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Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study

OBJECTIVE

Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

RESEARCH DESIGN AND METHODS

The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

RESULTS

There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

CONCLUSIONS

The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.




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Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach

OBJECTIVE

To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery.

RESEARCH DESIGN AND METHODS

A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use.

RESULTS

The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient’s data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery.

CONCLUSIONS

The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions.




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Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study

OBJECTIVE

Coronary artery disease (CAD) is a major challenge in patients with type 2 diabetes (T2D). Coronary computed tomography angiography (CCTA) provides a detailed anatomic map of the coronary circulation. Proteomics are increasingly used to improve diagnostic and therapeutic algorithms. We hypothesized that the protein panel is differentially associated with T2D and CAD.

RESEARCH DESIGN AND METHODS

In CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation—a cohort of 528 individuals with no previous cardiovascular event undergoing CCTA), participants were grouped into CAD (clean coronaries) and CAD+ (diffuse lumen narrowing or plaques). Plasma proteins were screened by aptamer analysis. Two-way partial least squares was used to simultaneously rank proteins by diabetes status and CAD.

RESULTS

Though CAD+ was more prevalent among participants with T2D (HbA1c 6.7 ± 1.1%) than those without diabetes (56 vs. 30%, P < 0.0001), CCTA-based atherosclerosis burden did not differ. Of the 20 top-ranking proteins, 15 were associated with both T2D and CAD, and 3 (osteomodulin, cartilage intermediate-layer protein 15, and HTRA1) were selectively associated with T2D only and 2 (epidermal growth factor receptor and contactin-1) with CAD only. Elevated renin and GDF15, and lower adiponectin, were independently associated with both T2D and CAD. In multivariate analysis adjusting for the Framingham risk panel, patients with T2D were "protected" from CAD if female (P = 0.007), younger (P = 0.021), and with lower renin levels (P = 0.02).

CONCLUSIONS

We concluded that 1) CAD severity and quality do not differ between participants with T2D and without diabetes; 2) renin, GDF15, and adiponectin are shared markers by T2D and CAD; 3) several proteins are specifically associated with T2D or CAD; and 4) in T2D, lower renin levels may protect against CAD.




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A fresh look for your Microblogs, Twitter and Facebook Feeds

If you’ve browsed your Twitter or Facebook page feeds in the last week, you have probably noticed that we changed…




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Inoreader mobile apps updated to support Automatic Night Mode, Microblogs, Sort by Magic and popularity indicators.

Hey, it’s been quite some time without updates on this front, but our latest updates to our Android and iOS…




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How we made our Free COVID-19 Alerting System and how you can build your own for any topic

Ever since we launched our Free COVID-19 Alerting System, we’ve been continuously asked how we made it. In this blog…




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Autologous Umbilical Cord Blood Transfusion in Young Children With Type 1 Diabetes Fails to Preserve C-Peptide

OBJECTIVE

We conducted an open-label, phase I study using autologous umbilical cord blood (UCB) infusion to ameliorate type 1 diabetes (T1D). Having previously reported on the first 15 patients reaching 1 year of follow-up, herein we report on the complete cohort after 2 years of follow-up.

RESEARCH DESIGN AND METHODS

A total of 24 T1D patients (median age 5.1 years) received a single intravenous infusion of autologous UCB cells and underwent metabolic and immunologic assessments.

RESULTS

No infusion-related adverse events were observed. β-Cell function declined after UCB infusion. Area under the curve C-peptide was 24.3% of baseline 1 year postinfusion (P < 0.001) and 2% of baseline 2 years after infusion (P < 0.001). Flow cytometry revealed increased regulatory T cells (Tregs) (P = 0.04) and naive Tregs (P = 0.001) 6 and 9 months after infusion, respectively.

CONCLUSIONS

Autologous UCB infusion in children with T1D is safe and induces changes in Treg frequency but fails to preserve C-peptide.




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Effects of MK-0941, a Novel Glucokinase Activator, on Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes

OBJECTIVE

To assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this double-blind study, 587 patients taking stable-dose insulin glargine (±metformin ≥1,500 mg/day) were randomized (1:1:1:1:1) to MK-0941 10, 20, 30, or 40 mg or matching placebo t.i.d. before meals (a.c.). This study included an initial 14-week, dose-ranging phase followed by a 40-week treatment phase during which patients were to be uptitrated as tolerated to 40 mg (or placebo) t.i.d. a.c. The primary efficacy end point was change from baseline in A1C at Week 14.

RESULTS

At Week 14, A1C and 2-h postmeal glucose (PMG) improved significantly versus placebo with all MK-0941 doses. Maximal placebo-adjusted least squares mean changes from baseline in A1C (baseline A1C 9.0%) and 2-h PMG were –0.8% and –37 mg/dL (–2 mmol/L), respectively. No significant effects on fasting plasma glucose were observed at any dose versus placebo. By 30 weeks, the initial glycemic responses noted at 14 weeks were not sustained. MK-0941 at one or more doses was associated with significant increases in the incidence of hypoglycemia, triglycerides, systolic blood pressure, and proportion of patients meeting criteria for predefined limits of change for increased diastolic blood pressure.

CONCLUSIONS

In patients receiving stable-dose insulin glargine, the GKA MK-0941 led to improvements in glycemic control that were not sustained. MK-0941 was associated with an increased incidence of hypoglycemia and elevations in triglycerides and blood pressure.




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Chronicling Migration in the 21st Century Through One Family’s Journey

Marking the launch of New York Times reporter Jason DeParle's book tracing the arc of migration and its impacts through the life of an extended family of Filipino migrants over a three-decade period, from Manila and through Dubai to the Houston area, this conversation with MPI's Andrew Selee and the World Bank's Dilip Ratha explores migration at both a global and very personal level.




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Latin American Responses to the Venezuelan and Nicaraguan Migration Crises

Leading policymakers and key stakeholders from Latin America, as well as representatives of major international institutions, offer their views on the challenges ahead as Latin American governments seek to chart strategies for responding to large-scale forced migration flows, such as those from Venezuela and Nicaragua. Spanish and English versions of the remarks are available.




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Respuestas latinoamericanas a las crisis migratorias venezolanas y nicaragüenses

Responsables de políticos principales y partes interesadas de América Latina, así como representantes de instituciones internacionales claves, ofrecen sus puntos de vista sobre los desafíos futuros mientras gobiernos latinoamericanos buscan establecer las estrategias para responder a flujos migratorios forzados a gran escala, como los de Venezuela y Nicaragua.




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16th Annual Immigration Law and Policy Conference

With immigration a central plank of the Trump administration's policy agenda, the 16th annual Immigration Law and Policy Conference, held in October 2019, featured analysis by top experts in and out of government regarding changing policies implemented at the U.S.-Mexico border, narrowing of asylum, cooperation with migrant-transit countries, and actions that could reduce legal immigration, including revisions to the public-charge rule.




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Employment Services for Refugees: Leveraging Mainstream U.S. Systems and Funding

On this webinar, experts and state refugee resettlement program leaders discuss activities that can be key parts of a broader strategy for sustaining and improving employment services for refugees, including partnerships with experts in workforce development strategies, access to federal workforce development funding, and other policies and resources.




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Is the Door Closing? Latin American and Caribbean Responses to Venezuelan Migration

Fleeing crisis, nearly 4 million Venezuelans have moved to other Latin American and Caribbean countries over the past few years. This webinar marked the launch of a Latin American and Caribbean Migration Portal, and a report examining the migration and integration policy responses in the region. 




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¿Se Están Cerrando las Puertas? Respuestas a la Migración Venezolana en América Latina y el Caribe

MPI llevó a cabo un seminario en línea para marcar el lanzamiento de: Un portal sobre Migración en América Latina y el Caribe; y un informe que examina los efectos de las políticas migratorias y de integración en 11 países en América Latina y el Caribe ante el aumento de la migración venezolana y nicaragüense.




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An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA

Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, areas where the law and state efforts to support English Learners can be improved, and findings from the compendium, The Patchy Landscape of State English Learner Policies under ESSA




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Migration &amp; Coronavirus: A Complicated Nexus Between Migration Management and Public Health

This webinar, organized by MPI and the Zolberg Institute on Migration and Mobility at The New School, discussed migration policy responses around the globe in response to the COVID-19 pandemic, and examined where migration management and enforcement tools may be useful and where they may be ill-suited to advancing public health goals. 




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COVID-19 in Latin America: Tackling Health Care &amp; Other Impacts for Vulnerable Migrant Populations

This MPI webinar brought together public health and migration experts to analyze the impact that COVID-19 preventative measures will have on vulnerable immigrants and refugees in Colombia and Latin America. Speakers also discussed how policymakers and international organizations can include migrant populations in their emergency response plans.




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Humanitarian Protection in an Era of Pandemic

MPI and MPI Europe experts discuss the effects of the coronavirus pandemic on asylum systems in Europe and North America, as well as in developing regions, where 85 percent of refugees live. During this freeform conversation, our analysts also assess the implications for the principle of asylum and the future for a post-World War II humanitarian protection system that is under threat.
 




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Immigration and the U.S.-Mexico Border during the Pandemic: A Conversation with Members of Congress

In this bipartisan discussion, two border-state members of Congress—Rep. Veronica Escobar and Rep. Dan Crenshaw—discuss the response to the coronavirus outbreak, how it is affecting the interconnected border region, and what the future might hold.
 




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A Study of Pregnancy and Birth Outcomes among African-Born Women Living in Utah

Resettled African refugee women may experience particularly acute complications during pregnancy, birth, and the child's early infancy. Yet health care-providers and policymakers may not be aware of the particular challenges that these women and their children face. This report, examining women giving birth in Utah over a seven-year period, compares perinatal complications of the African born and a segment of the U.S. born.




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Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use

According to leaked drafts, the Trump administration is considering a rule that could have sweeping effects on both legal immigration to the United States and the use of public benefits by legal immigrants and their families. This report examines the potential scale of the expected rule’s impact, including at national and state levels and among children, as well as Hispanic and Asian American/Pacific Islander immigrants.




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Chilling Effects: The Expected Public-Charge Rule and Its Impact on Immigrant Families

This webinar highlights findings from an MPI report examining the potential impacts of expected changes to the public charge rule by the Trump administration. Leaked draft versions suggest the rule could sharply expand the number of legally present noncitizens facing difficulty getting a green card or extending a visa as a result of their family's use of public benefits. The rule likely would discourage millions from accessing health, nutrition, and social services for which they or their U.S.-citizen dependents are eligible.




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Through the Back Door: Remaking the Immigration System via the Expected “Public-Charge” Rule

A Trump administration “public-charge” rule expected to be unveiled soon could create the potential to significantly reshape family-based legal immigration to the United States—and reduce arrivals from Asia, Latin America, and Africa—by imposing a de facto financial test that 40 percent of the U.S. born themselves would fail, as this commentary explains.




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Immigrant Families and Child Welfare Systems: Emerging Needs and Promising Policies

With the children of immigrants a growing share of all U.S. children, and federal immigration enforcement and other policies undergoing significant change, some state and local child welfare agencies are developing new ways to improve how they work with immigrant families. This report examines key cultural, linguistic, and legal challenges, and how agencies are adjusting staffing, training, placement, and other policies to tackle them.




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Millions Will Feel Chilling Effects of U.S. Public-Charge Rule That Is Also Likely to Reshape Legal Immigration

The public-charge rule issued by the Trump administration in August 2019 will have profound effects on future immigration and on use of public benefits by millions of legal noncitizens and their U.S.-citizen family members. Complex standards for determining when an immigrant is likely to become a public charge could cause a significant share of the nearly 23 million noncitizens and U.S. citizens in benefits-using immigrant families to disenroll, as this commentary explains.




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Health Insurance Test for Green-Card Applicants Could Sharply Cut Future U.S. Legal Immigration

A new Trump administration action requiring intending immigrants to prove they can purchase eligible health insurance within 30 days of arrival has the potential to block fully 65 percent of those who apply for a green card from abroad, MPI estimates.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar MPI experts discuss their estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They also discuss the broader consequences of the public-charge rule implemented in February 2020, through its "chilling effects" and imposition of a wealth test aimed at assessing whether green-card applicants ever would be likely to use a public benefit in the future. 




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The Public-Charge Rule: Broad Impacts, But Few Will Be Denied Green Cards Based on Actual Benefits Use

While the Trump administration public-charge rule is likely to vastly reshape legal immigration based on its test to assess if a person might ever use public benefits in the future, the universe of noncitizens who could be denied a green card based on current benefits use is quite small. That's because very few benefit programs are open to noncitizens who do not hold a green card. This commentary offers estimates of who might be affected.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar, MPI experts discussed the public-charge rule and released estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They examined the far larger consequences of the rule, through its "chilling effects" and imposition of a test aimed at assessing whether green-card applicants are likely to ever use a public benefit in the future. And they discussed how the latter holds the potential to reshape legal immigration to the United States. 




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As U.S. Health-Care System Buckles under Pandemic, Immigrant &amp; Refugee Professionals Could Represent a Critical Resource

In a time of critical shortages of U.S. health-care workers during the COVID-19 pandemic, retired doctors are being called back to work and medical students are graduating on a fast track. There is another important pool that could be tapped: Immigrants and refugees who have college degrees in health fields but are working in low-skilled jobs or out of work. MPI estimates 263,000 immigrants are experiencing skill underutilization and could be a valuable resource.




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Musculoskeletal Complications of Diabetes Mellitus

Rachel Peterson Kim
Jul 1, 2001; 19:
Practical Pointers




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Evaluating the Effect of U-500 Insulin Therapy on Glycemic Control in Veterans With Type 2 Diabetes

Joseph A. Granata
Jan 1, 2015; 33:14-19
Feature Articles




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Case Study: Potential Pitfalls of Using Hemoglobin A1c as the Sole Measure of Glycemic Control

Huy A. Tran
Jul 1, 2004; 22:141-143
Case Studies




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Effects of Glycemic Control on Diabetes Complications and on the Prevention of Diabetes

Jay S. Skyler
Oct 1, 2004; 22:162-166
Feature Articles




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Medical Nutrition Therapy: A Key to Diabetes Management and Prevention

Sara F. Morris
Dec 1, 2010; 28:12-18
Feature Articles




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Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain

Lorenzo Rinaldo
Jul 1, 2017; 35:126-131
Feature Articles




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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Margaret A. Powers
Apr 1, 2016; 34:70-80
Position Statements




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Integration of Clinical Psychology in the Comprehensive Diabetes Care Team

Steven B. Leichter
Jul 1, 2004; 22:129-131
The Business of Diabetes




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Therapeutic Inertia is a Problem for All of Us

Stephen Brunton
Apr 1, 2019; 37:105-106
Editorials




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SGLT-2 Inhibitors: A New Mechanism for Glycemic Control

Edward C. Chao
Jan 1, 2014; 32:4-11
Feature Articles




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Self-Monitoring of Blood Glucose: The Basics

Evan M. Benjamin
Jan 1, 2002; 20:
Practical Pointers




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Interdisciplinary Team Care for Diabetic Patients by Primary Care Physicians, Advanced Practice Nurses, and Clinical Pharmacists

David Willens
Apr 1, 2011; 29:60-68
Feature Articles




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Diabetes Management Issues for Patients With Chronic Kidney Disease

Kerri L. Cavanaugh
Jul 1, 2007; 25:90-97
Feature Articles




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Management of Diabetic Peripheral Neuropathy

Andrew J.M. Boulton
Jan 1, 2005; 23:9-15
Feature Articles




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Building Therapeutic Relationships: Choosing Words That Put People First

Jane K. Dickinson
Jan 1, 2017; 35:51-54
Commentary




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Application of Adult-Learning Principles to Patient Instructions: A Usability Study for an Exenatide Once-Weekly Injection Device

Gayle Lorenzi
Sep 1, 2010; 28:157-162
Bridges to Excellence




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Helping Patients Make and Sustain Healthy Changes: A Brief Introduction to Motivational Interviewing in Clinical Diabetes Care

Michele Heisler
Oct 1, 2008; 26:161-165
Practical Pointers




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Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

Daren Anderson
Jan 1, 2008; 26:22-27
Bridges to Excellence




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Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2019; 37:11-34
Position Statements