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  1. American Diabetes Association
Diabetes Care 2019 the 1 last update 06 Jul 2020 Jan; 2019 Jan; 42fasting for diabetics cleanse fatigue (🔥 means) | fasting for diabetics cleanse meal planhow to fasting for diabetics cleanse for (Supplement 1): S81 the 1 last update 06 Jul 2020 --S89. https://doi.org/10.2337/dc19-S008
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Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes 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, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes (15) and is beneficial in the treatment of type 2 diabetes (617). In patients with type 2 diabetes who are overweight or obese, modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications (68). Small studies have demonstrated that in patients with type 2 diabetes and obesity, more extreme dietary energy restriction with very low-calorie diets can reduce A1C to <6.5% (48 mmol/mol) and fasting glucose to <126 mg/dL (7.0 mmol/L) in the absence of pharmacologic therapy or ongoing procedures (10,18,19). Weight loss–induced improvements in glycemia are most likely to occur early in the natural history of type 2 diabetes when obesity-associated insulin resistance has caused reversible β-cell dysfunction but insulin secretory capacity remains relatively preserved (8,11,19,20). The goal of this section is to provide evidence-based recommendations for weight-loss therapy, including diet, behavioral, pharmacologic, and surgical interventions, for obesity management as treatment for hyperglycemia in type 2 diabetes.

ASSESSMENT

Recommendation

  • 8.1 At each patient encounter, BMI should be calculated and documented in the medical record. B

At each routine patient encounter, BMI should be calculated as weight divided by height squared (kg/m2) (21). BMI should be classified to determine the presence of overweight or obesity, discussed with the patient, and documented in the patient record. In Asian Americans, the BMI cutoff points to define overweight and obesity are lower than in other populations (Table 8.1) (22,23). Providers should advise patients who are overweight or obese that, in general, higher BMIs increase the risk of cardiovascular disease and all-cause mortality. Providers should assess each patient’s readiness to achieve weight loss and jointly determine weight-loss goals and intervention strategies. Strategies may include diet, physical activity, behavioral therapy, pharmacologic therapy, and metabolic surgery (Table 8.1). The latter two strategies may be prescribed for carefully selected patients as adjuncts to diet, physical activity, and behavioral therapy.

View this table:
Table 8.1

Treatment options for overweight and obesity in type 2 diabetes

DIET, PHYSICAL ACTIVITY, AND BEHAVIORAL THERAPY

Recommendations

  • 8.2 Diet, physical activity, and behavioral therapy designed to achieve and maintain >5% weight loss should be prescribed for patients with type 2 diabetes who are overweight or obese and ready to achieve weight loss. A

  • 8.3 Such interventions should be high intensity (≥16 sessions in 6 months) and focus on diet, physical activity, and behavioral strategies to achieve a 500750 kcal/day energy deficit. A

  • 8.4 Diets should be individualized, as those that provide for 1 last update 06 Jul 2020 the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. A8.4 Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. A

  • 8.5 For patients who achieve short-term weight-loss goals, long-term (≥1 year) comprehensive weight-maintenance programs should be prescribed. Such programs should provide at least monthly contact and encourage ongoing monitoring of body weight (weekly or more frequently) and/or other self-monitoring strategies, such as tracking intake, steps, etc.; continued consumption of a reduced-calorie diet; and participation in high levels of physical activity (200300 min/week). A

  • 8.6 To achieve weight loss of >5%, short-term (3-month) interventions that use very low-calorie diets (≤800 kcal/day) and total meal replacements may be prescribed for carefully selected patients by trained practitioners in medical care settings with close medical monitoring. To maintain weight loss, such programs must incorporate long-term comprehensive weight-maintenance counseling. B

Among patients with type 2 diabetes who are overweight or obese and have inadequate glycemic, blood pressure, and lipid control and/or other obesity-related medical conditions, lifestyle changes that result in modest and sustained weight loss produce clinically meaningful reductions in blood glucose, A1C, and triglycerides (68). Greater weight loss produces even greater benefits, including reductions in blood pressure, improvements in LDL and HDL cholesterol, and reductions in the need for medications to control blood glucose, blood pressure, and lipids (68,24), and may result in achievement of glycemic goals in the absence of antihyperglycemia agent use in some patients (25).

Look AHEAD Trial

Although the Action for Health in Diabetes (Look AHEAD) trial did not show that an intensive lifestyle intervention reduced cardiovascular events in adults with type 2 diabetes who were overweight or obese (26), it did show the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes. In the Look AHEAD intensive lifestyle intervention group, mean weight loss was 4.7% at 8 years (27). Approximately 50% of intensive lifestyle intervention participants lost and maintained ≥5% and 27% lost and maintained ≥10% of their initial body weight at 8 years (27). Participants randomly assigned to the intensive lifestyle group achieved equivalent risk factor control but required fewer glucose-, blood pressure–, and lipid-lowering medications than those randomly assigned to standard care. Secondary analyses of the Look AHEAD trial and other large cardiovascular outcome studies document other benefits of weight loss in patients with type 2 diabetes, including improvements in mobility, physical and sexual function, and health-related quality of life (28). A post hoc analysis of the Look AHEAD study suggests that heterogeneous treatment effects may have been present. Participants who had moderately or poorly controlled diabetes (A1C ≥6.8% [51 mmol/mol]) as well as both those with well-controlled diabetes (A1C <6.8% [51 mmol/mol]) and good self-reported health were found to have significantly reduced cardiovascular events with intensive lifestyle intervention during follow-up (29).

Lifestyle Interventions

Significant weight loss can be attained with lifestyle programs that achieve a 500750 kcal/day energy deficit, which in most cases is approximately 1,2001,500 kcal/day for women and 1,5001,800 kcal/day for men, adjusted for the individual’s baseline body weight. Weight loss of 3–5% is the minimum necessary for any clinical benefit (21,30). However, weight-loss benefits are progressive; more intensive weight-loss goals (>5%, >7%, >15%, etc.) may be pursued if needed to achieve a healthy weight and if they can be feasibly and safely attained.

These diets may differ in the types of foods they restrict (such as high-fat or high-carbohydrate foods) but are effective if they create the necessary energy deficit (21,3133). Use of meal replacement plans prescribed by trained practitioners, with close patient monitoring, can be beneficial. Within the intensive lifestyle intervention group of the Look AHEAD trial, for example, use of a partial meal replacement plan was associated with improvements in diet quality (34). The diet choice should be based on the patient’s health status and preferences.

fasting for diabetics cleanse vision (🔴 oral medications) | fasting for diabetics cleanse lipidhow to fasting for diabetics cleanse for Intensive the 1 last update 06 Jul 2020 behavioral lifestyle interventions should include ≥16 sessions in 6 months and focus on diet, physical activity, and behavioral strategies to achieve an ∼500750 kcal/day energy deficit. Interventions should be provided by trained interventionists in either individual or group sessions (30).Intensive behavioral lifestyle interventions should include ≥16 sessions in 6 months and focus on diet, physical activity, and behavioral strategies to achieve an ∼500750 kcal/day energy deficit. Interventions should be provided by trained interventionists in either individual or group sessions (30).

Patients with type 2 diabetes who are overweight or obese and have lost weight during the 6-month intensive behavioral lifestyle intervention should be enrolled in long-term (≥1 year) comprehensive weight-loss maintenance programs that provide at least monthly contact with a trained interventionist and focus on ongoing monitoring of body weight (weekly or more frequently) and/or other self-monitoring strategies such as tracking intake, steps, etc.; continued consumption of a reduced-calorie diet; and participation in high levels of physical activity (200300 min/week (35). Some commercial and proprietary weight-loss programs have shown promising weight-loss results (36).

When provided by trained practitioners in medical care settings with close medical monitoring, short-term (3-month) interventions that use very low-calorie diets (defined as ≤800 kcal/day) and total meal replacements may achieve greater short-term weight loss (10%15%) than intensive behavioral lifestyle interventions that typically achieve 5% weight loss. However, weight regain following the cessation of very low-calorie diets is greater than following intensive behavioral lifestyle interventions unless a long-term comprehensive weight-loss maintenance program is provided (37,38).

PHARMACOTHERAPY

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  • fasting for diabetics cleanse reddit (⭐️ kidney) | fasting for diabetics cleanse reddithow to fasting for diabetics cleanse for 8.7 When choosing glucose-lowering medications for overweight or obese patients with type 2 diabetes, consider their effect on weight. E

  • 8.8 Whenever possible, minimize medications for comorbid conditions that are associated with for 1 last update 06 Jul 2020 weight gain. E8.8 Whenever possible, minimize medications for comorbid conditions that are associated with weight gain. E

  • fasting for diabetics cleanse fruit (👍 blood sugar range chart) | fasting for diabetics cleanse carb counthow to fasting for diabetics cleanse for 8.9 Weight-loss medications are effective as adjuncts to diet, physical activity, and behavioral counseling for selected patients with type 2 diabetes and BMI ≥27 kg/m2. Potential benefits must be weighed against the potential risks of the medications. A

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