The DOI matches its Crossref record; 435 of the 442 references it cites were found in a registry or an index; 14 of the 514 sources its claims cite were checked for support.
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023
Open accessAbstract
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.
Overview
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.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
260 Not checked yet · 19 No basis given · 4 Partly supported · 3 Own interpretation · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Studies have demonstrated that a variety of eating plans, varying in macronutrient composition, can be used effectively and safely in the short term (1-2 years) to achieve weight loss in people with diabetes.”
What the sources say
- Partly supportedcites [106] Lean, 2018, Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial, Lancet sourceExperimental — accuracy not yet measured
The Procedures describe one staged Counterweight-Plus programme, not a variety of eating plans with differing macronutrient compositions. The Results report substantial weight loss at 12 months and mostly mild or moderate adverse events, supporting short-term effectiveness with some safety evidence. This trial does not establish effectiveness or safety across multiple plans or at two years. (LLM, conf=0.88)
- Partly supportedcites [117] Hamdy, 2017, Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study, BMJ Open Diabetes Res Care sourceExperimental — accuracy not yet measured
The Methods (Why WAIT program; page unavailable) describe calorie-restricted meal plans for people with type 2 diabetes, and the Results (page unavailable) report significant weight loss at one year. But the plans followed a common macronutrient prescription; the paper does not establish that plans varying in macronutrient composition are effective and safe over 1–2 years. (LLM, conf=0.87)
- Partly supportedcites [119] Mottalib, 2018, Effects of nutrition therapy on HbA1c and cardiovascular disease risk factors in overweight and obese patients with type 2 diabetes, Nutr J sourceExperimental — accuracy not yet measured
The Results (Table 2) show significant weight loss with two structured eating plans in overweight or obese people with type 2 diabetes, but not with the individualized plan. The Methods and Discussion state that follow-up lasted only 16 weeks, not 1–2 years. The paper also does not establish that a variety of plans differing in macronutrient composition can be used safely; the Results report some withdrawals due to gastrointestinal symptoms thought to be related to the nutrition formula. (LLM, conf=0.88)
- Could not verifycites [120] Estruch, 2018, Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts, N Engl J Med sourceExperimental — accuracy not yet measured
The Discussion (p. 10) reports cardiovascular outcomes over about five years, not short-term weight loss. Although the Participant Selection section (p. 2) includes people with type 2 diabetes and the Adherence section (p. 6) reports no relevant diet-related adverse effects, no passage found evaluates whether varied eating plans safely achieve weight loss in people with diabetes over 1–2 years. (LLM, conf=0.76)
- Partly supportedcites [121] Saslow, 2017, Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes, Nutr Diabetes sourceExperimental — accuracy not yet measured
The Results (Body weight and other health outcomes; page unavailable) report weight loss at 12 months with both diets: 8.3% with the very low-carbohydrate diet and 3.8% with the moderate-carbohydrate diet. But the trial included people with prediabetes as well as type 2 diabetes, followed them for only one year, and does not establish that a variety of eating plans are safe over one to two years; the Discussion notes a temporary LDL-cholesterol increase and uncertainty about longer-term effects. (LLM, conf=0.87)
- Not checked yetcites [122] Yancy, 2019, Comparison of group medical visits combined with intensive weight management vs group medical visits alone for glycemia in patients with type 2 diabetes: a noninferiority randomized clinical trial, JAMA Intern Med
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“There is strong and consistent evidence that modest, sustained weight loss can delay the progression from prediabetes to type 2 diabetes (97-99) (see Section 3, “Prevention or Delay of Type 2 Diabetes and Associated Comorbidities”) and is beneficial for the management of type 2 diabetes (see Section 8, “Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes”).”
What the sources say
- Not checked yetcites [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
- Partly supportedcites [98] Mudaliar, 2016, Cardiometabolic risk factor changes observed in diabetes prevention programs in US settings: a systematic review and meta-analysis, PLoS Med sourceExperimental — accuracy not yet measured
The Introduction describes modest weight loss as a principle of diabetes-prevention programs, and the Conclusion reports one-year improvements in weight and glycemic measures among people at high risk of diabetes. The paper does not establish that sustained weight loss benefits the management of established type 2 diabetes; its Discussion says benefits beyond one year remain largely unknown. (LLM, conf=0.84)
- Could not verifycites [99] Balk, 2015, Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the community preventive services task force combined diet and physical activity promotion programs to prevent diabetes, Ann Intern Med sourceExperimental — accuracy not yet measured
The Methods (Study Selection; page unavailable) explicitly exclude studies of people with established type 2 diabetes. The paper addresses weight loss for diabetes prevention, not whether sustained weight loss benefits management after diagnosis. In the citing sentence, the citations accompany the prevention clause; the management clause instead points to Section 8. (LLM, conf=0.90)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Regular intake of sufficient dietary fiber is associated with lower all-cause mortality in people with diabetes (173,174), and prospective cohort studies have found dietary fiber intake is inversely associated with risk of type 2 diabetes (175-177).”
What the sources say
- Supportedcites [175] Partula, 2020, Associations between consumption of dietary fibers and the risk of cardiovascular diseases, cancers, type 2 diabetes, and mortality in the prospective NutriNet-Santé cohort, Am J Clin Nutr source
The Results section (“Associations between DF intakes and mortality or the risk of chronic diseases”) reports that higher total dietary fiber intake was associated with lower incident type 2 diabetes risk during follow-up. The Discussion also identifies this as a finding from a prospective cohort and says it is consistent with meta-analyses of prospective studies. (LLM, conf=0.94)
- Supportedcites [176] Reynolds, 2019, Carbohydrate quality and human health: a series of systematic reviews and meta-analyses, Lancet source
The Dietary fibre section reports a dose–response relationship between total fibre intake and type 2 diabetes incidence in prospective studies. Figure 2c reports a lower risk ratio for every additional 8 grams of fibre consumed per day, supporting the stated inverse association. (LLM, conf=0.94)
- Partly supportedcites [177] Hu, 2020, Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies, BMJ sourceExperimental — accuracy not yet measured
The Introduction and Abstract Conclusion report an inverse association between whole-grain consumption and type 2 diabetes risk in prospective cohorts. The paper notes that whole grains contain dietary fiber, but it does not establish the claimed association for dietary fiber intake itself; whole-grain intake is a different exposure. No page numbers were provided in our copy. (LLM, conf=0.83)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Health behavior change strategies may be delivered by mental health professionals, DCES, or other trained health care professionals (307,312-314) or qualified community health workers (307,308).”
What the sources say
- Supportedcites [307] Rosales, 2021, Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial, Int J Epidemiol source
The citation attached to the community-health-worker portion is supported by the Intervention group section: community health workers were among the personnel who delivered the behaviour-change sessions. This paper need not establish the separately cited claims about mental health professionals or DCES. (LLM, conf=0.90)
- Partly supportedcites [312] Nicolucci, 2022, Effect of a behavioural intervention for adoption and maintenance of a physically active lifestyle on psychological well-being and quality of life in patients with type 2 diabetes: the IDES_2 randomized clinical trial, Sports Med sourceExperimental — accuracy not yet measured
The Methods > Intervention passage (page unavailable) says a diabetologist and a certified exercise specialist delivered the counselling, supporting delivery by trained health care professionals. It does not establish delivery by mental health professionals or DCES. The citing sentence attributes the community-health-worker option to different citations, so that option is not assessed here. (LLM, conf=0.84)
- Partly supportedcites [313] Crowley, 2022, Effect of a comprehensive telehealth intervention vs telemonitoring and care coordination in patients with persistently poor type 2 diabetes control: a randomized clinical trial, JAMA Intern Med sourceExperimental — accuracy not yet measured
The Methods > Interventions section (page unavailable) describes nurses who received training and delivered self-management, diet/activity, and depression-support components, with support from a psychiatrist. It does not identify DCES or community health workers as deliverers, so it supports only part of the list. (LLM, conf=0.86)
- Not checked yetcites [314] Kichler, 2015, Contemporary roles of the pediatric psychologist in diabetes care, Curr Diabetes Rev source
- Supportedcites [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
The citation supports the community-health-worker portion of the sentence. In “Intervention and controls,” the paper reports that trained CHWs delivered the intervention and used motivational interviewing, goal setting, and strategies for overcoming barriers to behavioral change. (LLM, conf=0.93)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
None of the sources cited for this claim have been checked yet.
In the paper
“in response to the growing body of evidence that associates potentially judgmental words with increased feelings of shame and guilt”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Digital coaching and digital selfmanagement interventions can be effective methods to deliver diabetes self-management education and support.B”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
In the paper
“Furthermore, following a DSMES curriculum improves quality of care (11).”
What the sources say
- Not checked yetcites [11] Brunisholz, 2014, Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure, J Multidiscip Healthc source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“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.”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [27] Robbins, 2008, Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study, Diabetes Care source
- Not checked yetcites [28] Duncan, 2011, Assessing the value of the diabetes educator, Diabetes Educ source
- Not checked yetcites [29] Strawbridge, 2017, One-year outcomes of diabetes self-management training among medicare beneficiaries newly diagnosed with diabetes, Med Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 27
- It may state two separate claims as one. 65
None of the sources cited for this claim have been checked yet.
In the paper
“Building positive health behaviors and maintaining psychological well-being are foundational for achieving diabetes treatment goals and maximizing quality of life (1,2).”
What the sources say
- Not checked yetcites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Reimbursement by third-party payers is recommended C because diabetes self-management education and support can improve outcomes and reduce costs.B”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [30] Johnson, 2010, Associations between self-management education and comprehensive diabetes clinical care, Diabetes Spectr source
- Not checked yetcites [65] Isaacs, 2020, Technology integration: the role of the diabetes care and education specialist in practice, Diabetes Educ source
- Not checked yetcites [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
- Not checked yetcites [67] Greenwood, 2021, A new taxonomy for technology-enabled diabetes self-management interventions: results of an umbrella review, J Diabetes Sci Technol source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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).”
What the sources say
- Not checked yetcites [81] Horigan, 2016, Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review, Diabet Med
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
What the sources say
- Not checked yetcites [43] Davis, 2022, 2022 National standards for diabetes self-management education and support, Diabetes Care source
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [115] Lipman, 2013, Increasing incidence of type 1 diabetes in youth: twenty years of the Philadelphia Pediatric Diabetes Registry, Diabetes Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [109] Garvey, 2021, Long-term health benefits of intensive lifestyle intervention in the Look AHEAD study, Obesity (Silver Spring) source
- Not checked yetcites [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
- Not checked yetcites [111] Jastreboff, 2022, Tirzepatide once weekly for the treatment of obesity, N Engl J Med source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [139] Snorgaard, 2017, Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes, BMJ Open Diabetes Res Care source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There may be evidence of harm for certain individuals with b carotene supplementation.B”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Efforts to modify habitual eating patterns are often unsuccessful in the long term; people generally go back to their usual macronutrient distribution (97).”
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“A few studies have extended up to 52 weeks and show similar findings (152-155).”
What the sources say
- Not checked yetcites [152] Liu, 2022, Calorie restriction with or without time-restricted eating in weight loss, N Engl J Med source
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [158] Zafar, 2019, Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis, Am J Clin Nutr source
- Not checked yetcites [159] Wheeler, 2012, Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [125] Korsmo-Haugen, 2019, Carbohydrate quantity in the dietary management of type 2 diabetes: a systematic review and meta-analysis, Diabetes Obes Metab source
- Not checked yetcites [126] Sacks, 2009, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, N Engl J Med source
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“However, the ketogenic plan led to a greater decrease in triglycerides (168) but also a greater increase in LDL cholesterol.”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source
- Not checked yetcites [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
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of carbohydrate and/or what is absent from the diet may contribute to confounding results.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [139] Snorgaard, 2017, Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes, BMJ Open Diabetes Res Care source
- Not checked yetcites [161] Thomas, 2009, Low glycaemic index, or low glycaemic load, diets for diabetes mellitus, Cochrane Database Syst Rev
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [170] Blau, 2017, Ketoacidosis associated with SGLT2 inhibitor treatment: analysis of FAERS data, Diabetes Metab Res Rev source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [197] Pan, 2008, Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials, Am J Clin Nutr source
- Not checked yetcites [198] Robertson, 2007, Protein restriction for diabetic renal disease, Cochrane Database Syst Rev
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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 yetcites [195] Tuttle, 2014, Diabetic kidney disease: a report from an ADA Consensus Conference, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [196] Ley, 2014, Prevention and management of type 2 diabetes: dietary components and nutritional strategies, Lancet source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“b-Carotene was significantly associated with increased lung cancer and cardiovascular mortality risk (219).”
What the sources say
- Not checked yetcites [219] Mangione, 2022, Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement, JAMA source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [218] Aroda, 2016, Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study, J Clin Endocrinol Metab source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
- Not checked yetcites [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
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [203] Brehm, 2009, One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes, Diabetes Care source
- Not checked yetcites [204] Shai, 2008, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, N Engl J Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [70] Evert, 2019, Nutrition therapy for adults with diabetes or prediabetes: a consensus report, Diabetes Care source
- Not checked yetcites [222] Mozaffarian, 2016, Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review, Circulation source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Exercise has been shown to improve blood glucose levels, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being (240).”
What the sources say
- Not checked yetcites [240] 2018 Physical Activity Guidelines Advisory Committee, 2018
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [243] Bootwong, 2022, The effects of text messages for promoting physical activities in prediabetes: a randomized controlled trial, Telemed J E Health
plaindirectn = 324- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [249] Boulé, 2003, Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus, Diabetologia source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [265] Wang, 2019, Leisure-time running reduces the risk of incident type 2 diabetes, Am J Med source
- Not checked yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Many individuals with type 2 diabetes do not meet the recommended exercise level per week (150 min).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plaindirectn = 1,366- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [252] Colberg, 2016, Physical activity/exercise and diabetes: a position statement of the American Diabetes Association, Diabetes Care source
- Not checked yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Cardiovascular autonomic neuropathy is also an independent risk factor for cardiovascular death and silent myocardial ischemia (278).”
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Given associations with glycemic outcomes and risk for future complications (298,299)”
What the sources say
- Not checked yetcites [298] Hood, 2009, Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis, Pediatrics source
- Not checked yetcites [299] Asche, 2011, A review of diabetes treatment adherence and the association with clinical and economic outcomes, Clin Ther source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [304] Powell, 2014, Motivational interviewing to promote adherence behaviors in pediatric type 1 diabetes, Curr Diab Rep source
- Not checked yetcites [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
- Not checked yetcites [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 yetcites [307] Rosales, 2021, Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial, Int J Epidemiol source
- Not checked yetcites [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 yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [274] Colberg, 2013 source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Data show tobacco use is higher among adults with chronic conditions (280) as well as in adolescents and young adults with diabetes (281).”
What the sources say
- Not checked yetcites [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
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [282] Śliwińska-Mossoń, 2017, The impact of smoking on the development of diabetes and its complications, Diab Vasc Dis Res source
- Not checked yetcites [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
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Standardized, validated, age-appropriate tools for psychosocial monitoring and screening can also be used (1).”
What the sources say
- Not checked yetcites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“cost analyses have shown that behavioral health interventions are both effective and cost-efficient approaches to the prevention of diabetes (335).”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [43] Davis, 2022, 2022 National standards for diabetes self-management education and support, Diabetes Care source
- Not checked yetcites [318] Anderson, 2002, Anxiety and poor glycemic control: a meta-analytic review of the literature, Int J Psychiatry Med source
- Not checked yetcites [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 yetcites [320] Anderson, 2001, The prevalence of comorbid depression in adults with diabetes: a meta-analysis, Diabetes Care source
- Not checked yetcites [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 yetcites [322] Ducat, 2014, The mental health comorbidities of diabetes, JAMA source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There was a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes.”
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [374] Li, 2008, Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System, Diabet Med source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [362] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [5] Fisher, 2013, REDEEM: a pragmatic trial to reduce diabetes distress, Diabetes Care source
- Not checked yetcites [358] Fisher, 2012, When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale, Diabetes Care source
- Not checked yetcites [362] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“While it shares some features with depression, diabetes distress is distinct and has unique relationships with glycemic and other outcomes (359,361).”
What the sources say
- Not checked yetcites [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 yetcites [361] Wasserman, 2021, Profiles of depressive symptoms and diabetes distress in preadolescents with type 1 diabetes, Can J Diabetes source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Diabetes distress is also associated with symptoms of anxiety, depression, and reduced health-related quality of life (363).”
What the sources say
- Not checked yetcites [363] Liu, 2020, Anxiety and depression in diabetes care: longitudinal associations with health-related quality of life, Sci Rep source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“General anxiety is a predictor of injection-related anxiety and is associated with fear of hypoglycemia (376,379).”
What the sources say
- Not checked yetcites [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 yetcites [379] Mitsonis, 2009, P01-138 Clinical implications of anxiety in diabetes: a critical review of the evidence base, Eur Psychiatry source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Fear of hypoglycemia and hypoglycemia unawareness often co-occur, so interventions aimed at treating one often benefit both (381).”
What the sources say
- Not checked yetcites [381] Yeoh, 2015, Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis, Diabetes Care source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Other common sources of diabetes-related anxiety include not meeting blood glucose targets (373), insulin injections or infusion (377), and onset of complications (1).”
What the sources say
- Not checked yetcites [373] Smith, 2013, Association of diabetes with anxiety: a systematic review and meta-analysis, J Psychosom Res source
- Not checked yetcites [377] Zambanini, 1999, Injection related anxiety in insulin-treated diabetes, Diabetes Res Clin Pract source
- Not checked yetcites [1] Young-Hyman, 2016, Psychosocial care for people with diabetes: a position statement of the American Diabetes Association, Diabetes Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“DSMES has been shown to reduce diabetes distress (5) and may also benefit A1C when combined with peer support (367).”
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“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.”
What the sources say
- Not checked yetcites [413] van Bloemendaal, 2014, GLP-1 receptor activation modulates appetite- and reward-related brain areas in humans, Diabetes source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [422] Biessels, 2020, Cognitive dysfunction in diabetes: how to implement emerging guidelines, Diabetologia source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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 yetcites [392] Katon, 2004, The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression, Arch Gen Psychiatry source
- Not checked yetcites [394] Atlantis, 2014, Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis, BMJ Open source
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [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 yetcites [403] Goebel-Fabbri, 2008, Insulin restriction and associated morbidity and mortality in women with type 1 diabetes, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Physical activity interventions also demonstrate benefits for depressive symptoms and A1C (398).”
What the sources say
- Not checked yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Episodes of severe hypoglycemia are independently associated with decline, as well as the more immediate symptoms of mental confusion (428).”
What the sources say
- Not checked yetcites [428] Feinkohl, 2014, Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study, Diabetes Care source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [436] Reutrakul, 2016, Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis, Sleep Med source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [444] Carreon, 2022, ‘I don’t sleep through the night’: qualitative study of sleep in type 1 diabetes, Diabet Med source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [444] Carreon, 2022, ‘I don’t sleep through the night’: qualitative study of sleep in type 1 diabetes, Diabet Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [442] Ogilvie, 2018, The epidemiology of sleep and diabetes, Curr Diab Rep source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [439] Schipper, 2021, Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature, Diabetologia source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [439] Schipper, 2021, Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature, Diabetologia source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“There is also evidence that sleep extension and pharmacological treatments for sleep can improve sleep outcomes and possibly insulin resistance (443,445).”
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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”
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 cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measured
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973
Janssen, I., & LeBlanc, A. G. (2010) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-7-40 · Cited by 4,829
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000678 · Cited by 4,536
(2019) · doi:10.1161/cir.0000000000000677 · Cited by 4,501
The Prevalence of Comorbid Depression in Adults With Diabetes
Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001) · Diabetes Care · doi:10.2337/diacare.24.6.1069 · Cited by 3,926
Tirzepatide Once Weekly for the Treatment of Obesity
Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2206038 · Cited by 3,838
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1800389 · Cited by 3,616
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018) · Diabetes Care · doi:10.2337/dci18-0033 · Cited by 3,518
Research works printed but not linked: 2
- 2018 Physical Activity Guidelines Advisory Committee, 2018, 2018 Physical Activity Guidelines Advisory Committee Scientific Report
- Peters, 2013, American Diabetes Association/JDRF Type 1 Diabetes Sourcebook
Cited by
Sorted by citations
Artificial intelligence in diabetes management: Advancements, opportunities, and challenges
Guan, Z., Li, H., Liu, R., Cai, C., Liu, Y., Li, J., Wang, X., Huang, S., Wu, L., Liu, D., et al. (2023) · Cell Reports Medicine · doi:10.1016/j.xcrm.2023.101213 · Cited by 287
Gallardo-Gómez, D., Salazar-Martínez, E., Alfonso-Rosa, R. M., Ramos-Munell, J., del Pozo-Cruz, J., del Pozo Cruz, B., & Álvarez-Barbosa, F. (2024) · Diabetes Care · doi:10.2337/dc23-0800 · Cited by 137
Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions
Levi, R., Bleich, S. N., & Seligman, H. K. (2023) · Diabetes Care · doi:10.2337/dci23-0002 · Cited by 127
Kerr, D., Ahn, D., Waki, K., Wang, J., Breznen, B., & Klonoff, D. C. (2024) · Journal of Medical Internet Research · doi:10.2196/55757 · Cited by 101
“They also need assistance in building insights into their daily health-related behaviors and routines [16,17].”
Is ChatGPT an Effective Tool for Providing Dietary Advice?
Ponzo, V., Goitre, I., Favaro, E., Merlo, F. D., Mancino, M. V., Riso, S., & Bo, S. (2024) · Nutrients · doi:10.3390/nu16040469 · Cited by 100
Metadata
- 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
- ElSayed, Nuha A.
- Aleppo, Grazia
- Aroda, Vanita R.
- Bannuru, Raveendhara R.
- Brown, Florence M.
- Bruemmer, Dennis
- Collins, Billy S.
- Hilliard, Marisa E.
- Isaacs, Diana
- Johnson, Eric L.
- Kahan, Scott
- Khunti, Kamlesh
- Lyons, Sarah K.
- Perry, Mary Lou
- Prahalad, Priya
- Pratley, Richard E.
- Seley, Jane Jeffrie
- Stanton, Robert C.
- Young-Hyman, Deborah
- Gabbay, Robert A.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-12-12
- Volume
- 46
- Issue
- Supplement_1
- Pages
- S68-S96
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC9810478
- OpenAlex
- W4311263988
- Semantic Scholar
- d1b8ee5dc0535dd108720c52832f2ab95ba99f34
- Cited by
- 362
- References
- 442
- Citations by year
- 2026: 35 · 2025: 78 · 2024: 146 · 2023: 97
- FWCI
- 11.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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