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ADA 2015 Summary PDF
ADA 2015 Summary PDF
ADA 2015 Summary PDF
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Physical inactivity
First-degree relative with diabetes
High-risk race/ethnicity
Women who delivered a baby >9 lb or were diagnosed with GDM
HDL-C <35 mg/dL TG >250 mg/dL
Hypertension (140/90 mm Hg or on therapy)
A1C 5.7%, IGT, or IFG on previous testing
Conditions associated with insulin resistance: severe obesity, acanthosis
nigricans, PCOS
History of CVD
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A1C
5.7-6.4%
(39-46 mmol/mol)
For all tests, risk is continuous, extending below lower limit of range
and becoming disproportionately greater at higher ends of range
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
Management of Hypoglycemia
Ask at-risk patients about symptomatic and asymptomatic hypoglycemia at each encounter
Glucose (15-20 g) is the preferred treatment of hypoglycemia for conscious patients
15 minutes after treatment, repeat if SMBG shows continued hypoglycemia
When SMBG is normal, the patient should consume a meal or snack to prevent hypoglycemia recurrence
Glucagon may be prescribed for all individuals who are at risk for severe hypoglycemia
If an individual has hypoglycemia unawareness or an episode of severe hypoglycemia:
Re-evaluate the treatment regimen
In patients treated with insulin, raise glycemic targets for several weeks to partially reverse hypoglycemia unawareness
and reduce the recurrence of hypoglycemia
For individuals with low or declining cognition, continually assess cognitive function with increased vigilance for
hypoglycemia
PG=plasma glucose; SMBG=self-monitoring of blood glucose
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
10
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
11
Not FDA approved for the treatment of type 1 diabetes in the United States
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise
noted. Consult individual prescribing information for approved uses outside of the United States.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
12
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
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7. Lifestyle Changes
Medical Nutrition Therapy (MNT)
The ADA acknowledges that there is no one-size-fits-all eating pattern for individuals with type 2 diabetes.
MNT is recommended for all individuals with type 1 and type 2 diabetes as part of an overall treatment plan, preferably
provided by a registered dietitian skilled in diabetes MNT
Goals of MNT:
A healthful eating pattern to improve overall health, specifically:
Achievement and maintenance of weight goals
Attainment of individualized glycemic, blood pressure, and lipid goals
Type 2 diabetes prevention or delay
Attain individualized glycemic, blood pressure, and lipid goals
Achieve and maintain body weight goals
Delay or prevent diabetes complications
Physical Activity
Adults with diabetes
Exercise programs should include:
150 min/wk moderate-intensity aerobic activity (50%-70% max heart rate), spread over
3 days/wk with no more than 2 consecutive days without exercise
Resistance training 2 times/wk (in absence of contraindications)*
Reduce sedentary time = break up >90 minutes spent sitting
Evaluate patients for contraindications prohibiting certain types of exercise before recommending exercise program
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
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14
Eg, uncontrolled hypertension, severe autonomic or peripheral neuropathy, history of foot lesions, unstable proliferative
retinopathy
Physical Activity in Individuals With Hypoglycemia
If an individual is taking insulin and/or insulin secretagogues, physical activity can cause hypoglycemia if medication
dose or carb consumption is not altered
Added carbohydrate should be ingested when pre-exercise glucose is <100 mg/dL (5.6 mmol/L)
Physical Activity in Individuals With Diabetes Complications
Retinopathy
Proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy
Vigorous aerobic or resistance exercise may be contraindicated
Autonomic neuropathy
Can increase the risk for exercise-induced injury
All individuals with autonomic neuropathy should undergo cardiac investigation before
beginning more-intense-than-usual physical activity
Peripheral neuropathy
Decreased pain sensation and a higher pain threshold in the extremities cause increased
risk of skin breakdown and infection
All individuals with neuropathy should wear proper footwear and examine feet daily for
lesions
Individuals with foot injury or open sores are restricted to nonweight-bearing activity
Albuminuria and
Physical activity can acutely increase urinary protein excretion
nephropathy
There is no evidence that vigorous-intensity exercise increases the progression of diabetic
kidney disease
No restrictions are necessary for individuals with diabetic kidney disease
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
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15
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
16
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
17
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
18
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
19
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
20
Lipid Management
Adults not taking a statin
Lifestyle changes
factors
Age >75 with diabetes and ASCVD risk factors
Moderate- or high-intensity statin + lifestyle
The intensity of statin therapy may require adjustment based on an individuals response
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21
Regardless of age
Routinely evaluate risk-benefit profile of statin therapy, with down-titration as needed
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
22
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
23
Screening
Treatment
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise
noted. Consult individual prescribing information for approved uses outside of the United States.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
24
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
25
Management
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
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26
annually
Retinopathy progressive or sight
More frequent dilated retinal exams are recommended
threatening
Eye exams should occur prior to
Thereafter, monitor every trimester and for 1 year postpartum as indicated
pregnancy or in the first trimester
by degree of retinopathy
Treatment
Refer individuals with macular edema, severe NPDR, or any PDR to an ophthalmologist
Laser photocoagulation therapy indicated to reduce the risk of vision loss in high-risk PDR and severe NPDR
Intravitreal injections of antivascular endothelial growth factor are indicated for center-involved diabetic macular edema
The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
27
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
28
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
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29
exceed:
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Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life
Maintain A1C levels as close to normal as is safely possible
Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia
Discuss family planning
Prescribe effective contraception until woman is prepared to become pregnant
Women with preexisting type 1 or type 2 diabetes
Counsel on the risk of development and/or progression of diabetic retinopathy
Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum
Management of Pregestational Diabetes
Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet,
exercise, and metformin
Insulin* management during pregnancy is complex
Requires frequent titration to match changing requirements
Referral to specialized center recommended
Women with type 1 diabetes are at high risk for hypoglycemia
Hypoglycemia education important before and during pregnancy to prevent hypoglycemia
Women with type 1 diabetes are at risk for ketoacidosis
At lower blood glucose levels than in the nonpregnant state
Provide education on prevention and treatment of diabetic ketoacidosis
Women with type 2 diabetes are at risk for obesity
Recommended weight gain during pregnancy: 15-25 lb overweight, 10-20 lb obese
Glycemic control easier to achieve than in type 1 but can require higher insulin doses
Targets:
Fasting 90 mg/dL (5.0 mmol/L)
1-hr postprandial 130-140 mg/dL (7.2-7.8 mmol/L)
2-hr postprandial 120 mg/dL (6.7 mmol/L
*
Most insulins are category B; glargine, glulisine, and degludec are category C
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
31
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
32
SBP: 110-129 mm Hg
DBP: 65-79 mm Hg
Unsafe medications (contraindicated)
ACEIs
ARBs
ACEI=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; BMI=body mass index; DBP=diastolic
blood pressure; OAD=oral antidiabetic drug; SBP=systolic blood pressure
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise
noted. Consult individual prescribing information for approved uses outside of the United States.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
33
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
34
hypoglycemia risk
110-140 mg/dL (6.1-7.8 mmol/L)
A hypoglycemia management protocol should be established for each patient:
A plan for prevention and treatment of hypoglycemia should be developed
All episodes of hypoglycemia should be documented and tracked
The treatment plan should be reviewed and changed when glucose is <70 mg/dL (3.9 mmol/L)
Glycemic Targets for Noncritically Ill Individuals
Glucose target of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most
A lower target (<140 mg/dL) may be appropriate for individuals with a prior history of successful tight glycemic control
and who are clinically stable
Higher ranges may be appropriate for individuals who are terminally ill, have severe comorbidities, or are in in-patient
care settings where frequent glucose monitoring is not feasible
Recommendations for Perioperative Care
Target glucose range for perioperative period:
80-180 mg/dL (4.4-10.0 mmol/L)
Perioperative risk assessment for individuals at high risk for ischemic heart disease and those with autonomic neuropathy
or renal failure
On the morning of the procedure, withhold OADs and give half of the NPH dose or full doses of long-acting analog or
pump basal insulin
Monitor blood glucose every 4-6 hours while NPO and dose with short-acting insulin as needed
NPH=neutral protamine hagedorn; NPO=nothing by mouth; OADs=oral antidiabetes drugs; SSI=sliding scale insulin
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise
noted. Consult individual prescribing information for approved uses outside of the United States.
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
35
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
36
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
37
90-130 mg/dL
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(preprandial)
Plasma glucose at bedtime and overnight
(5.0-7.2 mmol/L)
90-150 mg/dL
(5.0-8.3 mmol/L)
Glucose goals should be modified in children with frequent hypoglycemiaor hypoglycemia unawareness
If the child is taking basal-bolus therapy, measure postprandial glucose when there is a discrepancy between preprandial
glucose values and A1C levels, and to assess preprandial insulin doses
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
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Managing High Blood Pressure in Children and Adolescents With Type 1 Diabetes
Screening
Measure BP at every visit
Confirm elevated BP at separate visit
High-normal BP* or hypertension: confirm BP on 3 separate days
Treatment
High-normal BP*
Lifestyle changes (diet & physical activity) aimed at weight
control
Initial pharmacologic
If target BP is not achieved within
therapy:
3-6 months, initiate pharmacologic therapy
ACEI or ARB
Hypertension
Initiate lifestyle changes and pharmacologic therapy
BP target: Consistently <90th percentile for age, gender, and height
*
SBP or DBP consistently 90th percentile for age, , and height
SBP or DBP consistently 95th percentile for age, gender, and height
Statins are approved by the U.S. Food and Drug Administration for treatment of heterozygous familial
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hypercholesterolemia in children and adolescents. Not all statins are FDA approved for use under the age of 10 yrs;
statins should generally not be used in children with type 1 diabetes before age 10. Refer to full prescribing information
for indications and uses in pediatric populations. For postpubertal girls, pregnancy prevention is important as statins are
contraindicated in pregnancy.
Screening for Autoimmunities in Children and Adolescents With Type 1 Diabetes
Hypothyroidism
Soon after type 1 diabetes diagnosis
Consider screening for
Antithyroid peroxidase antibodies
Antithyroglobulin antibodies
Measure TSH soon after diagnosis and after glucose control has been
established
Reassess every 1-2 yrs if normal
Celiac disease
Screen soon after type 1 diabetes diagnosis by measuring tissue transglutaminase or deamidated gliadin antibodies, with
documentation of normal total serum IgA levels
Candidates for testing
Family history of celiac disease
Failure to grow or gain weight
Weight loss
Diarrhea or flatulence
Abdominal pain
Signs of malabsorption
Repeated hypoglycemia of unknown cause or decline in glycemic control
Biopsy confirms diagnosis
Place child on gluten-free diet and refer to dietitian
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
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This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
42
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
43
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
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Immunization Recommendations
Provide routine vaccinations for children and adults with diabetes according to age-related recommendations
Influenza vaccine
Annually in all patients with diabetes aged 6 mos
Pneumococcal polysaccharide
All patients with diabetes aged 2 yrs
vaccine 23 (PPSV23)
Routinely in patients with diabetes aged 65 yrs
Pneumococcal conjugate vaccine 13
Routinely in patients with diabetes aged 65 yrs
(PCV13)
Hepatitis B vaccine
All adults with diabetes
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
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This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
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The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.
46
CF=cystic fibrosis; CFRD=cystic fibrosis-related diabetes; IGT=impaired glucose tolerance; OGTT=oral glucose tolerance
test
This content was created by Ashfield Healthcare Communications and was not associated with funding via an educational grant or a
promotional/commercial interest.
The National Diabetes Education Initiative (NDEI) is sponsored by Ashfield Healthcare Communications, Lyndhurst, NJ.
Copyright 2016 Ashfield Healthcare Communications. All rights reserved.