When initiating therapy, teach patients necessary survival skills.

Refer patients to a skilled diabetes educator.

Instruct patients about self-monitoring of capillary blood glucose.

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Explain epidemiology and prognosis of microvascular disease and its close relationship to blood-sugar control.

Educate the patient about epidemiology and prognosis of macrovascular disease.

Instruct patients and family members on the signs, symptoms, and treatment of hypoglycemia.

Educate the patient about smoking cessation.

Educate the patient about the importance of diet and exercise.

Encourage patients to have information about their condition with them at all times.

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Discuss with patients the planned glycemic management strategy and how to recognize hypoglycemia.

Use the perioperative setting to review strategies to prevent complications of diabetes.

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Recognize that no evidence exists that patient education strategies improve screening strategies for diabetes.

Appreciate that patient lifestyle counseling programs aimed at dietary and exercise modification initiated in overweight persons with the prediabetic state of impaired glucose tolerance can prevent the progression to diabetes.

Know that diabetes education strategies involving patient collaboration have been shown to improve glycemic control, weight loss, and lipid profiles in patients with type 2 diabetes.

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This "Call to Action" from the National Foundation for Infectious Diseases and co-sponsored by the ACP outlines the importance of influenza vaccination in patients with diabetes.

Vaccination of those at increased risk for complications from influenza, such as adults and children with diabetes, is a key U.S. public health strategy for preventing associated morbidity and mortality. Despite recommendations from the Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA) and others to administer influenza vaccine annually to all persons with diabetes six months of age and older, influenza vaccination rates in this population remain low. In fact, more than ten million Americans with diabetes lack the protection afforded by a single annual influenza vaccination.

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Question
In overweight patients with impaired glucose tolerance, are the benefits of a lifestyle intervention for preventing type 2 diabetes maintained after the program is stopped?

Conclusion
In overweight, middle-aged patients with impaired glucose tolerance, a lifestyle intervention continued to prevent type 2 diabetes for at least 3 years after the program was stopped.

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Question
In patients with impaired fasting glucose or impaired glucose tolerance, does rosiglitazone reduce the incidence of type 2 diabetes mellitus?

Conclusion
In patients with impaired fasting glucose or impaired glucose tolerance, rosiglitazone reduced the incidence of type 2 diabetes but increased the incidence of heart failure.

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Question
In patients with impaired fasting glucose or impaired glucose tolerance at low risk for cardiovascular (CV) events, does ramipril reduce risk for diabetes?

Conclusion
In patients with impaired fasting glucose or impaired glucose tolerance at low risk for cardiovascular events, ramipril did not reduce diabetes or death.

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Question
In patients with hypertension or other cardiovascular risk factors, can angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs) reduce new-onset diabetes mellitus?

Conclusion
Angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers reduce new-onset diabetes mellitus in patients with hypertension or other cardiovascular risk factors.

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Question
In patients with hypertension or other cardiovascular risk factors, do angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) reduce risk for type 2 diabetes?

Conclusion
In patients with hypertension or cardiovascular risk factors, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers prevent the development of type 2 diabetes.

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Question
In patients with heart failure, does candesartan prevent development of diabetes mellitus?

Conclusion
In patients with heart failure, candesartan reduced development of diabetes and a composite endpoint of diabetes and all-cause mortality.

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Question
In persons with impaired glucose tolerance, does an intensive lifestyle intervention (ILS) or treatment with metformin plus standard lifestyle recommendations prevent onset or promote resolution of the metabolic syndrome?

Conclusions
In persons with impaired glucose tolerance, an intensive lifestyle intervention or treatment with metformin plus standard lifestyle recommendations was more effective than standard lifestyle recommendations alone for preventing or delaying onset of the metabolic syndrome. Also, the intensive lifestyle intervention was more effective than metformin for preventing the metabolic syndrome.

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Question
What is the evidence that pharmacologic therapies can prevent type 2 diabetes mellitus?

Conclusion
In patients with type 2 diabetes mellitus, some oral hypoglycemic agents and antiobesity drugs reduce the incidence of diabetes, but the findings are inconsistent and many studies have low patient follow-up or show high drug-related gastrointestinal adverse effects.

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Question
In patients with impaired glucose tolerance (IGT), does acarbose reduce the risk for cardiovascular disease and hypertension?

Conclusion
In patients with impaired glucose tolerance, acarbose reduced the risk for cardiovascular disease and hypertension.

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Question
In nondiabetic patients with left ventricular dysfunction, does the angiotensin-converting enzyme (ACE) inhibitor enalapril reduce the risk for new-onset diabetes mellitus more than placebo?

Conclusion
In nondiabetic patients with left ventricular dysfunction, the angiotensin-converting enzyme inhibitor enalapril reduced the risk for new-onset diabetes mellitus.

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Question
In postmenopausal women with coronary heart disease (CHD), does hormone replacement therapy (HRT) prevent an increase in fasting glucose level and reduce the incidence of diabetes in those at risk?

Conclusion
In postmenopausal women with coronary heart disease, hormone replacement therapy slowed increase in fasting glucose level and reduced the incidence of diabetes in those at risk.

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Question
In overweight persons with elevated fasting and postload plasma glucose levels, does an intensive lifestyle intervention or treatment with metformin plus standard lifestyle recommendations prevent or delay the onset of type 2 diabetes mellitus?

Conclusion
In overweight persons with elevated fasting and postload plasma glucose concentrations, an intensive lifestyle intervention or treatment with metformin plus standard lifestyle recommendations was more effective than standard lifestyle recommendations alone for preventing or delaying the onset of type 2 diabetes mellitus.

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