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Tey must remove the drug coverage from your Medigap policy and adjust your premium based on this change best nimodipine 30mg. Also discount nimodipine 30 mg with amex, you may have to pay a lifetime late enrollment penalty to join a Medicare Prescription Drug Plan if the drug coverage you’ve had under your Medigap policy isn’t creditable prescription drug coverage order 30mg nimodipine. You may have to pay this higher premium for as long as you’re in a Medicare Prescription Drug Plan. I have Medicare and get drug coverage from a current or former employer or union Before making a decision about whether to join a Medicare drug plan, fnd out how your employer or union drug coverage works with Medicare, because your coverage may change if you join a Medicare drug plan. Your employer or union (or the plan that administers your drug coverage) will send you a “Creditable Coverage” disclosure each year, letting you know if it’s creditable prescription drug coverage and how it compares to Medicare drug coverage. Read carefully, and save all materials from your employer or union to know your options. You may have to make choices about your employer/union drug coverage and Medicare drug coverage: During your 7-month Initial Enrollment Period, when you frst become eligible for Medicare (see page 18 for details) During Open Enrollment, between October 15–December 7 each year When your employer/union coverage changes or ends 53 Your Coverage Choices 4 I have Medicare and get drug coverage from a current or former employer or union (continued) Some important questions to answer before making a decision: Is your employer or union drug coverage creditable (on average, does it expect to pay at least as much as standard Medicare drug coverage)? If not, in most cases, you’ll have to pay a late enrollment penalty if you don’t join a Medicare drug plan when you’re frst eligible. Note: Keep materials your employer or union sends you that tell you your drug coverage is creditable. You may need to show it to your Medicare drug plan as proof of creditable prescription drug coverage if you decide to join a Medicare drug plan later. If you don’t enroll when you’re frst eligible, you may have to wait to join a Medicare drug plan until Open Enrollment, which is October 15–December 7. You may be able to do one of these: Keep your current employer or union drug coverage, and join a Medicare drug plan to get more complete drug coverage. If you join a Medicare drug plan later, you may have to pay a late enrollment penalty if your current drug coverage isn’t creditable. Words in Drop your current coverage and join a Medicare drug plan, or red are join a Medicare health plan that covers prescription drugs. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents. Medicare doesn’t have information about how your current employer or union drug coverage will be afected by your enrollment in a Medicare drug plan, so talk to your employer or union’s benefts administrator before you make any decisions about your drug coverage. It’ll almost always be to your advantage to keep your current coverage without any changes. It’s almost always on pages to your advantage to keep your current coverage without any changes. Words in Because you have Medicaid, Medicare automatically gives you Extra Help red are with your Medicare drug plan costs. If you live in an institution (like a nursing home), in most on pages cases, you pay nothing for your covered drugs. If you haven’t joined a Medicare drug plan, Medicare will enroll you in a drug plan to make sure you have drug coverage (unless you already have certain retiree drug coverage). Medicare sends you a yellow notice telling you what drug plan you’re in and when your coverage starts. Check to see if the plan covers the drugs you take and includes the pharmacies you use. If you flled any covered prescriptions before your Medicare drug plan coverage started, you may be able to get back some of the money you spent. In limited cases, some state Medicaid programs may pay for drugs Medicare doesn’t cover. If you continue to qualify for Medicaid, Medicaid will still cover the other health care costs that Medicare doesn’t cover. If you aren’t sure whether you still qualify for Medicaid, call your State Medical Assistance (Medicaid) ofce. If you don’t join a Medicare drug plan on your own, Medicare will enroll you in a Medicare Prescription Drug Plan, to make sure you have coverage, unless you already have certain retiree drug coverage. Medicare sends you a yellow or a green notice letting you know when your coverage begins. You can switch to a diferent Medicare drug plan at any time as long as you continue to qualify for Extra Help. You can change your mind and join a Medicare drug plan at any time without paying a late enrollment penalty as long as you continue to qualify for Extra Help. Tis long-term care pharmacy usually contracts with (or is owned and operated by) your institution. Medicaid coverage, you pay nothing for your covered drugs afer Medicaid has paid for your stay for at least one full calendar month. Note: Institutions don’t include assisted living, adult living facilities, residential homes, or any kind of nursing home not certifed by Medicare or Medicaid. If you don’t have Medicaid coverage, you may still qualify for Extra Help paying for Medicare drug coverage. If they don’t cover other drugs, they aren’t creditable prescription drug coverage. If you don’t have creditable prescription drug coverage and delay joining a Medicare drug plan, you may have to pay a late enrollment penalty to join later. Ask your health provider or benefts coordinator if joining a plan is right for you. See your Indian Words in health provider or check with the benefts coordinator at your local red are Indian health pharmacy to get more information on how to join a defned plan. Ask your Indian health care provider for a letter stating you have creditable prescription drug coverage. Use the personal worksheets on pages 68–69 to help decide which plan meets your needs: Step 1: Prepare—Gather information about your current drug coverage and needs. Step 2: Compare—Compare Medicare drug plans based on cost, coverage, and customer service. Tip: Before considering which Medicare drug plan to join, check out how any current health coverage you have could afect your drug coverage choices. Step 1: Gather information about your current drug coverage and needs Before choosing a Medicare drug plan, you may want to gather some information. You need information about any drug coverage you may currently have, as well as a list of the drugs and doses you currently take. Also, gather any notices you get from Medicare, Social Security, or your current Medicare drug plan about changes to your plan. If you have drug coverage, you need to fnd out whether it’s creditable prescription drug coverage. Your current insurer or plan provider is required to notify you each year whether your coverage is creditable prescription drug coverage. If you haven’t heard from your insurer or plan, call the insurer, your plan, or your benefts administrator to fnd out.

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Human immunodeficiency virus type 1 mother-to-child transmission and prevention: success and controversies buy nimodipine 30 mg. Virologic and immunologic derminants of herosexual transmission of human immunodeficiency virus type 1 in Africa cheap nimodipine 30mg on-line. Prevalence and correlas of herosexual anal and oral sex in adolescents and adults in the Unid Stas purchase 30 mg nimodipine with amex. Effectiveness and cost-effectiveness of stragies to expand antiretroviral therapy in St. Human immunodeficiency virus viral load in blood plasma and semen: Review and implications of empirical findings. Factors associad with nucleic acids relad to human immunodeficiency virus type 1 in cervico-vaginal secretions. Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy. Human immunodeficiency virus in plasma and cervicovaginal secretions in Filipino women. A longitudinal study of human immunodeficiency virus transmission by herosexual partners. Herosexual transmission of human immunodeficiency virus - Variability of infectivity throughouthe course of infection. Initiating highly active antiretroviral therapy in sub-Saharan Africa: an assessmenof the revised World Health Organization scaling-up guidelines. Derminants of mother-to- infanhuman immunodeficiency virus 1 transmission before and afr the introduction of zidovudine prophylaxis. Abstracts of the Inrscience Conference on Antimicrobial Agents and Chemotherapy 2001;41:317. Prevention of human immunodeficiency virus mother-to-child transmission in Israel. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1997;14(3):232�6. Risk of perinatal transmission with treatmencombinations of intrapartum and newborn zidovudine monotherapy. Effecof immedia neonatal zidovudine on prevention of vertical transmission of human immunodeficiency virus type 1. The Ariel Project: A prospective cohorstudy of marnal-child transmission of human immunodeficiency virus type 1 in the era of marnal antiretroviral therapy. A trial of shorned zidovudine regimens to prevenmother-to-child transmission of human immunodeficiency virus type 1. Elective cesarean delivery plus short-course lamivudine and zidovudine for the prevention of mother-to-child transmission of human immunodeficiency virus type 1. Abstracts of the Inrscience Conference on Antimicrobial Agents and Chemotherapy 2001;41:318. Trends in inrventions to reduce perinatal human immunodeficiency virus type 1 transmission in North Carolina. A multicenr randomized controlled trial of nevirapine versus a combination of zidovudine and lamivudine to reduce intrapartum and early postpartum mother-to-child transmission of human immunodeficiency virus type 1. A Window Into A Public Programme for Prevention of Mother-To-Child Transmission of Hiv: Evidence from A Prospective Clinical Trial. Exnded annatal antiretroviral use correlas with improved infanoutcomes throughouthe firsyear of life. Combination antiretroviral therapy in human immunodeficiency virus-infecd pregnanwomen. The Impacof Marnal Highly Active Antiretroviral Therapy and Short-Course Combination Antiretrovirals for Prevention of Mother-to-Child Transmission on Early InfanInfection Ras athe Mulago National Referral Hospital in Kampala, Uganda, January 2007 to May 2009. The use of highly active antiretroviral therapy for the prevention of mother-to-child transmission of the human immunodeficiency virus in Nigeria. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1 - A meta-analysis of 15 prospective cohorstudies. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases 2005;9(1):20�7. Risk factors for perinatal transmission of Human Immunodeficiency Virus Type 1 in women tread with zidovudine. Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data. Assessmenof birth defects according to marnal therapy among infants in the Women and Infants Transmission Study. Assessing ratogenicity of antiretroviral drugs: monitoring and analysis plan of the Antiretroviral Pregnancy Registry. Effectiveness of Non-nucleoside Reverse-Transcriptase Inhibitor-Based Antiretroviral Therapy in Women Previously Exposed to a Single Intrapartum Dose of Nevirapine: A Multi-country, Prospective CohorStudy. Women exposed to single-dose nevirapine in successive pregnancies: effectiveness and nonnucleoside reverse transcriptase inhibitor resistance. The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 - A Meta-Analysis of 15 Prospective CohorStudies. European Journal of Obstrics Gynecology and Reproductive Biology 2008;139(2):127�32. Cellular targets of infection and rou of viral dissemination afr an intravaginal inoculation of simian immunodeficiency virus into rhesus macaques. Efficacy of posxposure prophylaxis afr intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). Sysmatic review of the effectiveness and safety of assisd reproduction chniques in couples serodiscordanfor human immunodeficiency virus where the man is positive. Human immunodeficiency virus serodiscordancouples on highly active antiretroviral therapies with undectable viral load: conception by unprocd sexual inrcourse or by assisd reproduction chniques? Full participation in harm reduction programmes is associad with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsrdam CohorStudies among drug users. Search language=Auto Lemmatization=On Da of search: 15th October 2011 Identified by Web of Knowledge: 512 Selecd for full xreview: 52 Identified by grey lirature: 4 Included in lirature review: 8 56 Appendix 2. Del Romero (61), Estima the risk and Cross-sectional and longitudinal analysis 476 stable (reporting this sexual 9. No: Studies included in this table are noparof formal lirature review for treatmenas prevention. Breasfeeding (1) 48% (2) 65% Ferguson, 2011, Ped Evalua the efficacy Observational, Median age 28. All Neonatal: (2)1016 abirth): and Taha 2011, differenstragies Malawi breastfeed for 6 months. Author, Journal Title Type of study, Population Aim Main Results/Conclusions and Year and Setting Roland eal. Self-treatmenof benign positional vertigo (left) Starsitting on a bed and turn your head 45� Lie back Turn your to the left.

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The intervention group received counseling to ment of clinical nutrient defciencies discount nimodipine 30mg without prescription. Prospective epidemi- reduce weight via nutritional intervention (lower fat intake order 30 mg nimodipine otc, ologic studies and randomized trials of nutrition and nutri- higher fber intake) and increased daily physical activity generic nimodipine 30mg with amex. Growing evidence suggests that intervention group and 23% in the control subjects. A large number of potentially anticar- sis of cohort studies also found that a higher intake of fruits cinogenic and antioxidant agents are found in fsh, fruits, and vegetables is associated with a lower risk of stroke. A number of studies have exam- One study found the lowest risk of stroke was associated ined the hypothesis that antioxidants may prevent cancer with a high consumption of cruciferous vegetables (e. However, caution must be used Table 5 Natural Compounds in Food Important in Maintaining Health Greater nutrition • Whole foods contain a variety of compounds important to health. As an example, an orange provides vitamin C, beta carotene, calcium, and other nutrients, whereas a vitamin C supplement does not. Essential fber • Fiber is important in digestion and may play a role in disease prevention. Flavonoid is a common name for a phytochemical that may function as an antioxidant. Antioxidants • A compound that can protect the body against free radicals, which are unstable molecules that can form anywhere in the body leading to cell damage and have been linked to both cardiovascular disease and cancer. The European The relationship between fber intake and colorectal Prospective Investigation into Cancer and Nutrition study cancer risk is unclear. In contrast, no relationship was noted between a in meat and meat products was more signifcantly associ- high-fber meal plan and the recurrence rate of colorectal ated with lower mortality than was eating cereal and fsh. It is worth noting that healthy eat- for the conficting results seen in these large observa- ing requires a healthy food supply, and implicit in this is tional studies. Of note, a pooled analysis of 13 prospec- the role of government and public health organizations. The Optimal Macronutrient Intake Thus, increasing fber intake should not be recommended Trial to Prevent Heart Disease (Omni-Heart) compared to lower the risk of colorectal neoplasia. Mortality was reduced among individu- pertension or stage 1 hypertension with uncontrolled but als who adhered to the healthier Mediterranean dietary pat- relatively normal blood lipid levels (i. Fruits and vegetables are individuals within the guidelines for calories and macro- naturally low in sodium and high in potassium, which con- nutrient distributions. Healthy carbohydrates are high in fber (both soluble and insoluble), sterols, and stanols, low in energy den- Whole Grains sity, and contain bioavailable micronutrients. Whole grains, such as oats, whole wheat, subtracted from total grams of carbohydrates, resulting in barley, rye, and brown and wild rice vary in their fber and the gram amount of available carbohydrates in the product. For exam- Therefore, it is possible to eat a plant-based meal that is ple, the soluble fber content is high in oats and barley, low in carbohydrate (sugars and starches) due to the high while insoluble fber is found in the bran of whole wheat. For example, 3 grams of beta-glucan soluble fber per day from oats Fruits and Vegetables and barley or 7 grams per day of soluble fber from psyl- Fruit and vegetable intake should be ≥4. The refned grains, thus the availability of some micronutri- concentration of plant sterol and stanol esters in fruits ents typically is less. The food industry has increased the and vegetables is relatively low; therefore, to attain effec- amount of whole grain products available, which facilitates tive levels of sterols and stanols, foods with concentrated meeting the whole-grain intake recommendation. However, the Mediterranean meal plan daily servings of reduced-fat milk and yogurt (3. Mediterranean dietary pattern adapted with permission from Oldways Mediterranean Pyramid (Copyright of Oldways Preservation and Exchange Trust; Accessed at: http://www. Diet and lifestyle recommendations, revision 2006: A scientifc statement from the American Heart Association Nutrition Committee. Many com- mon cheeses are available as reduced- or no-fat versions, Protein Sources such as mozzarella, cheddar, Monterey Jack, brie, Swiss, Higher intake of protein (24% vs. Similar to dairy products, food sources of ani- The Mediterranean Diet Pyramid specifes increased plant mal proteins are an excellent source of micronutrients. Nuts, fruits, vegetables, and grains Skinless Poultry, Lean Fish, Reduced-Fat Cheese are discussed in either the carbohydrate or fats sections. Animal sources of protein can be sources of saturated Although less commonly eaten in the American meal plan, fat and cholesterol as well. Reduced-fat animal protein pulses and legumes (which include beans and lentils), are sources are recommended. Lean meat cuts, reduced-fat good sources of protein, soluble fber, and micronutrients. Soy foods can be incorporated into Clinical Practice Guidelines for Healthy Eating, Endocr Pract. Soy protein in concentrated tant when recommending increased intake of omega-3 forms (such as supplements) should be used with caution fatty acids. Increasing intake of omega-3 fatty acids can be due to its potential estrogenic effects. Omega-3 atherosclerotic progression in humans is more diffcult, fatty acids produce eicosanoids that are vasodilatory and and these results have not been replicated in humans. Olive oil and nuts have other as part of a meal plan low in saturated fat and cholesterol benefcial components, such as polyphenols. With the exception gin olive oil but absent in refned olive oil are thought to be of vitamin D, vitamins are not synthesized by the body responsible for this effect. A meal plan emphasizing clinical vitamin defciency syndromes but can also lead to Clinical Practice Guidelines for Healthy Eating, Endocr Pract. Gross vitamin defciency still occurs in for adults in the post-folate food fortifcation era found that populated areas of the world where meals are poor in nutri- patients with vitamin B12 defciency had higher folate lev- tional value. Given the high prevalence of vitamin malabsorptive bariatric surgery, hemodialysis, and inborn B12 defciency and the ease and safety of treatment, some errors of metabolism. This policy has not been ent in 10 to 20% of older adults and is more prevalent in endorsed in formal guidelines. Methyl malonic intranasal) vitamin B12 treatment, patients with vitamin acid is elevated in the presence of vitamin B12 defciency. B12 defciency can generally be treated with oral vitamin Vitamin B12 defciency can result from lack of the intrin- B12 (1,000 µg/day of oral crystalline cobalamin). Regardless, for individuals to reach ing, nor are there guidelines for when that testing should a level of 30 ng/mL, vitamin D intake needs to be greater occur. This will often mentation has been shown to reduce fall frequency by half require the use of vitamin D supplements. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. This is the highest level of daily consumption that current data have shown to cause no side effects in humans when used indefnitely without medical supervision.

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Strong social support leads to im- Socioeconomic and ethnic inequalities Recommendations proved clinical outcomes cheap nimodipine 30mg overnight delivery, a reduction in exist in the provision of health care to c Providers should assess social con- psychosocial issues discount nimodipine 30mg, and adoption of individuals with diabetes (46) cheap nimodipine 30 mg fast delivery. A for poor metabolic control and poor ability of nutritious food and the inability c Patients should be referred to lo- emotional functioning (47). Significant to consistently obtain food without re- cal community resources when racial differences and barriers exist in sorting to socially unacceptable practices. Over 14% (or one of every seven people c Patients should be provided with self- in the U. The rate is management support from lay health Lack of Health Insurance higher in some racial/ethnic minority coaches, navigators, or community Not having health insurance affects the groups including African American and health workers when available. A processes and outcomes of diabetes Latino populations, in low-income house- care. Individuals without insurance cov- holds,andinhomesheadedbyasin- The causes of health disparities are com- erage for blood glucose monitoring sup- gle mother. In a recent study of tritious food and less expensive energy- socioeconomic status, poor access to predominantly African American or His- and carbohydrate-dense processed foods, health care, education, and lack of health panic uninsured patients with diabetes, which may contribute to obesity. Therefore, in mental, political, and social conditions in by treatments to under 130 mmHg (50). Reasons activity, and smoking place on the health System-Level Interventions for the increased risk of hyperglycemia in- of patients with diabetes, efforts are Eliminating disparities will require indi- clude the steady consumption of inexpen- needed to address and change the societal vidualized, patient-centered, and cultur- sive carbohydrate-rich processed foods, determinants of these problems (41). Structured filling of diabetes medication prescrip- tween social and environmental factors interventions that are developed for di- tions, and anxiety/depression leading to and the development of obesity and verse populations and that integrate poor diabetes self-care behaviors. Hypo- type 2 diabetes and has issued a call for culture, language, finance, religion, and glycemia can occur as a result of inade- research that seeks to better understand literacy and numeracy skills positively quate or erratic carbohydrate consumption how these social determinants influence influence patient outcomes (51). All following administration of sulfonylureas behaviors and how the relationships be- providers and health care systems are orinsulin. StandardsforAmbulatory CaredMeasuring tients and the parents of patients with Healthcare Disparities (52). Ethnic, cultural, and sex differences may Community Support affect diabetes prevalence and out- Identification or development of re- Treatment Options comes. Long-term tailored diabetes self-management interven- immediately before meals, thus obviating and recent progress in blood pressure levels tion for low-income Latinos: Latinos en Control. Beyond Health literacy explains racial disparities in di- For those needing insulin, short-acting comorbidity counts: how do comorbidity type abetes medication adherence. J Health Com- insulin analogs, preferably delivered by a and severity influence diabetes patients’ treat- mun 2011;16(Suppl. Di- tern Med 2007;22:1635–1640 abetes performance measures: current status consumption, whenever food becomes 5. While such insulin analogs Language barriers, physician-patient language 1651–1659 may becostly,many pharmaceuticalcom- concordance, and glycemic control among in- 22. J Gen Intern port systems on practitioner performance and Med 2011;26:170–176 patient outcomes: a systematic review. Chronic care model and ultra-long-acting insulin analog may be tes Care 2010;33:940–947 shared care in diabetes: randomized trial of an prescribed simply to prevent marked hy- 7. Therefore, it is important to con- 3-year follow-up of clinical and behavioral im- nitoring in veterans with type 2 diabetes: the provements following a multifaceted diabetes DiaTel randomized controlled trial. Collabo- Diabetes self-management education and sup- educational programs and materials in rative care for patients with depression and chronic port in type 2 diabetes: a joint position state- multiple languages with the specific illnesses. N Engl J Med 2010;363:2611–2620 ment of the American Diabetes Association, the 11. Risk of coronary artery disease in type 2 di- and the Academy of Nutrition and Dietetics. Di- diabetes awareness in people who can- abetes and the delivery of care consistent with abetes Care 2015;38:1372–1382 not easily read or write in English. How our current medical improving adherence to treatment recommenda- Homelessness often accompanies many care system fails people with diabetes: lack of tions in people with type 2 diabetes mellitus. Treat- Effectiveness of quality improvement strategies ciencies, lack of insurance, cognitive ment intensification and risk factor control: to- on the management of diabetes: a systematic dysfunction, and mental health issues. Lancet 2012;379: Therefore, providers who care for Med Care 2009;47:395–402 2252–2261 14. Effects homeless individuals should be well tensification of antihyperglycemic therapy of care coordination on hospitalization, quality versed or have access to social workers among patients with incident diabetes: a Surveil- of care, and health care expenditures among to facilitate temporary housing for their lance Prevention and Management of Diabetes Medicare beneficiaries: 15 randomized trials. Ann Fam Med places to keep their diabetes supplies ogy and definitions of medication adherence and 2007;5:233–241 and refrigerator access to properly store persistence in research employing electronic da- 31. Shareddecision-making Twelve evidence-based principles for implement- [Internet], 2001. Arch Intern Med 2003;163:83–90 for type 2 diabetes mellitus: a randomized con- in U. Arch Intern Med 2008;168:1776– 2013;368:1613–1624 domized trial of a literacy-sensitive, culturally 1782 S10 Promoting Health and Reducing Disparities in Populations Diabetes Care Volume 40, Supplement 1, January 2017 35. Community health ambassadors: a model betes as risk factor for incident coronary heart 53. J Public Health tematic review and meta-analysis of 64 cohorts lable from http://www. Curr Diab Rep 2013;13: striking the balance between participation and treatment, control and monitoring of diabetes? The Patient- nity 2010;18:572–587 abetes control with reciprocal peer support ver- CenteredOutcomesResearchInstitutedpromoting 47. Glucose control in diabetes: the impact of through action on the social determinants of in African American veterans: a randomized tri- racial differences on monitoring and outcomes. Self-management education pro- iris/bitstream/10665/43943/1/9789241563703_eng testing supplies is associated with poorer glyce- grammes by lay leaders for people with chronic. Who for multidisciplinary approaches to eliminate ical outcomes for low-income adults with canprovide diabetesself-management supportin diabetes-related health disparities. The impact of social tific statement: socioecological determinants of The impact of culturally competent diabetes care support on outcomes in adult patients with prediabetes and type 2 diabetes. Diabetes Care interventions for improving diabetes-related out- type 2 diabetes: a systematic review. Curr Diab 2013;36:2430–2439 comes in ethnic minority groups: a systematic re- Rep 2012;12:769–781 43. Diabetes Care 2002;25:1862–1868 consensus standards for ambulatory cared Engl J Med 2010;363:6–9 Diabetes Care Volume 40, Supplement 1, January 2017 S11 American Diabetes Association 2. Type 1 diabetes (due to autoimmune b-cell destruction, usually leading to ab- solute insulin deficiency) 2. Type 2 diabetes (due to a progressive loss of b-cell insulin secretion frequently on the background of insulin resistance) 3. Type 1 diabetes and type 2 diabetes are heterogeneous diseases in which clinical presentation and disease progression may vary considerably. Classification is im- portant for determining therapy, but some individuals cannot be clearly classified as having type 1 or type 2 diabetes at the time of diagnosis. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both cohorts. The onset of type 1 diabetes may be more variable in adults, and they may not present with the classic symptoms seen in children.