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Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

William J. Jeffcoate
Apr 1, 2018; 41:645-652
Perspectives in Care




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The Pros and Cons of Diagnosing Diabetes With A1C

Enzo Bonora
May 1, 2011; 34:S184-S190
Diabetes




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What Should Be the Target Blood Pressure in Elderly Patients With Diabetes?

Anna Solini
Aug 1, 2016; 39:S234-S243
VI. Cardiovascular Risk and Diabetes




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Guideline Approach to Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Itamar Raz
Aug 1, 2013; 36:S139-S144
Diabetes Pathophysiology




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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino
Aug 1, 2019; 42:1593-1603
International Consensus Report




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Professional Practice Committee: Standards of Medical Care in Diabetes--2020


Jan 1, 2020; 43:S3-S3
Professional Practice Committee




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Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report

Alison B. Evert
May 1, 2019; 42:731-754
Continuing Evolution of Nutritional Therapy for Diabetes




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Vasodilatory Actions of Glucagon-Like Peptide 1 Are Preserved in Skeletal and Cardiac Muscle Microvasculature but Not in Conduit Artery in Obese Humans With Vascular Insulin Resistance

OBJECTIVE

Obesity is associated with microvascular insulin resistance, which is characterized by impaired insulin-mediated microvascular recruitment. Glucagon-like peptide 1 (GLP-1) recruits skeletal and cardiac muscle microvasculature, and this action is preserved in insulin-resistant rodents. We aimed to examine whether GLP-1 recruits microvasculature and improves the action of insulin in obese humans.

RESEARCH DESIGN AND METHODS

Fifteen obese adults received intravenous infusion of either saline or GLP-1 (1.2 pmol/kg/min) for 150 min with or without a euglycemic insulin clamp (1 mU/kg/min) superimposed over the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow velocity and blood flow, brachial artery diameter and blood flow, and pulse wave velocity (PWV) were determined.

RESULTS

Insulin failed to change MBV or flow in either skeletal or cardiac muscle, confirming the presence of microvascular insulin resistance. GLP-1 infusion alone increased MBV by ~30% and ~40% in skeletal and cardiac muscle, respectively, with no change in flow velocity, leading to a significant increase in microvascular blood flow in both skeletal and cardiac muscle. Superimposition of insulin to GLP-1 infusion did not further increase MBV or flow in either skeletal or cardiac muscle but raised the steady-state glucose infusion rate by ~20%. Insulin, GLP-1, and GLP-1 + insulin infusion did not alter brachial artery diameter and blood flow or PWV. The vasodilatory actions of GLP-1 are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.

CONCLUSIONS

In obese humans with microvascular insulin resistance, GLP-1’s vasodilatory actions are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.




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Respective Contributions of Glycemic Variability and Mean Daily Glucose as Predictors of Hypoglycemia in Type 1 Diabetes: Are They Equivalent?

OBJECTIVE

To evaluate the respective contributions of short-term glycemic variability and mean daily glucose (MDG) concentration to the risk of hypoglycemia in type 1 diabetes.

RESEARCH DESIGN AND METHODS

People with type 1 diabetes (n = 100) investigated at the University Hospital of Montpellier (France) underwent continuous glucose monitoring (CGM) on two consecutive days, providing a total of 200 24-h glycemic profiles. The following parameters were computed: MDG concentration, within-day glycemic variability (coefficient of variation for glucose [%CV]), and risk of hypoglycemia (presented as the percentage of time spent below three glycemic thresholds: 3.9, 3.45, and 3.0 mmol/L).

RESULTS

MDG was significantly higher, and %CV significantly lower (both P < 0.001), when comparing the 24-h glycemic profiles according to whether no time or a certain duration of time was spent below the thresholds. Univariate regression analyses showed that MDG and %CV were the two explanatory variables that entered the model with the outcome variable (time spent below the thresholds). The classification and regression tree procedure indicated that the predominant predictor for hypoglycemia was %CV when the threshold was 3.0 mmol/L. In people with mean glucose ≤7.8 mmol/L, the time spent below 3.0 mmol/L was shortest (P < 0.001) when %CV was below 34%.

CONCLUSIONS

In type 1 diabetes, short-term glycemic variability relative to mean glucose (i.e., %CV) explains more hypoglycemia than does mean glucose alone when the glucose threshold is 3.0 mmol/L. Minimizing the risk of hypoglycemia requires a %CV below 34%.




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The Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes: Findings From the T1D Exchange

OBJECTIVE

To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S.

RESEARCH DESIGN AND METHODS

DPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ≥5 years of type 1 diabetes duration. A score of ≥4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed.

RESULTS

Among 5,936 T1D Exchange participants (mean ± SD age 39 ± 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA1c] 8.1 ± 1.6% [65.3 ± 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA1c, had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P < 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P < 0.001), worse CVD risk factors of smoking (P = 0.008), hypertriglyceridemia (P = 0.002), higher BMI (P = 0.009), retinopathy (P = 0.004), reduced estimated glomerular filtration rate (P = 0.02), and Charcot neuroarthropathy (P = 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P = 0.04) and/or diabetic ketoacidosis (P < 0.001) in the past 3 months.

CONCLUSIONS

The prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.




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As the Trump Administration Seeks to Remove Families, Due-Process Questions over Rocket Dockets Abound

The U.S. government is operating accelerated dockets to handle the rising number of cases of families in immigration court. While it is essential to have timely, fair case processing and removal of those who have truly had their day in court and been found to be removable, using “rocket” dockets to speed up proceedings only heightens the breakdowns that are a recurring feature of the court system on its best day, as this commentary explains.




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USCIS Fee Increase Proposed Rule Could Represent the Latest Step in Reshaping Immigration to United States

While much attention has been given to the move by U.S. Citizenship and Immigration Services to raise its application fees—including an 83 percent hike to apply for U.S. citizenship—the policy changes embedded in the proposed rule have been less scrutinized. The changes, including the elimination of most fee waivers for lower-income applicants, would likely reduce the number and shift the profile of those getting a green card or other immigration status.




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Coronavirus Is Spreading across Borders, But It Is Not a Migration Problem

Travel bans, border closures, and other migration management tools did not prove effective at blocking COVID-19 from spreading across international borders. Yet as governments have shifted from containment to mitigation with the coronavirus now in community transmission in many countries, these restrictions are a logical part of the policy toolkit in the context of social distancing and restricting all forms of human movement, as this commentary explores.




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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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Will Supreme Court Ruling on DACA Finally Force Congress to Break the Ice on Immigration Reform?

The fate of the Deferred Action for Childhood Arrivals (DACA) program has ping ponged between all three branches of government. But with the Supreme Court poised to decide DACA's future in spring 2020, Congress may finally be forced to act to resolve the status of DREAMers after nearly two decades of considering various DREAM Act bills. Could this break the long stalemate Congress has had on passing substantive immigration legislation, and pave the way for other actions?




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A Proxy War on Minorities? India Crafts Citizenship and Refugee Policies through the Lens of Religion

The Modi government's push for a Citizenship Amendment Act and National Register of Citizens sparked deadly riots and chilled India's 200 million Muslims, who fear being relegated to second-class citizenship—and for some, even statelessness. This article explores actions by Modi's Bharatiya Janata Party, the significance of Bangladeshi illegal immigration as a driver, and what a register of citizens in Assam might mean for India.




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Promising Strategies for Reintegration of Migrants Returning to Mexico and Central America

This MPI webinar focuses on reception and reintegration services for returning migrants, along with the heightened pressure policymakers in Mexico and Central America are facing to design systems and programs that support both returnees and the communities in which they settle. Authors of a year-long study of reception and reintegration services in Mexico and the Northern Triangle discuss the findings of their fieldwork.




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ADA supports proposed rules to update federal Anti-Kickback Statute, Stark Law

The American Dental Association supports a new safe harbor for cybersecurity technology and services and modifying the existing safe harbor for electronic health records to add protections for cybersecurity. This was in response to the Office of the Inspector General and Centers for Medicare & Medicaid Services’ proposed changes to the federal Anti-Kickback Statute and Stark Law exceptions.




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ADA CERP collaboration focuses on dentistry’s role in interprofessional education

The ADA’s Continuing Education Recognition Program, or ADA CERP, announced in December that it is collaborating with Joint Accreditation for Interprofessional Continuing Education, in an effort to offer dentists more opportunities to participate in interprofessional education.




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Former ADA vice president dies at 87

Dr. Chauncey Cross, who served as vice president of the American Dental Association from 1997-98, died Sept. 5, 2019, on his 87th birthday.




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ADA seeks nominations for representation on Dental Quality Alliance

The ADA is calling for nominations for two seats to represent the Association in the Dental Quality Alliance.




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Nonprofit recruiting dentists to volunteer in Puerto Rico

The U.S.-based International Medical Relief is sponsoring outreach trips to Puerto Rico in response to the earthquakes that have devastated the region.




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Arizona Mission of Mercy event provides treatment to over 1,700

The Central Arizona Dental Society hosted a Mission of Mercy event Dec. 13-14 at the Arizona State Fairgrounds in Phoenix, providing treatment to 1,785 patients totaling just over $2 million in free dental service.




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ADA House rescinds The Dentist’s Prayer, amends recognition of religious diversity policy to be more inclusive

In an effort to advance the Association’s diversity and inclusion efforts, the ADA House of Delegates voted at its meeting in September to rescind the policy titled “The Dentist’s Prayer,” used by some state and local dental societies during their meetings, and amend its policy on recognition of religious diversity.




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Tufts University program provides homeless veterans with advanced dental care

Service With A Smile was among 10 programs from nine universities to receive funding this year through the ADA Foundation’s E. “Bud” Tarrson Dental School Student Community Leadership Awards.




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ADA provides suggestions to help protect dentists from employee theft

Nearly 49% of responding dental practices have experienced employee theft, and nearly 46% of those have experienced theft or embezzlement more than once, according to a survey conducted by the ADA Council on Dental Practice.




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Study clubs ‘enhance the level of care provided’

The Duluth Dental Forum in northeastern Minnesota celebrated its 75th anniversary in late 2019, stating that it was the second-oldest study club of its kind in the United States.




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Dental practice sued for allegedly sending unsolicited text messages

A class action lawsuit alleging that a Florida dental practice sent unsolicited text messages in violation of the Telephone Consumer Protection Act was filed in the U.S. District Court for the Southern District of Florida Jan. 6.




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Florida oral surgeon stays atop branding as practice expands

There is an art to conveying just who you are at every stage of your dental practice. One minute you could be a single-dentist practice with a hygienist and a receptionist, and then, the next thing you know, you could have a group practice and maybe even several locations.




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ADA provides suggestions to help protect dentists from employee theft




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CDC reminds clinicians to use standard precautions, recommends isolating patients with coronavirus symptoms

In light of the “emerging, rapidly evolving” outbreak of the novel coronavirus 2019-nCoV, the Centers for Disease Control and Prevention is reminding clinicians to use standard precautions consistently and advising they isolate patients who show signs and symptoms of the virus.




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Dr. Bettie McKaig, first female ADA vice president, dies

Dr. Bettie R. McKaig, who served as the Association’s first vice president from 1998-99, died Feb. 3. She was 70.




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ADA comments on surprise billing

The American Dental Association is weighing in on two pieces of legislation aimed at streamlining billing procedures for patients.




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Former ADA President Robert M. Anderton dies at 82

Dr. Robert M. Anderton, ADA president from 2000-01 and ADA trustee from 1995-99, died Feb. 14.




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NIDCR seeks comments on research proposal

The National Institute of Dental and Craniofacial Research is seeking comments on a proposed research initiative on dental fear and anxiety.




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ADA Practice Transitions offering promotional trial for dentists who sign up through March 1

ADA Practice Transitions, a service offered by the ADA focused on helping dentists make the process of joining or leaving a practice successful, is offering a free three-month trial.




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FDA approves combination ibuprofen-acetaminophen drug for U.S.

The Food and Drug Administration has approved the first over-the-counter ibuprofen and acetaminophen combination drug for the U.S.




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Phishing email claims to be from ADA president

At least one American Dental Association member has reported receiving a phishing email appearing to come from an address containing ADA President Chad P. Gehani's name and including a link to "view member's details."




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ADA standards committees seek volunteers for new projects

The American Dental Association's Standards Committee on Dental Products and Standards Committee on Dental Informatics are looking for volunteers to help in the development of new projects.




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ADA to stream dental insurance webinar in April

Trying to navigate the world of dental benefits can be full of choppy seas, and the ADA is holding a free webinar in April to help dentists and their staff find a safe harbor full of information.




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New compendium summarizes best practices in oral health service delivery

Titled “Compendium of Innovations in Oral Health Service Delivery,” the 64-page digital booklet features organizations from across the country that have found success through varied measures in expanding oral care to underserved populations.




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Private practice pays $100,000 settlement for potential HIPAA violation

Ogden, Utah — The Office for Civil Rights announced March 3 that it had reached a settlement with Dr. Steven A. Porter’s medical practice to settle a potential violation of the Health Insurance Portability and Accountability Act security rule.




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ADA recommending dentists postpone elective procedures

The ADA is recommending that dentists nationwide postpone elective procedures in response to the spread of the coronavirus, COVID-19, across the country.




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Free ADA webinar offering answers to pressing COVID-19 questions

The ADA is partnering with the Organization for Safety, Asepsis and Prevention in providing a free on-demand webinar on Friday, March 20, with content for the program based on questions the ADA has received from members looking for guidance while navigating the novel coronavirus pandemic.




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Association provides coronavirus infection control resources for dentists

The ADA is sharing with members the CDC guidelines on the use of personal protective equipment on its website dedicated to COVID-19.




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ADA begins to address coding, billing procedures during COVID-19 outbreak

The ADA is releasing a guide intended to help dental offices navigate issues related to coding and billing for virtual check-ins in the midst of the COVID-19 outbreak.




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ADA president thanks dentists for grassroots efforts in response to CARES Act

As the Senate works to pass a stimulus package aimed at granting relief to the millions of Americans affected by the COVID-19 pandemic, the ADA is thanking dentists across the nation for making their voices heard in Washington on that same legislation.




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Scholarship due date for dental education program for directors pushed to April 15

The extension comes after it was announced the program will now be held Oct. 22-23 in Atlanta due to concerns over COVID-19. LEAP was originally set for May 7-8.




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ADA urges CDC to provide ‘immediate guidance’ on protecting dental patients, staff from COVID-19 during emergency treatments

The American Dental Association is urging the Centers for Disease Control and Prevention to provide immediate guidance on the best way to protect dental patients and staff from the transmission of COVID-19 during emergency and urgent care situations.




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April JADA compares zirconia-ceramic fixed dental prostheses with metal-ceramic

Posterior multiunit zirconia-ceramic restorations are slightly more susceptible to chipping of the veneering ceramic than metal-ceramic restorations, but they are considered a reliable treatment in the medium term, according to a systematic review and meta-analysis published in the April issue of The Journal of the American Dental Association.