Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Alcohol:

• Alcohol:

• Adults with diabetes should drink alcohol only in moderation (no more than one drink per day for adult women and no more than two drinks per day for adult men). C

• Alcohol consumption may place people with diabetes at an increased risk for hypoglycemia, especially if taking insulin or insulin secretagogues. Education and awareness regarding the recognition and management of delayed hypoglycemia are warranted. B

Sodium:

• Sodium:

• As for the general population, people with diabetes should limit sodium consumption to less than 2,300 mg/day, although further restriction may be indicated for those with both diabetes and hypertension. B

Nonnutritive sweeteners:

• Nonnutritive sweeteners:

• The use of nonnutritive sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels. B

Children with diabetes/prediabetes: at least 60 min/day physical activity B

• Children with diabetes/prediabetes: at least 60 min/day physical activity B

• Most adults with type 1 C and type 2 B diabetes: 150+ min/wk of moderate-to-vigorous activity over at least 3 days/week with no more than 2 consecutive days without exercise. Shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals.

• Adults with type 1 C and type 2 B diabetes should perform resistance training in 2-3 sessions/week on nonconsecutive days

All adults, and particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior. B Prolonged sitting should be interrupted every 30 min for blood glucose benefits, particularly in adults with type 2 diabetes. C

• All adults, and particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior. B Prolonged sitting should be interrupted every 30 min for blood glucose benefits, particularly in adults with type 2 diabetes. C

• Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance. C

Advise all patients not to use cigarettes, other tobacco products A or e-cigarettes E.

• Advise all patients not to use cigarettes, other tobacco products A or e-cigarettes E.

• Include smoking cessation counseling and other forms of treatment as a routine component of diabetes care. B

Provide routine vaccinations for children and adults with diabetes per age-specific CDC recommendations. C

• Provide routine vaccinations for children and adults with diabetes per age-specific CDC recommendations. C

• CDC.gov/vaccines

• Administer hepatitis B vaccine to unvaccinated adults with diabetes aged 19-59 years. C

• Consider administering hepatitis B vaccine to unvaccinated adults with diabetes ≥ 60 years old. C

Psychosocial care should be provided to all people with diabetes, with the goals of optimizing health outcomes and QOL . A

• Psychosocial care should be provided to all people with diabetes, with the goals of optimizing health outcomes and QOL . A

• Psychosocial screening and follow-up include:

Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating, and cognitive capacities using patient-appropriate standardized and validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. B

• Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating, and cognitive capacities using patient-appropriate standardized and validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. B

• Consider screening older adults (aged ≥65 years) with diabetes for cognitive impairment and depression. B

Diabetes distress

• Diabetes distress

• Very common and distinct from other psychological disorders
• Negative psychological reactions related to emotional burdens of managing a demanding chronic disease

• Recommendation: Routinely monitor people with diabetes for diabetes distress, particularly when treatment targets are not met and/or at the onset of diabetes complications. B

Patients with prediabetes should be referred to an intensive diet and physical activity behavioral counseling program adhering to the tenets of the DPP targeting a loss of 7% of body weight, and should increase their moderate physical activity to at least 150 min/week. A

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