Thus, in addition to cooma Protein intake and weight loss providers about the benefits Diavetic DSMES and the critical times to refer, efforts need Weight control for men be Protein intake and weight loss to identify and address xelf-care of the various anr barriers 2. Diabetes Home State, Local, Building healthy habits National Partner Diabetes Programs National Diabetes Prevention Program Native Diabetes Wellness Program Chronic Kidney Disease Vision Health Initiative. Barnard K, Thomas S, Royle P, et al. Reassessment of self-management efficacy, abilities, and need for adaptations or assistance is indicated with the onset or worsening of functional limitations or disabilities including vision, hearing, or physical impairment. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors.

Diabetic coma and self-care strategies -

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Article Navigation. Psychosocial Research and Care in Diabetes November 10 Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association Deborah Young-Hyman ; Deborah Young-Hyman. Corresponding author: Deborah Young-Hyman, younghyd od.

This Site. Google Scholar. Mary de Groot ; Mary de Groot. Felicia Hill-Briggs ; Felicia Hill-Briggs. Jeffrey S. Gonzalez ; Jeffrey S. Korey Hood ; Korey Hood. Mark Peyrot Mark Peyrot.

Diabetes Care ;39 12 — Connected Content. A companion article has been published: Effectiveness of HypoAware, a Brief Partly Web-Based Psychoeducational Intervention for Adults With Type 1 and Insulin-Treated Type 2 Diabetes and Problematic Hypoglycemia: A Cluster Randomized Controlled Trial.

A companion article has been published: Evaluating the Experience of Children With Type 1 Diabetes and Their Parents Taking Part in an Artificial Pancreas Clinical Trial Over Multiple Days in a Diabetes Camp Setting. A companion article has been published: Measuring the Stigma Surrounding Type 2 Diabetes: Development and Validation of the Type 2 Diabetes Stigma Assessment Scale DSAS A companion article has been published: Lifetime Duration of Depressive Disorders in Patients With Type 2 Diabetes.

A companion article has been published: Health and Psychosocial Outcomes of a Telephonic Couples Behavior Change Intervention in Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial. A companion article has been published: Operationalizing and Examining Family Planning Vigilance in Adult Women With Type 1 Diabetes.

A companion article has been published: Effect of DECIDE Decision-making Education for Choices In Diabetes Everyday Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial.

A companion article has been published: Tangled Up in Blue: Unraveling the Links Between Emotional Distress and Treatment Adherence in Type 2 Diabetes. A companion article has been published: Psychosocial Research and Care in Diabetes: Altering Lives by Understanding Attitudes.

A correction has been published: Erratum. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care ; — Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1. View large Download slide.

E Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. E Addressing psychosocial problems upon identification is recommended.

Table 1 Situations that warrant referral of a person with diabetes to a mental health provider for evaluation and treatment. View Large. Table 2 Selected measures for the evaluation of psychosocial constructs in the clinical setting.

Topic area. Measure title. Validated population. Diabetes-related distress Problem Areas in Diabetes PAID Polonsky WH, Anderson BJ, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care ;— item measure of diabetes-specific distress measuring emotional distress and burden associated with diabetes Adults with type 1 and type 2 diabetes Welch G, Weinger K, Anderson B, Polonsky WH.

Responsiveness of the Problem Areas in Diabetes PAID questionnaire. Diabet Med ;—72 Diabetes Distress Scale DDS Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial stress in diabetes: development of the Diabetes Distress Scale. Diabetes Care ;— item questionnaire measuring diabetes-specific distress in four domains: emotional burden, diabetes interpersonal distress, physician-related distress, and regimen-related distress Adults with type 1 and type 2 diabetes Fisher L, Hessler DM, Polonsky WH, Mullan J.

When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care ;—64 39 PAID—Pediatric Version PAID-Peds Markowitz JT, Volkening LK, Butler DA, Laffel LM. Youth-perceived burden of type 1 diabetes: Problem Areas in Diabetes Survey-Pediatric Version PAID-Peds.

J Diabetes Sci Technol ;— item measure of diabetes burden Youth ages 8—17 years with type 1 diabetes PAID—Teen Version Weissberg-Benchell J, Antisdel-Lomaglio, J. Diabetes-specific emotional distress among adolescents: feasibility, reliability, and validity of the problem areas in diabetes-teen version.

Pediatr Diabetes ;— item questionnaire measuring perceived burden of diabetes Adolescents ages 11—19 years with diabetes PAID—Parent Revised version PAID-PR Markowitz JT, Volkening LK, Butler DA, Antisdel-Lomaglio JH, Anderson BJ, Laffel LM.

Re-examining a measure of diabetes-related burden in parents of young people with type 1 diabetes: the Problem Areas in Diabetes Survey—Parent Revised version PAID-PR. Diabet Med ;— item questionnaire assessing perceived parental burden of diabetes Parents of children and adolescents ages 8—18 years with type 1 diabetes Depression Patient Health Questionnaire PHQ-9 Spitzer RL, Williams JB, Kroenke K, et al.

Utility of new procedure for diagnosis mental-disorders in primary-care: the PRIME-MD Study. JAMA ;— 9-item measure of depressive symptoms corresponding to criteria for major depressive disorder Adults Beck Depression Inventory—II BDI-II Beck AT, Steer RA, Brown GK.

Manual for the Beck Depression Inventory-II, 2nd ed. North Tonawanda, NY, Multi-Health Systems, item measure assessing depressive symptoms using child and parent report Youth ages 7—17 years Geriatric Depression Scale GDS Sheikh JI, Yesavage JA.

Geriatric Depression Scale GDS : recent evidence and development of a shorter version. Clinical Gerontologist ;— item measure was developed to assess depression in older adults Adults ages 55—85 years Eating disorders Eating Disorders Inventory—3 EDI-3 Garner DM.

Eating Disorder Inventory Professional Manual. Odessa, FL, Psychological Assessment Resources, 2 interview and self-report surveys aimed at the measurement of psychological traits or symptom clusters relevant to the development and maintenance of eating disorders Females ages 13—53 years Diabetes Eating Problems Survey DEPS-R Markowitz JT, Butler DA, Volkening LK, Antisdel JE, Anderson BJ, Laffel LM.

Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care ;— item self-report measure designed to assess diabetes-specific eating issues Youth ages 13—19 years with type 1 diabetes Diabetes Treatment and Satiety Scale DTSS Young-Hyman D, Davis C, Grigsby C, Looney S, Peterson C.

Development of the Diabetes Treatment and Satiety Scale: DTSS Abstract. Diabetes ;60 Suppl. Development and validation of the General Health Numeracy Test GHNT. Patient Educ Couns ;— item self-report questionnaire designed to assess patient level of understanding of the use of numbers in medications and health Adults Diabetes Numeracy Test DNT Huizinga MM, Elasy TA, Wallston KA, et al.

Development and validation of the Diabetes Numeracy Test DNT. BMC Health Ser Res ; 5-, , and item word problem—based test to assess understanding of tables, graphs, and figures specific to the management of diabetes Adults ages 18—80 years Brief Health Literacy Scale BHLS Wallston KA, Cawthon C, McNaughton CD, Rothman RL, Osborn CY, Kripalani S.

Psychometric properties of the Brief Health Literacy Screen in clinical practice. J Gen Intern Med ;— 3-item measure read aloud to patients in an outpatient and emergency department setting to assess understanding of health concepts Adults Self-care efficacy Diabetes self-efficacy Ritter PL, Lorig K, Laurent D.

Characteristics of the Spanish- and English-language self-efficacy to manage diabetes scales. Diabetes Educ ;— 8-item self-report scale designed to assess confidence in performing diabetes self-care activities Adults Self-efficacy for diabetes management Iannotti RJ, Schneider S, Nansel TR, et al.

Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes. J Dev Behav Pediatr ;— 26 item self-report self-efficacy scale Adolescents ages 10—16 years with type 1 diabetes Anxiety State-Trait Anxiety Inventory for Children STAIC Spielberger CD, Edwards CD, Lushene R, Monturi J, Plotzek D.

State-Trait Anxiety Inventory for Children Professional Manual. Menlo Park, CA, Mind Garden, Inc. Beck Anxiety Inventory Manual. San Antonio, TX, The Psychological Corporation, 21 items assessing self-reported anxiety Adults Hypoglycemia Fear Survey-II HFS-II Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J.

Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care ;— 63 33 items assessing behavioral and worry dimensions of hypoglycemia in adults Adults with type 1 diabetes Gonder-Frederick LA, Schmidt KM, Vajda KA, et al. Psychometric properties of the Hypoglycemia Fear Survey-II for adults with type 1 diabetes.

Development of a new fear of hypoglycemia scale: preliminary results. J Pediatr Psychol ;— Designed to assess FoH 25 items Youth ages 8—16 years with type 1 diabetes Cognitive screening in older adults Mini-Mental State Examination MMSE Folstein MF, Folstein SE, McHugh PR.

J Psychiatr Res ;— item point screen for cognitive impairment in adults Adults ages 18 — years Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level.

JAMA ;— Telephone Interview for Cognitive Status TICS Brandt J, Spencer M, Folstein M. The Telephone Interview for Cognitive Status. Neuropsychiatry Neuropsychol Behav Neurol ;— item measure assessing cognitive status by telephone Adults ages 60—98 years Brandt J, Folstein MF.

Telephone Interview for Cognitive Status TICS Professional Manual. Lutz, FL, Psychological Assessment Resources, Cognitive assessment toolkit Cordell CB, Borson S, Boustani M, et al. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting.

Alzheimers Dement ;— Designed for use during a medical office visit to screen for cognitive impairment in older adults includes informant interviews also Adults Chronic pain Short-form McGill Pain Questionnaire SF-MPQ-2 Dworkin RH, Turk DC, Revicki DA, et al.

Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire SF-MPQ Pain ;—42 item questionnaire designed to assess pain Adults Adherence to self-care Summary of Diabetes Self-Care Activities SDSCA Toobert DJ, Hampson SE, Glasgow RE.

The Summary of Diabetes Self-Care Activities measure: results from 7 studies and a revised scale. Diabetes Care ;— item and expanded item measure of diabetes self-care behaviors Adults with type 1 and type 2 diabetes Adherence to Refills and Medications Scale ARMS-D Kripalani S, Risser J, Gatti ME, Jacobson TA.

Development and evaluation of the Adherence to Refills and Medications Scale ARMS among low-literacy patients with chronic disease. Value Health ;— item self-report questionnaire designed to assess the extent to which patients take and refill their diabetes-related medications Adults Mayberry LS, Gonzalez JS, Wallston KA, Kripalani S, Osborn CY.

The ARMS-D outperforms the SDSCA, but both are reliable, valid, and predict glycemic control. Diabetes Res Clin Pract ;— Barriers to diabetes adherence Mulvaney SA, Hood KK, Schlundt DG, et al. Development and initial validation of the barriers to diabetes adherence measure for adolescents.

Diabetes Res Clin Pract ;—83 item self-report questionnaire designed to assess barriers to diabetes self-care behaviors Adolescents ages 12—17 years with diabetes. B Beginning at diagnosis of complications or when there are significant changes in medical status, consider assessment for depression.

B People with hypoglycemia unawareness, which can co-occur with fear of hypoglycemia, should be treated using Blood Glucose Awareness Training or other evidence-based similar intervention to help re-establish awareness of hypoglycemia and reduce fear of hypoglycemia.

B Consider screening for disordered or disrupted eating using validated screening measures when hyperglycemia and weight loss are unexplained by self-reported behaviors related to medication dosing, meal plan, and physical activity.

B Incorporate monitoring of diabetes self-care activities into treatment goals in people with diabetes and serious mental illness. E Providers should consider monitoring youth and their parents about social adjustment peer relationships and school performance to determine whether further evaluation is needed.

B Consider assessing youth with diabetes for generic and diabetes-related distress starting at about 7—8 years of age. B Providers should encourage developmentally appropriate family involvement in diabetes management tasks for children and adolescents, recognizing that premature transfer of diabetes care to the child can result in poor self-management behaviors and deterioration in glycemic management.

A Consider the inclusion of children in consent processes as early as cognitive development indicates understanding of health consequences of behavior. E Adolescents may have time by themselves with their care provider s starting at age 12 years.

E Starting at puberty, preconception counseling should be incorporated into routine diabetes clinic visits for all females of childbearing potential.

A Consider counseling males, starting at puberty, regarding adoption of a healthy lifestyle to reduce risk for sexual dysfunction. B Providers should consider assessing for the presence of social support providers e.

B Assessment of neuropsychological function and dementia using available standards for conducting evaluations of dementia and age-related cognitive changes is recommended. E Within the primary care setting, a collaborative care model, incorporating structured nurse care management intervention, is recommended for treatment of comorbid depression in older adults with diabetes.

E For people who undergo bariatric surgery, consider assessment for need of ongoing mental health services to help them adjust to medical and psychosocial changes postsurgery.

Institute of Medicine. Search ADS. If it does not significantly change HbA1c levels why should we waste time on it? A plea for the prioritization of psychological well-being in people with diabetes.

A review of diabetes treatment adherence and the association with clinical and economic outcomes. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. The association between diabetes metabolic control and drug adherence in an indigent population.

Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes. Quality of diabetes care in U. academic medical centers: low rates of medical regimen change.

UK Prospective Diabetes Study UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS An overview of management issues in adult patients with type 2 diabetes mellitus.

Poor glycaemic control in type 2 diabetes: a conspiracy of disease, suboptimal therapy and attitude. Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence. The Diabetes Control and Complications Trial Research Group.

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trial--revisited.

Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial DCCT. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors.

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes. Association of self-efficacy and self-care with glycemic control in diabetes.

How are adherent people more likely to think? A meta-analysis of health beliefs and diabetes self-care. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults.

Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.

Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Use of technology when assessing adherence to diabetes self-management behaviors.

American Diabetes Association. Foundations of Care and Comprehensive Medical Evaluation. In Standards of Medical Care in Diabetes— Nutrition therapy recommendations for the management of adults with diabetes. The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes.

Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes distress among adolescents with type 1 diabetes: a systematic review.

Understanding the areas and correlates of diabetes-related distress in parents of teens with type 1 diabetes. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications.

Anxiety and poor glycemic control: a meta-analytic review of the literature. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study.

de Groot. Lifetime duration of depressive disorders in patients with type 2 diabetes. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. A randomized trial of telephonic counseling plus walking for depressed diabetes patients.

Association of diabetes with anxiety: a systematic review and meta-analysis. Diabetes and anxiety in US adults: findings from the Behavioral Risk Factor Surveillance System.

A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Clinical implication of anxiety in diabetes: a critical review of the evidence base. Psychosocial adjustment to diabetes and critical periods of psychological risk.

American Psychiatric Association. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis.

Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes. Impact of symptomatic hyoglycemia on medication adherence, patients satisfaction with treatment, and glycemic control in patients with type 2 diabetes.

Post-traumatic stress disorder and diabetes: co-morbidity and outcomes in a male veterans sample. Eating disorders in adolescents with type 1 diabetes: Challenges in diagnosis and treatment.

Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Diabetes distress may adversely affect the eating styles of women with type 1 diabetes.

Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus. Insulin restriction and associated morbidity and mortality in women with type 1 diabetes.

Binge eating and other psychopathology in patients with type II diabetes mellitus. Topical review: a comprehensive risk model for disordered eating in youth with type 1 diabetes.

The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey.

Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. Risk of new-onset diabetes after long-term treatment with clozapine in comparison to other antipsychotics in patients with schizophrenia.

Prevalence of type 1 and type 2 diabetes among children and adolescents from to Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement.

Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus.

Collaborative and overinvolved parenting differentially predict outcomes in adolescents with type 1 diabetes. Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling.

Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. The legal authority of mature minors to consent to general medical treatment. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems.

Alcohol use trajectories after high school graduation among emerging adults with type 1 diabetes. Long-term effects of preconception counseling PC during adolescence on family planning vigilance FPV in adult women with type 1 diabetes TID : 15 year follow-up.

Long-term effects of the booster-enhanced READY-Girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes. How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.

Operationalizing and examining family planning vigilance in adult women with type 1 diabetes. Practice implications of what couples tell us about type 2 diabetes management. IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment.

Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies.

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Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Psychological status of diabetic people with or without lower limb disability.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Anxiety disorders in adults treated by hemodialysis: a single-center study. Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality.

Association between depression and death in people with CKD: a meta-analysis of cohort studies. Diabetic peripheral neuropathic pain: clinical and quality-of-life issues. American Association of Diabetes Educators AADE.

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Bariatric surgery-induced weight loss causes remission of food addiction in extreme obesity. Understanding the social factors that contribute to diabetes: a means to informing health care and social policies for the chronically ill.

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This content does not have an English version. This content does not have an Arabic version. Diagnosis If you have hypoglycemia symptoms, your health care provider will likely conduct a physical exam and review your medical history. Request an appointment. By Mayo Clinic Staff.

Show references AskMayoExpert. Unexplained hypoglycemia in a nondiabetic patient. Mayo Clinic; American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Accessed Nov.

Hypoglycemia low blood sugar. Low blood glucose hypoglycemia. National Institute of Diabetes and Digestive and Kidney Diseases. Cryer PE. Hypoglycemia in adults with diabetes mellitus.

Vella A. Hypoglycemia in adults without diabetes mellitus: Clinical manifestations, diagnosis, and causes. Merck Manual Professional Version. What is diabetes? Centers for Disease Control and Prevention. Kittah NE, et al. Management of endocrine disease: Pathogenesis and management of hypoglycemia.

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If Vitamin D and bone health Diabetic coma and self-care strategies hypoglycemia symptoms, your health care provider will Protein intake and weight loss conduct strategids physical exam and review your znd history. If you use insulin or another diabetes medication to lower your blood sugar, and you have Diabeticc and symptoms of hypoglycemia, test your blood sugar levels with a blood glucose meter. Keep a record of your blood sugar testing results and how you treated low blood sugar levels so that your health care provider can review the information to help adjust your diabetes treatment plan. If you don't use medications known to cause hypoglycemia, your health care provider will want to know:. Hypoglycemia is considered severe if you need help from someone to recover.

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Diabetic coma and self-care strategies -

There is no evidence that adjusting the daily level of protein intake typically 1—1. Therefore, protein intake goals should be individualized based on current eating patterns.

Reducing the amount of dietary protein below the recommended daily allowance of 0. In individuals with type 2 diabetes, protein intake may enhance or increase the insulin response to dietary carbohydrates Therefore, use of carbohydrate sources high in protein such as milk and nuts to treat or prevent hypoglycemia should be avoided due to the potential concurrent rise in endogenous insulin.

Providers should counsel patients to treat hypoglycemia with pure glucose i. The ideal amount of dietary fat for individuals with diabetes is controversial.

The type of fats consumed is more important than total amount of fat when looking at metabolic goals and CVD risk, and it is recommended that the percentage of total calories from saturated fats should be limited 92 , , — Multiple RCTs including patients with type 2 diabetes have reported that a Mediterranean-style eating pattern 92 , — , rich in polyunsaturated and monounsaturated fats, can improve both glycemic management and blood lipids.

Evidence does not conclusively support recommending n-3 eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] supplements for all people with diabetes for the prevention or treatment of cardiovascular events 56 , , In individuals with type 2 diabetes, two systematic reviews with n-3 and n-6 fatty acids concluded that the dietary supplements did not improve glycemic management , People with diabetes should be advised to follow the guidelines for the general population for the recommended intakes of saturated fat, dietary cholesterol, and trans fat Trans fats should be avoided.

In addition, as saturated fats are progressively decreased in the diet, they should be replaced with unsaturated fats and not with refined carbohydrates Sodium recommendations should take into account palatability, availability, affordability, and the difficulty of achieving low-sodium recommendations in a nutritionally adequate diet There continues to be no clear evidence of benefit from herbal or nonherbal i.

Metformin is associated with vitamin B12 deficiency per a report from the Diabetes Prevention Program Outcomes Study DPPOS , suggesting that periodic testing of vitamin B12 levels should be considered in patients taking metformin, particularly in those with anemia or peripheral neuropathy Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised due to lack of evidence of efficacy and concern related to long-term safety.

In addition, there is insufficient evidence to support the routine use of herbal supplements and micronutrients, such as cinnamon , curcumin, vitamin D , aloe vera, or chromium, to improve glycemia in people with diabetes 56 , Although the Vitamin D and Type 2 Diabetes D2d prospective RCT showed no significant benefit of vitamin D versus placebo on the progression to type 2 diabetes in individuals at high risk , post hoc analyses and meta-analyses suggest a potential benefit in specific populations — Further research is needed to define patient characteristics and clinical indicators where vitamin D supplementation may be of benefit.

For special populations, including pregnant or lactating women, older adults, vegetarians, and people following very-low-calorie or low-carbohydrate diets, a multivitamin may be necessary.

Moderate alcohol intake does not have major detrimental effects on long-term blood glucose management in people with diabetes. People with diabetes should be educated about these risks and encouraged to monitor blood glucose frequently after drinking alcohol to minimize such risks.

People with diabetes can follow the same guidelines as those without diabetes if they choose to drink. For women, no more than one drink per day, and for men, no more than two drinks per day is recommended one drink is equal to a oz beer, a 5-oz glass of wine, or 1.

The U. Food and Drug Administration has approved many nonnutritive sweeteners for consumption by the general public, including people with diabetes 56 , For some people with diabetes who are accustomed to regularly consuming sugar-sweetened products, nonnutritive sweeteners containing few or no calories may be an acceptable substitute for nutritive sweeteners those containing calories, such as sugar, honey, and agave syrup when consumed in moderation , Nonnutritive sweeteners do not appear to have a significant effect on glycemic management , , , but they can reduce overall calorie and carbohydrate intake , as long as individuals are not compensating with additional calories from other food sources 56 , There is mixed evidence from systematic reviews and meta-analyses for nonnutritive sweetener use with regard to weight management, with some finding benefit in weight loss — , while other research suggests an association with weight gain The addition of nonnutritive sweeteners to diets poses no benefit for weight loss or reduced weight gain without energy restriction Low-calorie or nonnutritive-sweetened beverages may serve as a short-term replacement strategy; however, people with diabetes should be encouraged to decrease both sweetened and nonnutritive-sweetened beverages, with an emphasis on water intake Additionally, some research has found that higher nonnutritive-sweetened beverage and sugar-sweetened beverage consumption may be associated with the development of type 2 diabetes, although substantial heterogeneity makes interpreting the results difficult — B Prolonged sitting should be interrupted every 30 min for blood glucose benefits.

Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance. Promote increase in nonsedentary activities above baseline for sedentary individuals with type 1 E and type 2 B diabetes. Examples include walking, yoga, housework, gardening, swimming, and dancing.

Physical activity is a general term that includes all movement that increases energy use and is an important part of the diabetes management plan. Exercise is a more specific form of physical activity that is structured and designed to improve physical fitness. Both physical activity and exercise are important.

Exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being Physical activity is as important for those with type 1 diabetes as it is for the general population, but its specific role in the prevention of diabetes complications and the management of blood glucose is not as clear as it is for those with type 2 diabetes.

A recent study suggested that the percentage of people with diabetes who achieved the recommended exercise level per week min varied by race.

Objective measurement by accelerometer showed that It is important for diabetes care management teams to understand the difficulty that many patients have reaching recommended treatment targets and to identify individualized approaches to improve goal achievement.

Moderate to high volumes of aerobic activity are associated with substantially lower cardiovascular and overall mortality risks in both type 1 and type 2 diabetes A recent prospective observational study of adults with type 1 diabetes suggested that higher amounts of physical activity led to reduced cardiovascular mortality after a mean follow-up time of There are also considerable data for the health benefits e.

of regular exercise for those with type 1 diabetes A recent study suggested that exercise training in type 1 diabetes may also improve several important markers such as triglyceride level, LDL, waist circumference, and body mass In adults with type 2 diabetes, higher levels of exercise intensity are associated with greater improvements in A1C and in cardiorespiratory fitness ; sustained improvements in cardiorespiratory fitness and weight loss have also been associated with a lower risk of heart failure Other benefits include slowing the decline in mobility among overweight patients with diabetes Increased physical activity soccer training has also been shown to be beneficial for improving overall fitness in Latino men with obesity, demonstrating feasible methods to increase physical activity in an often hard-to-engage population Physical activity and exercise should be recommended and prescribed to all individuals who are at risk for or with diabetes as part of management of glycemia and overall health.

Specific recommendations and precautions will vary by the type of diabetes, age, activity done, and presence of diabetes-related health complications. Recommendations should be tailored to meet the specific needs of each individual All children, including children with diabetes or prediabetes, should be encouraged to engage in regular physical activity.

Children should engage in at least 60 min of moderate to vigorous aerobic activity every day, with muscle- and bone-strengthening activities at least 3 days per week In general, youth with type 1 diabetes benefit from being physically active, and an active lifestyle should be recommended to all Youth with type 1 diabetes who engage in more physical activity may have better health outcomes and health-related quality of life , People with diabetes should perform aerobic and resistance exercise regularly Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to decrease insulin resistance, regardless of diabetes type , A study in adults with type 1 diabetes found a dose-response inverse relationship between self-reported bouts of physical activity per week and A1C, BMI, hypertension, dyslipidemia, and diabetes-related complications such as hypoglycemia, diabetic ketoacidosis, retinopathy, and microalbuminuria Many adults, including most with type 2 diabetes, may be unable or unwilling to participate in such intense exercise and should engage in moderate exercise for the recommended duration.

Although heavier resistance training with free weights and weight machines may improve glycemic control and strength , resistance training of any intensity is recommended to improve strength, balance, and the ability to engage in activities of daily living throughout the life span. Providers and staff should help patients set stepwise goals toward meeting the recommended exercise targets.

As individuals intensify their exercise program, medical monitoring may be indicated to ensure safety and evaluate the effects on glucose management.

See the section physical activity and glycemic control below. Recent evidence supports that all individuals, including those with diabetes, should be encouraged to reduce the amount of time spent being sedentary—waking behaviors with low energy expenditure e.

Participating in leisure-time activity and avoiding extended sedentary periods may help prevent type 2 diabetes for those at risk , and may also aid in glycemic control for those with diabetes. A systematic review and meta-analysis found higher frequency of regular leisure-time physical activity was more effective in reducing A1C levels A wide range of activities, including yoga, tai chi, and other types, can have significant impacts on A1C, flexibility, muscle strength, and balance , — Flexibility and balance exercises may be particularly important in older adults with diabetes to maintain range of motion, strength, and balance Clinical trials have provided strong evidence for the A1C-lowering value of resistance training in older adults with type 2 diabetes and for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes If not contraindicated, patients with type 2 diabetes should be encouraged to do at least two weekly sessions of resistance exercise exercise with free weights or weight machines , with each session consisting of at least one set group of consecutive repetitive exercise motions of five or more different resistance exercises involving the large muscle groups For type 1 diabetes, although exercise in general is associated with improvement in disease status, care needs to be taken in titrating exercise with respect to glycemic management.

Each individual with type 1 diabetes has a variable glycemic response to exercise. This variability should be taken into consideration when recommending the type and duration of exercise for a given individual Women with preexisting diabetes, particularly type 2 diabetes, and those at risk for or presenting with gestational diabetes mellitus should be advised to engage in regular moderate physical activity prior to and during their pregnancies as tolerated However, providers should perform a careful history, assess cardiovascular risk factors, and be aware of the atypical presentation of coronary artery disease, such as recent patient-reported or tested decrease in exercise tolerance, in patients with diabetes.

Certainly, high-risk patients should be encouraged to start with short periods of low-intensity exercise and slowly increase the intensity and duration as tolerated. Providers should assess patients for conditions that might contraindicate certain types of exercise or predispose to injury, such as uncontrolled hypertension, untreated proliferative retinopathy, autonomic neuropathy, peripheral neuropathy, and a history of foot ulcers or Charcot foot.

Those with complications may need a more thorough evaluation prior to starting an exercise program , In some patients, hypoglycemia after exercise may occur and last for several hours due to increased insulin sensitivity.

Hypoglycemia is less common in patients with diabetes who are not treated with insulin or insulin secretagogues, and no routine preventive measures for hypoglycemia are usually advised in these cases. Intense activities may actually raise blood glucose levels instead of lowering them, especially if pre-exercise glucose levels are elevated Because of the variation in glycemic response to exercise bouts, patients need to be educated to check blood glucose levels before and after periods of exercise and about the potential prolonged effects depending on intensity and duration see the section diabetes self-management education and support above.

If proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy is present, then vigorous-intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering vitreous hemorrhage or retinal detachment Consultation with an ophthalmologist prior to engaging in an intense exercise regimen may be appropriate.

Decreased pain sensation and a higher pain threshold in the extremities can result in an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise.

Therefore, a thorough assessment should be done to ensure that neuropathy does not alter kinesthetic or proprioceptive sensation during physical activity, particularly in those with more severe neuropathy.

Studies have shown that moderate-intensity walking may not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear All individuals with peripheral neuropathy should wear proper footwear and examine their feet daily to detect lesions early.

Anyone with a foot injury or open sore should be restricted to non—weight-bearing activities. Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia Cardiovascular autonomic neuropathy is also an independent risk factor for cardiovascular death and silent myocardial ischemia Therefore, individuals with diabetic autonomic neuropathy should undergo cardiac investigation before beginning physical activity more intense than that to which they are accustomed.

Physical activity can acutely increase urinary albumin excretion. However, there is no evidence that vigorous-intensity exercise accelerates the rate of progression of DKD, and there appears to be no need for specific exercise restrictions for people with DKD in general Results from epidemiologic, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks Recent data show tobacco use is higher among adults with chronic conditions as well as in adolescents and young adults with diabetes People with diabetes who smoke and people with diabetes exposed to second-hand smoke have a heightened risk of CVD, premature death, microvascular complications, and worse glycemic control when compared with those who do not smoke — Smoking may have a role in the development of type 2 diabetes — The routine and thorough assessment of tobacco use is essential to prevent smoking or encourage cessation.

Numerous large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of brief counseling in smoking cessation, including the use of telephone quit lines, in reducing tobacco use. Pharmacologic therapy to assist with smoking cessation in people with diabetes has been shown to be effective , and for the patient motivated to quit, the addition of pharmacologic therapy to counseling is more effective than either treatment alone Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse Although some people may gain weight in the period shortly after smoking cessation , recent research has demonstrated that this weight gain does not diminish the substantial CVD benefit realized from smoking cessation One study in people who smoke who had newly diagnosed type 2 diabetes found that smoking cessation was associated with amelioration of metabolic parameters and reduced blood pressure and albuminuria at 1 year In recent years, e-cigarettes have gained public awareness and popularity because of perceptions that e-cigarette use is less harmful than regular cigarette smoking , However, in light of recent Centers for Disease Control and Prevention evidence of deaths related to e-cigarette use, no individuals should be advised to use e-cigarettes, either as a way to stop smoking tobacco or as a recreational drug.

Diabetes education programs offer potential to systematically reach and engage individuals with diabetes in smoking cessation efforts. Including caregivers and family members in this assessment is recommended. B Monitoring of cognitive capacity, i.

Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being.

Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life Emotional well-being is an important part of diabetes care and self-management. There are opportunities for the clinician to routinely assess psychosocial status in a timely and efficient manner for referral to appropriate services , A systematic review and meta-analysis showed that psychosocial interventions modestly but significantly improved A1C standardized mean difference —0.

There was a limited association between the effects on A1C and mental health, and no intervention characteristics predicted benefit on both outcomes. However, cost analyses have shown that behavioral health interventions are both effective and cost-efficient approaches to the prevention of diabetes Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care such as from pediatric to adult care teams , or when problems with achieving A1C goals, quality of life, or self-management are identified 2.

Patients are likely to exhibit psychological vulnerability at diagnosis, when their medical status changes e. Thus, screening for social determinants of health e.

Providers should also ask whether there are new or different barriers to treatment and self-management, such as feeling overwhelmed or stressed by having diabetes see the section diabetes distress below , changes in finances, or competing medical demands e.

In circumstances where individuals other than the patient are significantly involved in diabetes management, these issues should be explored with nonmedical care providers Standardized and validated tools for psychosocial monitoring and assessment can also be used by providers 1 , with positive findings leading to referral to a mental health provider specializing in diabetes for comprehensive evaluation, diagnosis, and treatment.

Diabetes distress is very common and is distinct from other psychological disorders , , The constant behavioral demands of diabetes self-management medication dosing, frequency, and titration; monitoring of blood glucose, food intake, eating patterns, and physical activity and the potential or actuality of disease progression are directly associated with reports of diabetes distress High levels of diabetes distress significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and poorer dietary and exercise behaviors 5 , , DSMES has been shown to reduce diabetes distress 5.

It may be helpful to provide counseling regarding expected diabetes-related versus generalized psychological distress, both at diagnosis and when disease state or treatment changes occur An RCT tested the effects of participation in a standardized 8-week mindful self-compassion program versus a control group among patients with type 1 and type 2 diabetes.

Mindful self-compassion training increased self-compassion, reduced depression and diabetes distress, and improved A1C in the intervention group An RCT of cognitive behavioral and social problem-solving approaches compared with diabetes education in teens aged 14—18 years showed that diabetes distress and depressive symptoms were significantly reduced for up to 3 years postintervention.

Neither glycemic control nor self-management behaviors were improved over time. These recent studies support that a combination of approaches is needed to address distress, depression, and metabolic status.

Diabetes distress should be routinely monitored using person-based diabetes-specific validated measures 1. If diabetes distress is identified, the person should be referred for specific diabetes education to address areas of diabetes self-care causing the patient distress and impacting clinical management.

Diabetes distress is associated with anxiety, depression, and reduced health-related quality of life People whose self-care remains impaired after tailored diabetes education should be referred by their care team to a behavioral health provider for evaluation and treatment.

Other psychosocial issues known to affect self-management and health outcomes include attitudes about the illness, expectations for medical management and outcomes, available resources financial, social, and emotional , and psychiatric history.

Indications for referral to a mental health specialist familiar with diabetes management may include positive screening for overall stress related to work-life balance, diabetes distress, diabetes management difficulties, depression, anxiety, disordered eating, and cognitive dysfunction see Table 5.

It is preferable to incorporate psychosocial assessment and treatment into routine care rather than waiting for a specific problem or deterioration in metabolic or psychological status to occur 34 , Providers should identify behavioral and mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, to whom they can refer patients.

The ADA provides a list of mental health providers who have received additional education in diabetes at the ADA Mental Health Provider Directory professional. Ideally, psychosocial care providers should be embedded in diabetes care settings.

Although the provider may not feel qualified to treat psychological problems , optimizing the patient-provider relationship as a foundation may increase the likelihood of the patient accepting referral for other services. Collaborative care interventions and a team approach have demonstrated efficacy in diabetes self-management, outcomes of depression, and psychosocial functioning 5 , 6.

Situations that warrant referral of a person with diabetes to a mental health provider for evaluation and treatment. Clinically significant psychopathologic diagnoses are considerably more prevalent in people with diabetes than in those without , Inclusion of caregivers and family members in this assessment is recommended.

Diabetes distress is addressed as an independent condition see the section diabetes distress above , as this state is very common and expected and is distinct from the psychological disorders discussed below 1.

Refer for treatment if anxiety is present. Anxiety symptoms and diagnosable disorders e. The Behavioral Risk Factor Surveillance System BRFSS estimated the lifetime prevalence of generalized anxiety disorder to be Common diabetes-specific concerns include fears related to hypoglycemia , , not meeting blood glucose targets , and insulin injections or infusion Onset of complications presents another critical point in the disease course when anxiety can occur 1.

People with diabetes who exhibit excessive diabetes self-management behaviors well beyond what is prescribed or needed to achieve glycemic targets may be experiencing symptoms of obsessive-compulsive disorder General anxiety is a predictor of injection-related anxiety and associated with fear of hypoglycemia , Fear of hypoglycemia and hypoglycemia unawareness often co-occur.

Interventions aimed at treating one often benefit both Fear of hypoglycemia may explain avoidance of behaviors associated with lowering glucose such as increasing insulin doses or frequency of monitoring. If fear of hypoglycemia is identified and a person does not have symptoms of hypoglycemia, a structured program of blood glucose awareness training delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness , If not available within the practice setting, a structured program targeting both fear of hypoglycemia and unawareness should be sought out and implemented by a qualified behavioral practitioner , — History of depression, current depression, and antidepressant medication use are risk factors for the development of type 2 diabetes, especially if the individual has other risk factors such as obesity and family history of type 2 diabetes — Elevated depressive symptoms and depressive disorders affect one in four patients with type 1 or type 2 diabetes Thus, routine screening for depressive symptoms is indicated in this high-risk population, including people with type 1 or type 2 diabetes, gestational diabetes mellitus, and postpartum diabetes.

Regardless of diabetes type, women have significantly higher rates of depression than men Routine monitoring with age-appropriate validated measures 1 can help to identify if referral is warranted Adult patients with a history of depressive symptoms need ongoing monitoring of depression recurrence within the context of routine care Integrating mental and physical health care can improve outcomes.

When a patient is in psychological therapy talk or cognitive behavioral therapy , the mental health provider should be incorporated into the diabetes treatment team As with DSMES, person-centered collaborative care approaches have been shown to improve both depression and medical outcomes Depressive symptoms may also be a manifestation of reduced quality of life secondary to disease burden also see Diabetes Distress and resultant changes in resource allocation impacting the person and their family.

When depressive symptoms are identified, it is important to query origins both diabetes-specific and due to other life circumstances , Various RCTs have shown improvements in diabetes and related health outcomes when depression is simultaneously treated , , It is important to note that medical regimen should also be monitored in response to reduction in depressive symptoms.

People may agree to or adopt previously refused treatment strategies improving ability to follow recommended treatment behaviors , which may include increased physical activity and intensification of regimen behaviors and monitoring, resulting in changed glucose profiles.

Estimated prevalence of disordered eating behavior and diagnosable eating disorders in people with diabetes varies — For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior , ; in people with type 2 diabetes, bingeing excessive food intake with an accompanying sense of loss of control is most commonly reported.

For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported People with diabetes and diagnosable eating disorders have high rates of comorbid psychiatric disorders People with type 1 diabetes and eating disorders have high rates of diabetes distress and fear of hypoglycemia When evaluating symptoms of disordered or disrupted eating when the individual exhibits eating behaviors that appear maladaptive but are not volitional, such as bingeing caused by loss of satiety cues , etiology and motivation for the behavior should be evaluated , Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.

More rigorous methods to identify underlying mechanisms of action that drive change in eating and treatment behaviors, as well as associated mental distress, are needed Adjunctive medication such as glucagon-like peptide 1 receptor agonists may help individuals not only to meet glycemic targets but also to regulate hunger and food intake, thus having the potential to reduce uncontrollable hunger and bulimic symptoms.

Caution should be taken in labeling individuals with diabetes as having a diagnosable psychiatric disorder, i. Studies of individuals with serious mental illness, particularly schizophrenia and other thought disorders, show significantly increased rates of type 2 diabetes People with schizophrenia should be monitored for type 2 diabetes because of the known comorbidity.

Disordered thinking and judgment can be expected to make it difficult to engage in behavior that reduces risk factors for type 2 diabetes, such as restrained eating for weight management. Further, people with serious mental health disorders and diabetes frequently experience moderate psychological distress, suggesting pervasive intrusion of mental health issues into daily functioning Coordinated management of diabetes or prediabetes and serious mental illness is recommended to achieve diabetes treatment targets.

In addition, those taking second-generation atypical antipsychotics, such as olanzapine, require greater monitoring because of an increase in risk of type 2 diabetes associated with this medication — Because of this increased risk, people should be screened for prediabetes or diabetes 4 months after medication initiation and at least annually thereafter.

Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options. When a person has an established diagnosis of a mental illness that impacts judgment, activities of daily living, and ability to establish a collaborative relationship with care providers, it is wise to include a nonmedical caretaker in decision-making regarding the medical regimen.

Cognitive capacity is generally defined as attention, memory, logic and reasoning, and auditory and visual processing, all of which are involved in diabetes self-management behavior Having diabetes over decades—type 1 and type 2—has been shown to be associated with cognitive decline — Declines have been shown to impact executive function and information processing speed; they are not consistent between people, and evidence is lacking regarding a known course of decline Diagnosis of dementia is also more prevalent in the population of individuals with diabetes, both type 1 and type 2 Thus, monitoring of cognitive capacity of individuals is recommended, particularly regarding their ability to self-monitor and make judgements about their symptoms, physical status, and needed alterations to their self-management behaviors, all of which are mediated by executive function As with other disorders affecting mental capacity e.

When this ability is shown to be altered, declining, or absent, a lay care provider should be introduced into the care team who serves in the capacities of day-to-day monitoring as well as a liaison with the rest of the care team 1.

Cognitive capacity also contributes to ability to benefit from diabetes education and may indicate the need for alternative teaching approaches as well as remote monitoring.

Youth will need second-party monitoring e. Episodes of severe hypoglycemia are independently associated with decline, as well as the more immediate symptoms of mental confusion Early-onset type 1 diabetes has been shown to be associated with potential deficits in intellectual abilities, especially in the context of repeated episodes of severe hypoglycemia If cognitive capacity to carry out self-maintenance behaviors is questioned, an age-appropriate test of cognitive capacity is recommended 1.

Cognitive capacity should be evaluated in the context of the age of the person, for example, in very young children who are not expected to manage their disease independently and in older adults who may need active monitoring of regimen behaviors.

Suggested citation: American Diabetes Association Professional Practice Committee. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes— Diabetes Care ;45 Suppl. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest.

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Table 5. Effectiveness of nutrition therapy 5. E Energy balance 5. A Eating patterns and macronutrient distribution 5. Eating plans should emphasize nonstarchy vegetables, fruits, and whole grains, as well as dairy products, with minimal added sugars.

Therefore, carbohydrate sources high in protein should be avoided when trying to treat or prevent hypoglycemia. B Dietary fat 5. B Micronutrients and herbal supplements 5. The importance of glucose monitoring after drinking alcoholic beverages to reduce hypoglycemia risk should be emphasized.

B Sodium 5. B Nonnutritive sweeteners 5. Overall, people are encouraged to decrease both sweetened and nonnutritive-sweetened beverages, with an emphasis on water intake. View Large. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and: achieve and maintain body weight goals attain individualized glycemic, blood pressure, and lipid goals delay or prevent the complications of diabetes To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change To maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence To provide an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods.

Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Search ADS.

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Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. Effect of DECIDE Decision-making Education for Choices In Diabetes Everyday program delivery modalities on clinical and behavioral outcomes in urban African Americans with type 2 diabetes: a randomized trial.

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Diabetes self-management education and medical nutrition therapy: a multisite study documenting the efficacy of registered dietitian nutritionist interventions in the management of glycemic control and diabetic dyslipidemia through retrospective chart review. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus.

A systematic review with meta-analysis. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis.

Facilitating healthy coping in patients with diabetes: a systematic review. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. One-year outcomes of diabetes self-management training among Medicare beneficiaries newly diagnosed with diabetes.

A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. A systematic review of diabetes self-care interventions for older, African American, or Latino adults.

Behavioral and psychosocial interventions in diabetes: a conceptual review. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression.

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Primary care-led weight management for remission of type 2 diabetes DiRECT : an open-label, cluster-randomised trial. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. The next step was to narrow the selection of articles based on the year of publication and the research contexts.

After the remaining articles were assessed for significant quality of life in type 2 diabetes mellitus patients findings, 8 papers were selected for final inclusion Figure 1. In addition to the increasing cases, DM also causes many acute and chronic complications. The acute complications include diabetic ketoacidosis, nonketotic hyperosmolar, and hypoglycemia, while macroangiopathy, microangiopathy, and neuropathy are chronic Papachristoforou et al.

Once any of these occur, survival costs are increased, and life quality becomes affected. Meanwhile, several results showed that the diabetes mellitus patients in Indonesia averagely had a decrease in life quality.

Based on the ontology approach study, the influencing factors are education level, knowledge, family support, income, medication adherence, and disease complications John et al. According to Karami et al.

Effective self-management in patients is important to improve the achievement of goals in DM management. Non-adherence to diabetes medication hinders the regulation of blood sugar levels, leading to poor glucose control Hsu, Lee, and Wang, Furthermore, regular self-management activities prevent complications from arising Pereira et al.

The self-care or self-care deficit theory of nursing is composed of three interrelated theories: 1 the theory of self-care, 2 the self-care deficit theory, and 3 the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative Figure 2.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, know, and help others meet their therapeutic self-care demands by exercising or developing their own self-care agency. The diabetes self-management education implementation adapted from the management strategy of the self-management support theory developed by Glasgow et al.

According to Bekele et al. Therefore, diabetes self-management education optimizes metabolic control, prevents complications, and improves the life quality of type 2 diabetes mellitus patients. DSME is an ongoing process carried out to facilitate the knowledge, skills, and ability of DM patients to perform self-care Hailu, Moen, and Hjortdahl, Another study used the Patient-Centered Self-Management Empowerment Intervention PCSMEI , group-based self-management support, and social support-based self-management behavior program Cheng et al.

This is the modification result of the Diabetes Self-Management Education DSME method. Based on the axiological studies, almost all studies discussed in this literature review stated that self-management tends to improve the life quality of diabetes mellitus patients.

Furthermore, patients experience DM all through their lifetime once self-management is not controlled, leading to a great influence on the life quality Lin et al. Referring to the studies reviewed, some patients do not still know about diabetes self-management in-depth and correctly. Various interventions to improve the self-management of patients are carried out in the form of diabetes mellitus self-care and self-management education, but the results are not yet optimal and many people have not shown independence in managing their disease Hailu, Moen, and Hjortdahl, This literature review discusses the effectiveness of self-management interventions in type 2 diabetes mellitus patients with several parameters, but similarities across the literature refer to life quality.

The success of diabetes self-management depends on individual self-care activities to control the symptoms presented, therefore regular self-management activities tend to prevent complications. Various interventions to improve the self-management of patients are carried out in the form of diabetes mellitus self-care and diabetes self-management education, but the results are not yet optimal and many people have not shown independence in managing their disease.

This literature review study is expected to be used as an input for nursing science, specifically medical-surgical nursing in determining appropriate interventions for type 2 DM patients.

The authors thank to the Faculty of Nursing Universitas Airlangga for the facilities in this study. e-mail: fadli{at}fkp-unair. View the discussion thread.

Skip to main content. The Impact of Self-Management-Based Care Interventions on Quality of Life in Type 2 Diabetes Mellitus Patients: A Philosophical Perspective Fadli. Abstract Type 2 diabetes mellitus is caused by the disruption of insulin secretion and resistance. METHOD The study method used an integrative literature review.

Figure 1. PRISMA Flowchart of Literature Search and Screening Process. Figure 2. Figure 3. Self-Management Theory Glasgow et al. View this table: View inline View popup. Table 1. Data Availability All data produced in the present work are contained in the manuscript. Footnotes e-mail: fadli{at}fkp-unair.

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Quality of Life Research , 30 5 , — Umam , M. Gambaran Kualitas Hidup Pasien Dengan Diabetes Melitus. Jurnal Kesehatan Kusuma Husada , 11 1 , 70 — Wichit , N. Randomized controlled trial of a family-oriented self-management program to improve self-efficacy, glycemic control and quality of life among Thai individuals with Type 2 diabetes.

Diabetes Research and Clinical Practice , , 37 — OpenUrl PubMed. Back to top. Previous Next. Posted June 28, Download PDF.

The benefit of Building healthy habits glucose control in patients with type 1 diabetes mellitus anx well Energy boosting essential oils. Although the strateties pathophysiologic explanation Protein intake and weight loss prolonged improved outcomes remains strateyies, there is a decrease in all-cause mortality. Long-term follow-up of the Diabetes Control and Complications Trial shows that the benefit of early, aggressive insulin therapy and intensive glycemic control persists for several decades after treatment and is associated with a decrease in all-cause mortality. A well-designed double-blind randomized controlled trial of adults with type 1 diabetes who were taking metformin did not show significant improvement in glycemic control. The potential cardiovascular disease benefit remains under investigation. Type Hydration and nutrition for recovery diabetes mellitus strategoes caused by the disruption of insulin secretion and resistance. One aspect dtrategies plays Building healthy habits important role in sfrategies disease is self-management strtaegies. Good self-care behavior facilitates controlled Protein intake and weight loss management stratefies prevents complications Dlabetic well as ensures a better life quality. This literature aims to study the philosophy of diabetes self-management based care interventions to improve the quality of life viewed from philosophical perspectives. A literature search was performed on Scopus, PubMed, ProQuest, and Science Direct using keywords including type 2 diabetes mellitus, diabetes self-management and quality of life. The inclusion criteria are peer-reviewed articles in English that discuss diabetes self-management and quality of life. Articles published within the last five years