reducing overall carbohydrate intake with a low- or very-low-carbohydrate eating pattern is a viable option.

    “For individuals with type 2 diabetes not meeting glycemic targets or for whom reducing glucose-lowering drugs is a priority, reducing overall carbohydrate intake with a low-or verylow-carbohydrate eating pattern is a viable option (137-139).”
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    • cites [137] Sainsbury, 2018, Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis, Diabetes Res Clin Pract source

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    • cites [138] van Zuuren, 2018, Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments, Am J Clin Nutr source

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    • cites [139] Snorgaard, 2017, Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes, BMJ Open Diabetes Res Care source

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    § Micronutrients and herbal supplements 5.23

    There may be evidence of harm for certain individuals with beta carotene supplementation.

    “There may be evidence of harm for certain individuals with b carotene supplementation.B”
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    Premisecitation
    § Eating Patterns and Meal Planning

    Efforts to modify habitual eating patterns are often unsuccessful in the long term; people generally go back to their usual macronutrient distribution.

    “Efforts to modify habitual eating patterns are often unsuccessful in the long term; people generally go back to their usual macronutrient distribution (97).”
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    • cites [97] Franz, 2017, Academy of Nutrition and Dietetics Nutrition practice guideline for type 1 and type 2 diabetes in adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process, J Acad Nutr Diet source

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    Premisecitation
    § Eating Patterns and Meal Planning

    A few studies have extended up to 52 weeks and show similar findings on intermittent fasting and weight loss.

    “A few studies have extended up to 52 weeks and show similar findings (152-155).”
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    • cites [152] Liu, 2022, Calorie restriction with or without time-restricted eating in weight loss, N Engl J Med source

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    • cites [153] Trepanowski, 2017, Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial, JAMA Intern Med source

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    • cites [154] Carter, 2018, Effect of intermittent compared with continuous energy restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial, JAMA Netw Open source

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    • cites [155] Overland, 2018, The safety and efficacy of weight loss via intermittent fasting or standard daily energy restriction in adults with type 1 diabetes and overweight or obesity: A pilot study, Obes Med source

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    § Eating Patterns and Meal Planning

    Each form of intermittent fasting produces mild to moderate weight loss (3-8% loss from baseline) over short durations (8-12 weeks) with no significant differences in weight loss when compared with continuous calorie restriction.

    “Each produces mild to moderate weight loss (3-8% loss from baseline) over short durations (8-12 weeks) with no significant differences in weight loss when compared with continuous calorie restriction (148-151).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [148] Jamshed, 2022, Effectiveness of early time-restricted eating for weight loss, fat loss, and cardiometabolic health in adults with obesity: a randomized clinical trial, JAMA Intern Med source

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    • cites [149] Lowe, 2020, Effects of time-restricted eating on weight loss and other metabolic parameters in women and men with overweight and obesity: the TREAT randomized clinical trial, JAMA Intern Med source

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    • cites [150] Gabel, 2018, Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study, Nutr Healthy Aging source

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    • cites [151] Chow, 2020, Time-restricted eating effects on body composition and metabolic measures in humans who are overweight: a feasibility study, Obesity (Silver Spring) source

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    Premisecitation
    § Carbohydrates

    The literature concerning glycemic index and glycemic load in individuals with diabetes is complex, often with varying definitions of low- and high-glycemic-index foods.

    “The literature concerning glycemic index and glycemic load in individuals with diabetes is complex, often with varying definitions of low-and highglycemic-index foods (158,159).”
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    • cites [158] Zafar, 2019, Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis, Am J Clin Nutr source

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    • cites [159] Wheeler, 2012, Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010, Diabetes Care source

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    Premisecitation
    § Carbohydrates

    Systematic reviews and meta-analyses of RCTs found carbohydrate-restricted eating patterns, particularly low carbohydrate (<26% total energy), were effective in reducing A1C in the short term (<6 months), with less difference in eating patterns beyond 1 year.

    “Systematic reviews and meta-analyses of RCTs found carbohydrate-restricted eating patterns, particularly those considered low carbohydrate (<26% total energy), were effective in reducing A1C in the short term (<6 months), with less difference in eating patterns beyond 1 year (125,126,137,138,164).”
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    • cites [125] Korsmo-Haugen, 2019, Carbohydrate quantity in the dietary management of type 2 diabetes: a systematic review and meta-analysis, Diabetes Obes Metab source

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    • cites [126] Sacks, 2009, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, N Engl J Med source

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    • cites [137] Sainsbury, 2018, Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis, Diabetes Res Clin Pract source

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    Interpretationcitation
    § Carbohydrates

    The metabolic response to dietary intervention in type 2 diabetes is complex, and longer-term sustainability and results need better understanding.

    “This systematic review highlights the metabolic complexity of response to dietary intervention in type 2 diabetes as well as the need to better understand longer-term sustainability and results (166).”
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    • cites [166] Jayedi, 2022, Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials, Am J Clin Nutr source

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    Premisecitation
    § Carbohydrates

    The ketogenic plan led to a greater decrease in triglycerides but also a greater increase in LDL cholesterol.

    “However, the ketogenic plan led to a greater decrease in triglycerides (168) but also a greater increase in LDL cholesterol.”
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    • cites [168] Gardner, 2022, Effect of a ketogenic diet versus mediterranean diet on HbA1c in individuals with prediabetes and type 2 diabetes mellitus: the interventional keto-med randomized crossover trial, Am J Clin Nutr source

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    Premisecitation
    § Carbohydrates

    For people with type 2 diabetes, low-carbohydrate and very-low-carbohydrate eating patterns reduce A1C and the need for antihyperglycemic medications.

    “For people with type 2 diabetes, low-carbohydrate and verylow-carbohydrate eating patterns in particular have been found to reduce A1C and the need for antihyperglycemic medications (70,130,143,(163)(164)(165).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source

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    • cites [130] Schwingshackl, 2018, A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus, Eur J Epidemiol source

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    • cites [143] Kirkpatrick, 2019, Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: a scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force, J Clin Lipidol source

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    Premisecitation
    § Carbohydrates

    A systematic review and meta-analysis of RCTs found each 10% decrease in carbohydrate intake had reductions in levels of A1C, fasting plasma glucose, body weight, lipids, and systolic blood pressure at 6 months, but favorable effects diminished and were not maintained at follow-up or at greater than 12 months.

    “A systematic review and metaanalysis of RCTs investigating the dosedependent effect of carbohydrate restriction on metabolic control found each 10% decrease in carbohydrate intake had reductions in levels of A1C, fasting plasma glucose, body weight, lipids, and systolic blood pressure at 6 months, but favorable effects diminished and were not maintained at follow-up or at greater than 12 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [166] Jayedi, 2022, Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials, Am J Clin Nutr source

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    Interpretationnone given
    § Carbohydrates

    The quality of carbohydrate and/or what is absent from the diet may contribute to confounding results.

    “The quality of carbohydrate and/or what is absent from the diet may contribute to confounding results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Carbohydrates

    In a randomized crossover design, a low-carbohydrate ketogenic diet and a low-carbohydrate Mediterranean diet produced metabolic improvements in both diets without significant differences between them.

    “When Gardner et al. (168) tested a low-carbohydrate ketogenic diet and a low-carbohydrate Mediterranean diet, in a randomized crossover design, metabolic improvements were seen in both diets without significant differences between them.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [168] Gardner, 2022, Effect of a ketogenic diet versus mediterranean diet on HbA1c in individuals with prediabetes and type 2 diabetes mellitus: the interventional keto-med randomized crossover trial, Am J Clin Nutr source

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    Premisecitation
    § Carbohydrates

    Part of the challenge in interpreting low-carbohydrate research has been the wide range of definitions for a low-carbohydrate eating plan.

    “Part of the challenge in interpreting low-carbohydrate research has been due to the wide range of definitions for a low-carbohydrate eating plan (139,161).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [139] Snorgaard, 2017, Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes, BMJ Open Diabetes Res Care source

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    • cites [161] Thomas, 2009, Low glycaemic index, or low glycaemic load, diets for diabetes mellitus, Cochrane Database Syst Rev

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    Premisecitation
    § Carbohydrates

    Very-low-carbohydrate eating plans should be used with caution in those taking SGLT2 inhibitors because of the potential risk of ketoacidosis.

    “In addition, verylow-carbohydrate eating plans are not currently recommended for individuals who are pregnant or lactating, children, people who have renal disease, or people with or at risk for disordered eating, and these plans should be used with caution in those taking sodium-glucose cotransporter 2 inhibitors because of the potential risk of ketoacidosis (169,170).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [169] U.S. Food and Drug Administration . FDA revises labels of SGLT2 inhibitors for diabetes to include warnings about too much acid in the blood and serious urinary tract infections. Silver Spring, MD, U.S. Food and Drug Administration. Accessed 30 August 2022. Available from https://www.fda.gov/drugs/drug-safety-and-availability/fda-revises-labels-sglt2-inhibitors-diabetes-include-warnings-about-too-much-acid-blood-and-serious

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    • cites [170] Blau, 2017, Ketoacidosis associated with SGLT2 inhibitor treatment: analysis of FAERS data, Diabetes Metab Res Rev source

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    Premisecitation
    § Carbohydrates

    Dietary fat and protein can impact early and delayed postprandial glycemia, and it appears to have a dose-dependent response.

    “Studies have shown that dietary fat and protein can impact early and delayed postprandial glycemia (184-187), and it appears to have a dose-dependent response (188)(189)(190)(191).”
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    • cites [184] Bell, 2015, Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era, Diabetes Care source

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    • cites [185] Bell, 2016, Optimized mealtime insulin dosing for fat and protein in type 1 diabetes: application of a model-based approach to derive insulin doses for open-loop diabetes management, Diabetes Care source

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    • cites [186] Smart, 2013, Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive, Diabetes Care source

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    Premisecitation
    § Protein

    Reducing dietary protein below the recommended daily allowance of 0.8 g/kg does not alter glycemic measures, cardiovascular risk measures, or the rate at which glomerular filtration rate declines and may increase risk for malnutrition.

    “Reducing the amount of dietary protein below the recommended daily allowance of 0.8 g/kg is not recommended because it does not alter glycemic measures, cardiovascular risk measures, or the rate at which glomerular filtration rate declines and may increase risk for malnutrition (197,198).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [197] Pan, 2008, Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials, Am J Clin Nutr source

      Not checked in the free run.

    • cites [198] Robertson, 2007, Protein restriction for diabetic renal disease, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Protein

    There is no evidence that adjusting the daily level of protein intake (typically 1-1.5 g/kg body wt/day or 15-20% total calories) will improve health, and research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic management or CVD risk.

    “There is no evidence that adjusting the daily level of protein intake (typically 1-1.5 g/kg body wt/day or 15-20% total calories) will improve health, and research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic management or CVD risk (159,195).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [159] Wheeler, 2012, Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010, Diabetes Care source

      Not checked in the free run.

    • cites [195] Tuttle, 2014, Diabetic kidney disease: a report from an ADA Consensus Conference, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Protein

    Some research has found successful management of type 2 diabetes with meal plans including slightly higher levels of protein (20-30%), which may contribute to increased satiety.

    “Some research has found successful management of type 2 diabetes with meal plans including slightly higher levels of protein (20-30%), which may contribute to increased satiety (196).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [196] Ley, 2014, Prevention and management of type 2 diabetes: dietary components and nutritional strategies, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Micronutrients and Supplements

    Beta-carotene was significantly associated with increased lung cancer and cardiovascular mortality risk.

    “b-Carotene was significantly associated with increased lung cancer and cardiovascular mortality risk (219).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [219] Mangione, 2022, Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Micronutrients and Supplements

    Metformin is associated with vitamin B12 deficiency, suggesting that periodic testing of vitamin B12 levels should be considered in people taking metformin, particularly in those with anemia or peripheral neuropathy.

    “Metformin is associated with vitamin B12 deficiency per a report from the Diabetes Prevention Program Outcomes Study (DPPOS), suggesting that periodic testing of vitamin B12 levels should be considered in people taking metformin, particularly in those with anemia or peripheral neuropathy (218).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [218] Aroda, 2016, Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study, J Clin Endocrinol Metab source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss while other research suggests an association with weight gain.

    “There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss (233-235) while other research suggests an association with weight gain (236,237).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [233] Miller, 2014, Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies, Am J Clin Nutr source

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    • cites [234] Rogers, 2016, Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies, Int J Obes source

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    • cites [235] Laviada-Molina, 2020, Effects of nonnutritive sweeteners on body weight and BMI in diverse clinical contexts: systematic review and meta-analysis, Obes Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Fats

    Multiple RCTs including people with type 2 diabetes have reported that a Mediterranean eating pattern can improve both glycemic management and blood lipids.

    “Multiple RCTs including people with type 2 diabetes have reported that a Mediterranean eating pattern (120,203-208) can improve both glycemic management and blood lipids.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [120] Estruch, 2018, Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts, N Engl J Med source

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    • cites [203] Brehm, 2009, One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes, Diabetes Care source

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    • cites [204] Shai, 2008, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Alcohol

    Risks associated with alcohol consumption include hypoglycemia and/or delayed hypoglycemia (particularly for those using insulin or insulin secretagogue therapies), weight gain, and hyperglycemia (for those consuming excessive amounts).

    “Risks associated with alcohol consumption include hypoglycemia and/or delayed hypoglycemia (particularly for those using insulin or insulin secretagogue therapies), weight gain, and hyperglycemia (for those consuming excessive amounts) (70,222).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source

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    • cites [222] Mozaffarian, 2016, Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    Exercise has been shown to improve blood glucose levels, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being.

    “Exercise has been shown to improve blood glucose levels, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being (240).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [240] 2018 Physical Activity Guidelines Advisory Committee, 2018

      Not checked in the free run.

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

    Premisenone given
    § Hypoglycemia

    Hypoglycemia is less common in those who are not treated with insulin or insulin secretagogues, and no routine preventive measures for hypoglycemia are usually advised in these cases.

    “Hypoglycemia is less common in those who are not treated with insulin or insulin secretagogues, and no routine preventive measures for hypoglycemia are usually advised in these cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    Another RCT, including 324 individuals with prediabetes, showed increased physical activity at 8 weeks with supportive text messages, but by 12 weeks there was no difference between groups.

    “Another RCT, including 324 individuals with prediabetes, showed increased physical activity at 8 weeks with supportive text messages, but by 12 weeks there was no difference between groups (243).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [243] Bootwong, 2022, The effects of text messages for promoting physical activities in prediabetes: a randomized controlled trial, Telemed J E Health

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    In adults with type 2 diabetes, higher levels of exercise intensity are associated with greater improvements in A1C and in cardiorespiratory fitness.

    “In adults with type 2 diabetes, higher levels of exercise intensity are associated with greater improvements in A1C and in cardiorespiratory fitness (249); sustained improvements in cardiorespiratory fitness and weight loss have also been associated with a lower risk of heart failure (250).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [249] Boulé, 2003, Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    Increased physical activity (soccer training) has been shown to be beneficial for improving overall fitness in Latino men with obesity, demonstrating feasible methods to increase physical activity in an often hard-to-engage population.

    “Increased physical activity (soccer training) has also been shown to be beneficial for improving overall fitness in Latino men with obesity, demonstrating feasible methods to increase physical activity in an often hard-to-engage population (253).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [253] Frediani, 2020, Physical fitness and activity changes after a 24-week soccer-based adaptation of the U.S diabetes prevention program intervention in Hispanic men, Prog Cardiovasc Dis source

      Not checked in the free run.

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

    Premisenone given
    § Nonnutritive Sweeteners

    Physical activity is as important for those with type 1 diabetes as it is for the general population, but its specific role in the prevention of diabetes complications and the management of blood glucose is not as clear as it is for those with type 2 diabetes.

    “Physical activity is as important for those with type 1 diabetes as it is for the general population, but its specific role in the prevention of diabetes complications and the management of blood glucose is not as clear as it is for those with type 2 diabetes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Physical Activity and Glycemic Management

    For people with type 1 diabetes, although exercise in general is associated with improvement in disease status, care needs to be taken in titrating exercise with respect to glycemic management.

    “For people with type 1 diabetes, although exercise, in general, is associated with improvement in disease status, care needs to be taken in titrating exercise with respect to glycemic management.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Frequency and Type of Physical Activity

    Participating in leisure-time activity and avoiding extended sedentary periods may help prevent type 2 diabetes for those at risk and may also aid in glycemic management for those with diabetes.

    “Participating in leisure-time activity and avoiding extended sedentary periods may help prevent type 2 diabetes for those at risk (265,266) and may also aid in glycemic management for those with diabetes.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [265] Wang, 2019, Leisure-time running reduces the risk of incident type 2 diabetes, Am J Med source

      Not checked in the free run.

    • cites [266] Schellenberg, 2013, Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis, Ann Intern Med source

      Not checked in the free run.

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

    Premisenone given
    § Nonnutritive Sweeteners

    Many individuals with type 2 diabetes do not meet the recommended exercise level per week (150 min).

    “Many individuals with type 2 diabetes do not meet the recommended exercise level per week (150 min).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Nonnutritive Sweeteners

    An RCT in 1,366 individuals with prediabetes combined a physical activity intervention with text messaging and telephone support, which showed improvement in daily step count at 12 months compared with the control group, but this was not sustained at 48 months.

    “An RCT in 1,366 individuals with prediabetes combined a physical activity intervention with text messaging and telephone support, which showed improvement in daily step count at 12 months compared with the control group.Unfortunately, this was not sustained at 48 months (242).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [242] Khunti, 2021, Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT, Health Technol Assess source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Physical Activity and Glycemic Management

    Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes.

    “Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes (252) and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes (271).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [252] Colberg, 2016, Physical activity/exercise and diabetes: a position statement of the American Diabetes Association, Diabetes Care source

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    • cites [271] Church, 2010, Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Autonomic Neuropathy

    Cardiovascular autonomic neuropathy is an independent risk factor for cardiovascular death and silent myocardial ischemia.

    “Cardiovascular autonomic neuropathy is also an independent risk factor for cardiovascular death and silent myocardial ischemia (278).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [278] Pop-Busui, 2010, Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    Health-promoting behaviors are associated with glycemic outcomes and risk for future complications.

    “Given associations with glycemic outcomes and risk for future complications (298,299)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [298] Hood, 2009, Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis, Pediatrics source

      Not checked in the free run.

    • cites [299] Asche, 2011, A review of diabetes treatment adherence and the association with clinical and economic outcomes, Clin Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    Motivational interviewing, patient activation, goal setting and action planning, problem-solving, tracking or self-monitoring health behaviors, and facilitating opportunities for social support are behavioral strategies with empirical support.

    “Behavioral strategies with empirical support include motivational interviewing (303-305), patient activation (306), goal setting and action planning (305,307-309), problem-solving (308,310), tracking or self-monitoring health behaviors with or without feedback from a health care professional (305,307-309), and facilitating opportunities for social support (305,308,309).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [303] Berhe, 2020, Effect of motivational interviewing intervention on HgbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis), PLoS One source

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    • cites [304] Powell, 2014, Motivational interviewing to promote adherence behaviors in pediatric type 1 diabetes, Curr Diab Rep source

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    • cites [305] Liang, 2021, The effectiveness of self-management programmes for people with type 2 diabetes receiving insulin injection: a systematic review and meta-analysis, Int J Clin Pract source

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    • cites [306] Almutairi, 2020, The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs, Prim Care Diabetes source

      Not checked in the free run.

    • cites [307] Rosales, 2021, Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial, Int J Epidemiol source

      Not checked in the free run.

    • cites [308] Gray, 2021, Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial, Transl Behav Med source

      Not checked in the free run.

    • cites [309] Van Rhoon, 2020, A systematic review of the behaviour change techniques and digital features in technology-driven type 2 diabetes prevention interventions, Digit Health source

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  • May combine two claims.

    Premisecitation
    § Diabetic Kidney Disease

    There is no evidence that vigorous-intensity exercise accelerates the rate of progression of DKD, and there appears to be no need for specific exercise restrictions for people with DKD in general.

    “However, there is no evidence that vigorous-intensity exercise accelerates the rate of progression of DKD, and there appears to be no need for specific exercise restrictions for people with DKD in general (274).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [274] Colberg, 2013 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Diabetic Kidney Disease

    Data show tobacco use is higher among adults with chronic conditions as well as in adolescents and young adults with diabetes.

    “Data show tobacco use is higher among adults with chronic conditions (280) as well as in adolescents and young adults with diabetes (281).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [280] Stanton, 2016, Trends in tobacco use among US adults with chronic health conditions: National Survey on Drug Use and Health 2005-2013, Prev Med source

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    • cites [281] Bae, 2013, Differences in cigarette use behaviors by age at the time of diagnosis with diabetes from young adulthood to adulthood: results from the National Longitudinal Study of Adolescent Health, J Prev Med Public Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Diabetic Kidney Disease

    People with diabetes who smoke (and people with diabetes exposed to second-hand smoke) have a heightened risk of CVD, premature death, microvascular complications, and worse glycemic outcomes when compared with those who do not smoke.

    “People with diabetes who smoke (and people with diabetes exposed to second-hand smoke) have a heightened risk of CVD, premature death, microvascular complications, and worse glycemic outcomes when compared with those who do not smoke (282-284).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [282] Śliwińska-Mossoń, 2017, The impact of smoking on the development of diabetes and its complications, Diab Vasc Dis Res source

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    • cites [283] Kar, 2016, Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis, Cardiovasc Diabetol source

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    • cites [284] Pan, 2015, Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: a meta-analysis and systematic review, Circulation source

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

    Premisecitation
    § Screening

    Standardized, validated, age-appropriate tools for psychosocial monitoring and screening can also be used.

    “Standardized, validated, age-appropriate tools for psychosocial monitoring and screening can also be used (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Screening

    Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care, at the time of medical treatment changes, or when problems with achieving A1C goals, quality of life, or self-management are identified.

    “Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care such as from pediatric to adult care teams (341), at the time of medical treatment changes, or when problems with achieving A1C goals, quality of life, or self-management are identif”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [341] Weissberg-Benchell, 2017, A review of interventions aimed at facilitating successful transition planning and transfer to adult care among youth with chronic illness, Pediatr Ann source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    Psychosocial interventions modestly but significantly improve A1C (standardized mean difference -0.29%) and mental health outcomes.

    “A systematic review and meta-analysis showed that psychosocial interventions modestly but significantly improved A1C (standardized mean difference -0.29%) and mental health outcomes (334).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [334] Harkness, 2010, Identifying psychosocial interventions that improve both physical and mental health in patients with diabetes: a systematic review and meta-analysis, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    Behavioral health interventions are both effective and cost-efficient approaches to the prevention of diabetes.

    “cost analyses have shown that behavioral health interventions are both effective and cost-efficient approaches to the prevention of diabetes (335).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [335] Radcliff, 2020, Cost-effectiveness of three doses of a behavioral intervention to prevent or delay type 2 diabetes in rural areas, J Acad Nutr Diet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    Psychological and social problems can impair the individual's or family's ability to carry out diabetes care tasks and potentially compromise health status.

    “Psychological and social problems can impair the individual's (43,(318)(319)(320)(321)(322) or family's (321) ability to carry out diabetes care tasks and, therefore, potentially compromise health status.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [43] Davis, 2022, 2022 National standards for diabetes self-management education and support, Diabetes Care source

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    • cites [318] Anderson, 2002, Anxiety and poor glycemic control: a meta-analytic review of the literature, Int J Psychiatry Med source

      Not checked in the free run.

    • cites [319] Delahanty, 2007, Association of diabetes-related emotional distress with diabetes treatment in primary care patients with type 2 diabetes, Diabet Med source

      Not checked in the free run.

    • cites [320] Anderson, 2001, The prevalence of comorbid depression in adults with diabetes: a meta-analysis, Diabetes Care source

      Not checked in the free run.

    • cites [321] Nicolucci, 2013, Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes, Diabet Med source

      Not checked in the free run.

    • cites [322] Ducat, 2014, The mental health comorbidities of diabetes, JAMA source

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  • May combine two claims.

    Premisecitation
    § SUPPORTING POSITIVE HEALTH BEHAVIORS

    There is a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes.

    “There was a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [334] Harkness, 2010, Identifying psychosocial interventions that improve both physical and mental health in patients with diabetes: a systematic review and meta-analysis, Diabetes Care source

      Not checked in the free run.

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

    Premisecitation
    § Psychological Assessment and Treatment

    Other health care professionals who have been trained in behavioral and mental health interventions may also provide specialized psychosocial care.

    “other health care professionals who have been trained in behavioral and mental health interventions may also provide this specialized psychosocial care (326,329,345,346).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [326] Cho, 2021, Self-management nursing intervention for controlling glucose among diabetes: a systematic review and meta-analysis, Int J Environ Res Public Health source

      Not checked in the free run.

    • cites [329] Phillips, 2021, A multidisciplinary diabetes clinic improves clinical and behavioral outcomes in a primary care setting, J Am Board Fam Med source

      Not checked in the free run.

    • cites [345] Oyedeji, 2022, Effectiveness of non-specialist delivered psychological interventions on glycemic control and mental health problems in individuals with type 2 diabetes: a systematic review and meta-analysis, Int J Ment Health Syst source

      Not checked in the free run.

    • cites [346] Chen, 2020, Effect of a mindfulness programme for long-term care residents with type 2 diabetes: a cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression, Int J Older People Nurs source

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

    Premisecitation
    § Psychological Assessment and Treatment

    The lifetime prevalence of generalized anxiety disorder is estimated to be 19.5% in people with either type 1 or type 2 diabetes.

    “The Behavioral Risk Factor Surveillance System estimated the lifetime prevalence of generalized anxiety disorder to be 19.5% in people with either type 1 or type 2 diabetes (374).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [374] Li, 2008, Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System, Diabet Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    In people with type 1 and type 2 diabetes, mindful self-compassion training increased self-compassion, reduced depression and diabetes distress, and improved A1C.

    “An RCT among people with type 1 and type 2 diabetes found mindful self-compassion training increased self-compassion, reduced depression and diabetes distress, and improved A1C ( 372).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [372] Friis, 2016, Kindness matters: a randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA1c among patients with diabetes, Diabetes Care source

      Not checked in the free run.

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

    Premisecitation
    § Psychological Assessment and Treatment

    The prevalence of diabetes distress is 18-45%, with an incidence of 38-48% over 18 months in people with type 2 diabetes.

    “The prevalence of diabetes distress is reported to be 18-45%, with an incidence of 38-48% over 18 months in people with type 2 diabetes (362).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [362] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    A structured program of blood glucose awareness training delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness.

    “If fear of hypoglycemia is identified and a person does not have symptoms of hypoglycemia, a structured program of blood glucose awareness training delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (382,383).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [382] Cox, 2001, Blood glucose awareness training (BGAT-2): long-term benefits, Diabetes Care source

      Not checked in the free run.

    • cites [383] Gonder-Frederick, 2011, Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    High levels of diabetes distress significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and less optimal eating and exercise behaviors.

    “High levels of diabetes distress significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and less optimal eating and exercise behaviors (5,358,362).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Fisher, 2013, REDEEM: a pragmatic trial to reduce diabetes distress, Diabetes Care source

      Not checked in the free run.

    • cites [358] Fisher, 2012, When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale, Diabetes Care source

      Not checked in the free run.

    • cites [362] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Diabetes distress is distinct from depression and has unique relationships with glycemic and other outcomes.

    “While it shares some features with depression, diabetes distress is distinct and has unique relationships with glycemic and other outcomes (359,361).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [359] Fisher, 2010, The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [361] Wasserman, 2021, Profiles of depressive symptoms and diabetes distress in preadolescents with type 1 diabetes, Can J Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Diabetes distress is associated with symptoms of anxiety, depression, and reduced health-related quality of life.

    “Diabetes distress is also associated with symptoms of anxiety, depression, and reduced health-related quality of life (363).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [363] Liu, 2020, Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life, Sci Rep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    General anxiety is a predictor of injection-related anxiety and is associated with fear of hypoglycemia.

    “General anxiety is a predictor of injection-related anxiety and is associated with fear of hypoglycemia (376,379).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [376] Wild, 2007, A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education, Patient Educ Couns source

      Not checked in the free run.

    • cites [379] Mitsonis, 2009, P01-138 Clinical implications of anxiety in diabetes: a critical review of the evidence base, Eur Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Fear of hypoglycemia and hypoglycemia unawareness often co-occur, and interventions aimed at treating one often benefit both.

    “Fear of hypoglycemia and hypoglycemia unawareness often co-occur, so interventions aimed at treating one often benefit both (381).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [381] Yeoh, 2015, Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Common sources of diabetes-related anxiety include not meeting blood glucose targets, insulin injections or infusion, and onset of complications.

    “Other common sources of diabetes-related anxiety include not meeting blood glucose targets (373), insulin injections or infusion (377), and onset of complications (1).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [373] Smith, 2013, Association of diabetes with anxiety: a systematic review and meta-analysis, J Psychosom Res source

      Not checked in the free run.

    • cites [377] Zambanini, 1999, Injection related anxiety in insulin-treated diabetes, Diabetes Res Clin Pract source

      Not checked in the free run.

    • cites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    DSMES reduces diabetes distress and may also benefit A1C when combined with peer support.

    “DSMES has been shown to reduce diabetes distress (5) and may also benefit A1C when combined with peer support (367).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Fisher, 2013, REDEEM: a pragmatic trial to reduce diabetes distress, Diabetes Care source

      Not checked in the free run.

    • cites [367] Presley, 2020, Mobile-enhanced peer support for African Americans with type 2 diabetes: a randomized controlled trial, J Gen Intern Med source

      Not checked in the free run.

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

    Interpretationnone given
    § Serious Mental Illness

    Disordered thinking and judgment can be expected to make it difficult for people with serious mental illness to engage in behavior that reduces risk factors for type 2 diabetes, such as restrained eating for weight management.

    “Disordered thinking and judgment can be expected to make it difficult to engage in behavior that reduces risk factors for type 2 diabetes, such as restrained eating for weight management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § 5.48 Consider screening for disordered

    Incretin therapies work in the appetite and reward circuitries to modulate food intake and energy balance, reducing uncontrollable hunger, overeating, and bulimic symptoms.

    “Incretin therapies work in the appetite and reward circuitries to modulate food intake and energy balance, reducing uncontrollable hunger, overeating, and bulimic symptoms (413), although mechanisms are not completely understood.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [413] van Bloemendaal, 2014, GLP-1 receptor activation modulates appetite- and reward-related brain areas in humans, Diabetes source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation
    § Cognitive Capacity/Impairment

    Cognitive capacity components (attention, memory, logic and reasoning, and auditory and visual processing) are involved in diabetes self-management behavior.

    “Cognitive capacity is generally defined as attention, memory, logic and reasoning, and auditory and visual processing, all of which are involved in diabetes selfmanagement behavior (422).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [422] Biessels, 2020, Cognitive dysfunction in diabetes: how to implement emerging guidelines, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Trials have shown consistent evidence of improvements in depressive symptoms and variable benefits for A1C when depression is simultaneously treated, whether through pharmacological treatment, group therapy, psychotherapy, or collaborative care.

    “Trials have shown consistent evidence of improvements in depressive symptoms and variable benefits for A1C when depression is simultaneously treated (331,392,394), whether through pharmacological treatment, group therapy, psychotherapy, or collaborative care (328,348,349,395,396).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [331] Ali, 2020, Effect of a collaborative care model on depressive symptoms and glycated hemoglobin, blood pressure, and serum cholesterol among patients with depression and diabetes in India: the INDEPENDENT randomized clinical trial, JAMA source

      Not checked in the free run.

    • cites [392] Katon, 2004, The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [394] Atlantis, 2014, Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis, BMJ Open source

      Not checked in the free run.

    • cites [328] Diaz Bustamante, 2020, Does treatment for depression with collaborative care improve the glycemic levels in diabetic patients with depression? A systematic review, Cureus

      Not checked in the free run.

    • cites [348] Li, 2022, The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis, Diabetes Res Clin Pract source

      Not checked in the free run.

    • cites [349] Vlachou, 2022, Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: an update review of randomized controlled trials, J Diabetes Complications source

      Not checked in the free run.

    • cites [395] van der Feltz-Cornelis, 2021, Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta-analysis, Brain Behav source

      Not checked in the free run.

    • cites [396] Lu, 2021, Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: a meta-analysis of randomized controlled studies, Prim Care Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § 5.48 Consider screening for disordered

    For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior; for people with type 2 diabetes, bingeing is most commonly reported.

    “For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior (402,403); in people with type 2 diabetes, bingeing (excessive food intake with an accompanying sense of loss of control) is most commonly reported.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [402] Pinhas-Hamiel, 2013, Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus, Int J Eat Disord source

      Not checked in the free run.

    • cites [403] Goebel-Fabbri, 2008, Insulin restriction and associated morbidity and mortality in women with type 1 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Psychological Assessment and Treatment

    Physical activity interventions demonstrate benefits for depressive symptoms and A1C.

    “Physical activity interventions also demonstrate benefits for depressive symptoms and A1C (398).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [398] Mohammad Rahimi, 2022, The effect of exercise interventions to improve psychosocial aspects and glycemic control in type 2 diabetic patients: a systematic review and meta-analysis of randomized controlled trials, Biol Res Nurs source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Cognitive Capacity/Impairment

    Episodes of severe hypoglycemia are independently associated with cognitive decline and with more immediate symptoms of mental confusion.

    “Episodes of severe hypoglycemia are independently associated with decline, as well as the more immediate symptoms of mental confusion (428).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [428] Feinkohl, 2014, Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study, Diabetes Care source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    In type 1 diabetes, estimates of poor sleep range from 30% to 50%.

    “In type 1 diabetes, estimates of poor sleep range from 30% to 50% (441), and estimates of moderate to severe obstructive sleep apnea are >50% (436).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [441] Denic-Roberts, 2016, Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study, Diabetes Res Clin Pract source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    In type 1 diabetes, estimates of moderate to severe obstructive sleep apnea are >50%.

    “In type 1 diabetes, estimates of poor sleep range from 30% to 50% (441), and estimates of moderate to severe obstructive sleep apnea are >50% (436).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [436] Reutrakul, 2016, Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis, Sleep Med source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    Technology has been described as both a help and a challenge in relation to sleep for people with diabetes and their family members.

    “People with diabetes and their family members also describe diabetes management needs interfering with sleep and experiencing worries about poor sleep; technology has been described as both a help and challenge in relation to sleep (444).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [444] Carreon, 2022, ‘I don’t sleep through the night’: qualitative study of sleep in type 1 diabetes, Diabet Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Sleep Health

    People with diabetes and their family members describe diabetes management needs interfering with sleep and experiencing worries about poor sleep.

    “People with diabetes and their family members also describe diabetes management needs interfering with sleep and experiencing worries about poor sleep; technology has been described as both a help and challenge in relation to sleep (444).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [444] Carreon, 2022, ‘I don’t sleep through the night’: qualitative study of sleep in type 1 diabetes, Diabet Med source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    In type 2 diabetes, 24-86% of people are estimated to have obstructive sleep apnea.

    “In type 2 diabetes, 24-86% of people are estimated to have obstructive sleep apnea (442), 39% to have insomnia, and 8-45% to have restless leg syndrome (439).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [442] Ogilvie, 2018, The epidemiology of sleep and diabetes, Curr Diab Rep source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    In type 2 diabetes, 8-45% of people are estimated to have restless leg syndrome.

    “In type 2 diabetes, 24-86% of people are estimated to have obstructive sleep apnea (442), 39% to have insomnia, and 8-45% to have restless leg syndrome (439).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [439] Schipper, 2021, Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature, Diabetologia source

      Not checked in the free run.

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

    Premisecitation
    § Sleep Health

    In type 2 diabetes, 39% of people are estimated to have insomnia.

    “In type 2 diabetes, 24-86% of people are estimated to have obstructive sleep apnea (442), 39% to have insomnia, and 8-45% to have restless leg syndrome (439).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [439] Schipper, 2021, Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Sleep Health

    Sleep extension and pharmacological treatments for sleep can improve sleep outcomes and possibly insulin resistance.

    “There is also evidence that sleep extension and pharmacological treatments for sleep can improve sleep outcomes and possibly insulin resistance (443,445).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [443] Tan, 2018, Aiding sleep in type 2 diabetes: therapeutic considerations, Lancet Diabetes Endocrinol source

      Not checked in the free run.

    • cites [445] Kothari, 2021, Sleep interventions and glucose metabolism: systematic review and meta-analysis, Sleep Med source

      Not checked in the free run.

87 of 87

  • The paper relies on this without support.

    Support from institutional leadership is foundational for the success of diabetes self-management education and support services.

    “Support from institutional leadership is foundational for the success of DSMES services.”

  • The paper relies on this without support.

    There is not a one-size-fits-all eating pattern for individuals with diabetes.

    “There is not a “one-size-fits-all” eating pattern for individuals with diabetes, and meal planning should be individualized.”

  • The paper relies on this without support.

    Because of the progressive nature of type 2 diabetes, behavior modification alone may not be adequate to maintain euglycemia over time.

    “Because of the progressive nature of type 2 diabetes, behavior modification alone may not be adequate to maintain euglycemia over time.”

  • The paper relies on this without support.

    Management and reduction of weight is important for people with type 1 diabetes, type 2 diabetes, or prediabetes with overweight or obesity.

    “Management and reduction of weight is important for people with type 1 diabetes, type 2 diabetes, or prediabetes with overweight or obesity.”

  • The paper relies on this without support.

    Disordered eating, eating disorders, and/or disrupted eating can increase challenges for weight and diabetes management.

    “Disordered eating, eating disorders, and/or disrupted eating can increase challenges for weight and diabetes management.”

  • The paper relies on this without support.

    Diabetes self-management education and support is also covered by most health insurance plans.

    “DSMES is also covered by most health insurance plans.”

  • The paper relies on this without support.

    Diabetes self-management education and support is frequently reimbursed when performed in person.

    “DSMES is frequently reimbursed when performed in person.”

  • The paper relies on this without support.

    Ongoing support has been shown to be instrumental for improving outcomes when it is implemented after the completion of education services.

    “Ongoing support has been shown to be instrumental for improving outcomes when it is implemented after the completion of education services.”

  • The paper relies on this without support.

    Psychosocial factors influence living with diabetes, both type 1 and type 2, and achieving optimal health outcomes and psychological well-being.

    “Complex environmental, social, family, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving optimal health outcomes and psychological well-being.”

  • The paper relies on this without support.

    Emotional well-being is an important part of diabetes care and self-management.

    “Emotional well-being is an important part of diabetes care and selfmanagement.”

  • The paper relies on this without support.

    Significant changes in life circumstances and social determinants of health considerably affect a person's ability to self-manage their condition.

    “Significant changes in life circumstances and SDOH are known to considerably affect a person's ability to self-manage their condition.”

  • The paper relies on this without support.

    There is little outcome data on long-term systematic treatment of diabetes distress integrated into routine care.

    “As with treatment of other diabetesassociated behavioral and psychosocial factors affecting disease outcomes, there is little outcome data on long-term systematic treatment of diabetes distress integrated into routine care.”

  • The paper relies on this without support.

    Integrating mental and physical health care can improve outcomes.

    “Integrating mental and physical health care can improve outcomes.”

  • The paper relies on this without support.

    Depressive symptoms may be a manifestation of reduced quality of life secondary to disease burden and resultant changes in resource allocation impacting the person and their family.

    “Depressive symptoms may also be a manifestation of reduced quality of life secondary to disease burden (also see DIABETES DISTRESS, above) and resultant changes in resource allocation impacting the person and their family.”

  • The paper relies on this without support.

    Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.

    “Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.”

  • The paper relies on this without support.

    Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options.

    “Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options.”

  • The paper relies on this without support.

    Cognitive capacity contributes to the ability to benefit from diabetes education.

    “Cognitive capacity also contributes to ability to benefit from diabetes education”
17 of 17

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?

  • The predicted optimal physical activity dose differs from current guidelines' recommendations.

    “In this dose-response meta-analysis we found important differences between our predicted optimal physical activity dose and the current guidelines' recommendations (5,10).”

    From Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis (2024) · cites this paper as [5]

  • The latest guideline recommends ≥150 min/week of MPA to most T2D patients or ≥75 min/week of VPA to patients who are younger and more physically fit.

    “The latest guideline recommends ≥150 min/week of MPA to most T2D patients or ≥75 min/week of VPA to patients who are younger and more physically fit23.”

    From Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes (2024) · cites this paper as [23]

  • These recommendations were primarily made based on evidence from self-reported PA.

    “These recommendations were primarily made based on evidence from self-reported PA, which may be optimized by incorporating evidence from accelerometer-measured PA.”

    From Accelerometer-derived physical activity and mortality in individuals with type 2 diabetes (2024) · cites this paper as [23]

    The Physical Activity recommendations appear in the passage indexed under Nonnutritive Sweeteners (page unavailable), but the passage does not say how the evidence underlying them was measured. The same section cites an accelerometer-measured study; searches for self-reported physical activity and the recommendations’ evidentiary basis found no statement that the evidence was primarily self-reported. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

7 of the 442 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 2018 Physical Activity Guidelines Advisory Committee, 2018, 2018 Physical Activity Guidelines Advisory Committee Scientific Report
  2. Peters, 2013, American Diabetes Association/JDRF Type 1 Diabetes Sourcebook

Cited by

Sorted by citations

Related

Authors
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., Young-Hyman, D., & Gabbay, R. A.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2022-12-12
Volume
46
Issue
Supplement_1
Pages
S68-S96
ISSN
0149-5992 (ISSN-L)
DOI
10.2337/dc23-s005
PMC
PMC9810478
OpenAlex
W4311263988
Semantic Scholar
d1b8ee5dc0535dd108720c52832f2ab95ba99f34
Cited by
362
References
442
Citations by year
2026: 35 · 2025: 78 · 2024: 146 · 2023: 97 · 2016: 5 · 2014: 1
FWCI
11.42
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
diabetes mellitus, health behavior, well-being, health outcomes, clinical guidelines, quality of care, treatment goals, American Diabetes Association standards of care
MeSH terms
Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Health Behavior, Standard of Care

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.

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