Perioperative management of adult patients with concomitant diabetes mellitus: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (second revision)
ISSN (print) 1726-9806     ISSN (online) 1818-474X
#2023-1
PDF_2023-1_14-33 (Russian)
HTML_2023-1_14-33 (Russian)

Keywords

diabetes mellitus
impaired glucose tolerance
hyperglycemia
hypoglycemia
glycemic control
glycated hemoglobin A
perioperative period
stress hyperglycemia
anesthesia
intensive care

How to Cite

1.
Zabolotskikh I.B., Malyshev Y.P., Dunts P.V., Lebedinskii K.M., Leiderman I.N., Neimark М.I., Semenikhina Т.М., Yaroshetskiy A.I. Perioperative management of adult patients with concomitant diabetes mellitus: guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (second revision). Annals of Critical Care. 2023;(1):14-33. doi:10.21320/1818-474X-2023-1-14-33

Statistic

Abstract Views: 595
PDF_2023-1_14-33 (Russian) Downloads: 983
HTML_2023-1_14-33 (Russian) Downloads: 1474
Statistic from 01.07.2024

Language

English Русский

Social Networks

Abstract

Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.

PDF_2023-1_14-33 (Russian)
HTML_2023-1_14-33 (Russian)

References

  1. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 10-й вып. (дополненный). М., 2021. DOI: 10.14341/DM12802 [Standards of specialized diabetes care. Edited by I.I. Dedov, M.V. Shestakova, A.Yu. Mayorov. 10th Edition (revised). М., 2021. DOI: 10.14341/DM12802 (In Russ)]
  2. Интенсивная терапия: национальное руководство. Под ред. И.Б. Заболотских, Д.Н. Проценко. 2-е изд., перераб. и доп. Т. 2. М.: ГЭОТАР-Медиа, 2021. [Intensive care: National Guidelines. Ed. I.B. Zabolotskikh, D.N. Protsenko. 2nd ed., reprint. and additional T. 2. M.: GEOTAR-Media, 2021. (In Russ)]
  3. ADA. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022; 45(Suppl. 1): S17–S38. DOI: 10.2337/dc22-S002
  4. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD — Summary. Diab Vasc Dis Res. 2014; 11(3): 133–73. DOI: 10.1177/1479164114525548
  5. Tsubo T., Kudo T., Matsuki A., Oyama T. Decreased glucose utilization during prolonged anaesthesia and surgery. Can J Anaesth. 1990; 37: 645–9. DOI: 10.1007/BF03006483
  6. Эндокринология. Национальное руководство. Краткое издание. Под ред. И.И. Дедова, Г.А. Мельниченко. М.: ГЕОТАР-Медиа, 2011. [Endocrinology. National Guidelines. Short Edition. Ed. I.I. Dedov, G.А. Melnichenko. M.: GEOTAR-Media, 2011. (In Russ)]
  7. Miller J.D., Richman D.C. Preoperative Evaluation of Patients with Diabetes Mellitus. Anesthesiology Clin. 2016; 34: 155–69. DOI: 10.1016/j.anclin.2015.10.008
  8. Ewing D.J., Campbell I.W., Clarke B.F. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med. 1980; 92(2 Pt 2): 308–11. DOI: 10.7326/0003-4819-92-2-308
  9. Albertini J.P., Cohen R., Valensi P., et al. B-type natriuretic peptide, a marker of asymptomatic left ventricular dysfunction in type 2 diabetic patients. Diabetes Metab. 2008; 34(4 Pt 1): 355–62. DOI: 10.1016/j.diabet.2008.02.004
  10. Valensi P., Cosson E. It is not yet the time to stop screening diabetic patients for silent myocardial ischaemia. Diabetes Metab. 2010; 36: 91–6. DOI: 10.1016/j.diabet.2010.01.001
  11. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013; 34(39): 3035–87. DOI: 10.1093/eurheartj/eht108
  12. American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022; 45(Suppl 1): S144–S174. DOI: 10.2337/dc22-S010
  13. Spallone V., Ziegler D., Freeman R., et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011; 27: 639–53. DOI: 10.1002/dmrr.1239
  14. Ziegler D., Cicmir I., Mayer P., et al. Peripheral and autonomic nerve dysfunction in newly diagnosed insulin-dependent diabetes. Transplant Proc. 1986; 18: 1593–4.
  15. Pop-Busui R., Evans G.W., Gerstein H.C., et al. Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care. 2010; 33: 1578–84. DOI: 10.2337/dc10-0125
  16. Cheisson G., Jacqueminet S., Cosson E., et al. Perioperative management of adult diabetic patients: preoperative period. Anaesth Crit Care Pain Med. 2018; 37: S9–S19. DOI: 10.1016/j.accpm.2018.02.020
  17. Levey A.S., de Jong P.E., Coresh J., et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Intern. 2011; 80: 17–28. DOI: 10.1038/ki.2010.483
  18. Gerstein H.C., Mann J.F., Yi Q., et al. Albuminuria and risk of cardiovascular events, death and heart failure in diabetic and nondiabetic individuals. JAMA. 2001; 286: 421–6. DOI: 10.1001/jama.286.4.421
  19. Martínez-Castelao A., Navarro-González J.F., Górriz J.L., de Alvaro F. The Concept and the Epidemiology of Diabetic Nephropathy Have Changed in Recent Years. J Clin Med. 2015; 4(6): 1207–16. DOI: 10.3390/jcm4061207
  20. Eboh C., Chowdhury T.A. Management of diabetic renal disease. Ann Transl Med. 2015; 3: 154. DOI: 10.3978/j.issn.2305-5839.2015.06.25
  21. Ichai C., Vinsonneau C., Souweine B., et al. Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies). Anaesth Crit Care Pain Med. 2016; 35: 151–65. DOI: 10.1016/j.accpm.2016.03.004
  22. Genuth S., Alberti K.G., Bennett P., et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003; 26: 3160–7. DOI: 10.2337/diacare.26.11.3160
  23. WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Geneva: World Health Organization, 1999. Report no. 99.2. Available from: http://apps.who.int/iris/bitstream/handle/10665/66040/WHO_NCD_NCS_99.2.pdf Accessed on November 22, 2022
  24. Потемкин В.В., Старостина Е.Г. Неотложная эндокринология: Рук-во для врачей. М.: ООО «Медицинское информационное агентство», 2008. [Potemkin V.V., Starostina E.G. Emergency endocrinology: Hands. for doctors. M.: LLC "Medical information Agency", 2008. (In Russ)]
  25. World Health Organization & International Diabetes Federation. (‎2006)‎. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. World Health Organization. ISBN 9241594934 Available from: https://apps.who.int/iris/handle/10665/43588 Accessed on November 22, 2022
  26. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997; 20: 1183–97. DOI: 10.2337/diacare.20.7.1183
  27. Lazar H.L., McDonnell M., Chipkin S.R., et al. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009; 87: 663–9. DOI: 10.1016/j.athoracsur.2008.11.011
  28. Bhamidipati C.M., LaPar D.J., Stukenborg G.J., et al. Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011; 141: 543–51. DOI: 10.1016/j.jtcvs.2010.10.005
  29. Desai S.P., Henry L.L., Holmes S.D., et al. Strict versus liberal target range for perioperative glucose in patients undergoing coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac cardiovasc Surg. 2012; 143: 318–25. DOI: 10.1016/j.jtcvs.2011.10.070
  30. Fish L.H., Weaver T.W., Moore A.L., Steel L.G. Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting. Am J. Cardiol. 2003; 92: 74–6. DOI: 10.1016/s0002-9149(03)00472-7
  31. Schopman J.E., Geddes J., Frier B.M. Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated type 2 diabetes. Diabetes Res Clin Pract. 2010; 87: 64–8. DOI: 10.1016/j.diabres.2009.10.013
  32. American Diabetes Association Professional Practice Committee, Draznin B., Aroda V.R., et al. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022; 45(Suppl 1): S83–S96. DOI: 10.2337/dc22-S006
  33. Greci L.S., Kailasam M., Malkani S., et al. Utility of HbA(1c) levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes Care. 2003; 26(4): 1064–8. DOI: 10.2337/diacare.26.4.1064
  34. Association of Anaesthetists of Great Britain and Ireland. Barker P., Creasey P.E., Dhatariya K., et al. Guidelines. Perioperative management of the surgical patient with diabetes, 2015. Anaesthesia, 2015; 10: 1111–4. DOI: 10.1111/anae.13233
  35. van den Berghe G., Wouters P., Weekers F., et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345: 1359–67. DOI: 10.1056/NEJMoa011300
  36. Периоперационное ведение пациентов с сопутствующими заболеваниями. Рук-во для врачей. Под ред. И.Б. Заболотских. М.: Практическая медицина, 2019. [Perioperative management of patients with concomitant diseases. A guide for doctors. Ed. I.B. Zabolotskikh. M.: Practical medicine, 2019. (In Russ)]
  37. Dhatariya K., Levy N., Flanagan D., et al. JBDS-IP. Management of adults with diabetes undergoing surgery and elective procedures: Improving standards. Summary. Revised March. 2016.
  38. Ткачева О.Н., Верткин А.Л. Диабетическая автономная нейропатия: руководство для врачей. М.: ГЭОТАР-Медиа, 2009. [Tkacheva О.N., Vertkin А.L. Diabetic autonomic neuropathy: A guide for doctors. M.: GEOTAR-Media, 2009. (In Russ)]
  39. Ермолов А.С., Попова Т.С., Пахомова Г.В. и др. Синдром кишечной недостаточности в неотложной абдоминальной хирургии (от теории к практике). М.: МедЭкспертПресс, 2005. [Ermolov A.C., Popova T.S., Pahomova G.V., et al. Intestinal insufficiency syndrome in emergency abdominal surgery (from theory to practice). M.: MedExpertPress, 2005. (In Russ)]
  40. Kempler P. Neuropathies: pathomechanism, clinical presentation, diagnosis, therapy. Ed by P. Kemple. Springer, 2002.
  41. Roizen M.F., Fleisher L.A. Периоперационное ведение пациентов с сопутствующими заболеваниями. В кн.: «Анестезия» Рональда Миллера. Под ред. Р. Миллера. Пер. с англ. под общ. ред. К.М. Лебединского: В 4 т. СПб.: Человек, 2015. Т. 2. 1139–234. [Roizen M.F., Fleisher L.A. Perioperative management of patients with concomitant diseases. In: "Anesthesia" Ronald Miller / Ed. Ronald Miller. Translated from English under the general ed . K.M. Lebedinskii: in 4 vols. St. Petersburg: Chelovek, 2015, vol. 2. P. 1139–234. (In Russ)]
  42. Schumann R., Shikora S.A., Sigl J.C., et al. Association of metabolic syndrome and surgical factors with pulmonary adverse events, and longitudinal mortality in bariatric surgery. Br J Anaesth. 2015; 114(1): 83–90. DOI: 10.1093/bja/aeu362
  43. Welch M.B., Brummett C.M., Welch T.D., et al. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology. 2009; 111: 490–7. DOI: 10.1097/ALN.0b013e3181af61cb
  44. Williams B.A., Murinson B.B. Diabetes mellitus and subclinical neuropathy: a call for new paths in peripheral nerve block research. Anesthesiology. 2008; 109(3): 361–2. DOI: 10.1097/ALN.0b013e3181829f0d
  45. Robertshaw H.J., Hall G.M. Diabetes mellitus: anaesthetic management [published correction appears in Anaesthesia. 2007; 62(1): 100]. Anaesthesia. 2006; 61(12): 1187–90. DOI: 10.1111/j.1365-2044.2006.04834.x
  46. Куклин В.Н., Матри Ю., Барлоу Н.П. и др. Современные направления в лечении периоперационной гипергликемии у хирургических больных с сахарным диабетом: обзор литературы. Вестник интенсивной терапии им. А.И. Салтанова. 2021; 4: 33–47. DOI: 10.21320/1818-474X-2021-4-33-47 [Kuklin V.N., Matri J., Barlow N.P., et al. Current trends in management of hyperglycaemia in surgical patients with diabetes mellitus: a review. Annals of Critical Care. 2021; 4: 33–47. DOI: 10.21320/1818-474X-2021-4-33-47 (In Russ)]
  47. Kempler P., Amarenco G., Freeman R., et al. Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes Metab Res Rev. 2011; 27: 665–77. DOI: 10.1002/dmrr.1223
  48. Phillips L.K., Rayner C.K., Jones K.L., Horowitz M. Measurement of gastric emptying in diabetes. J Diabetes Complications. 2014; 28(6): 894–903. DOI: 10.1016/j.jdiacomp.2014.06.005
  49. Knüttgen D., Trojan S., Weber M., et al. Präoperative Bestimmung der Herzfrequenzvariabilität bei Diabetikern zur Einschätzung des Blutdruckverhaltens während der Anästhesieeinleitung [Pre-operative measurement of heart rate variability in diabetics: a method to estimate blood pressure stability during anaesthesia induction]. Anaesthesist. 2005; 54(5): 442–9. DOI: 10.1007/s00101-005-0837-y
  50. Packer M. Аспирация. В кн.: Секреты анестезии / Джеймс Дюк. Пер. с англ. под общ. ред. А.П. Зильбера, В.В. Мальцева. Гл. 43. М.: МЕДпресс-информ, 2005. С. 257–60. [Packer M. Aspiration. In: Secrets of anesthesia / James Duke. Translated from English: Under the general editorship of A.P. Zilber, V.V. Maltsev. Ch. 43. M.: MEDpress-inform, 2005. P. 257–60. (In Russ)]
  51. Huang C.J., Kuok C.H., Kuo T.B., et al. Pre-operative measurement of heart rate variability predicts hypotension during general anesthesia. Acta Anaesthesiol Scand. 2006; 50: 542–8. DOI: 10.1111/j.1399-6576.2006.001016.x
  52. Lankhorst S., Keet S.W., Bulte C.S., Boer C. The impact of autonomic dysfunction on perioperative cardiovascular complications. Anaesthesia. 2015; 70: 336–43. DOI: 10.1111/anae.12904
  53. Burgos L.G., Ebert T.J., Asiddao C., et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology. 1989; 70: 591–7. DOI: 10.1097/00000542-198904000-00006
  54. Kirno K., Lundin S., Elam M. Effects of intrathecal morphine and spinal anaesthesia on sympathetic nerve activity in humans. Acta anaesthesiol Scand. 1993; 37: 54–9. DOI: 10.1111/j.1399-6576.1993.tb03598.x
  55. Lundin S., Wallin B.G., Elam M. Intraneural recording of muscle sympathetic activity during epidural anesthesia in humans. Anesth Analg. 1989; 69: 788–93.
  56. Neukirchen M., Kienbaum P. Sympathetic nervous system: evaluation and importance for clinical general anesthesia. Anesthesiology. 2008; 109: 1113–31. DOI: 10.1097/ALN.0b013e31818e435c
  57. Kitamura A., Hoshino T., Kon T., Ogawa R. Patients with diabetic neuropathy are at risk of a greater intraoperative reduction in core temperature. Anesthesiology. 2000; 92: 1311–8. DOI: 10.1097/00000542-200005000-00019
  58. Заболотских И.Б., Малышев Ю.П. На пути к индивидуальной премедикации. Петрозаводск, 2006. [Zabolotskikh I.B., Malyshev Yu.P. On the way to individual premedication. Petrozavodsk, 2006. (In Russ)]
  59. Нираджан Н., Болтон Т., Бери К. Ускоряя восстановление после операции: современные достижения. Русская версия журнала Update in Anaesthesia. 2012; 26(1): 21–7. [Niradjan N., Bolton T., Beri K. Uskoryaya vosstanovleniye posle operatsii: sovremennye dostijeniya. Russkaya versiya jurnala Update in Anaesthesia. 2012; 26(1): 21–7. (In Russ)]
  60. Kitabchi A.E., Fisher J.N., Murphy M.B., Rumbak M.J. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In: Joslin’s Diabetes Mellitus 13th ed. Ed. C.R. Kann, G.C. Weir. Philadelphia, Pa., Lea & Febiger, 1994. P. 738–70.
  61. Kitabchi A.E., Umpierrez G.E., Miles J.M., et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009; 32(7): 1335–43. DOI: 10.2337/dc09-9032
  62. American Diabetes Association Professional Practice Committee, Draznin B., Aroda V.R., et al. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022; 45(Suppl 1): S97–S112. DOI: 10.2337/dc22-S007
  63. Clement S., Braithwaite S., Magee M.F., et al. Management of diabetes and hyperglycemia in hospital (ADA Technical Review). Diabetes Care. 2004; 27(2): 553–91. DOI: 10.2337/diacare.27.2.553
  64. Fisher J.N., Shahshahani M.N., Kitabchi A.E. Diabetic ketoacidosis: low-dose insulin. therapy by various routes. N Engl J Med. 1977; 297: 238–41. DOI: 10.1056/NEJM197708042970502
  65. Berger W., Keller U. Treatment of diabetic ketoacidosis and non-ketonic hyperosmolar coma. Clin Endocrinol Metab. 1992; 6: 1–22. DOI: 10.1016/s0950-351x(05)80328-3
  66. Walts L.F., Miller J., Davidson M.B., Brown J. Perioperative management of diabetes mellitus. Anesthesiology. 1981; 55: 104–9. DOI: 10.1097/00000542-198108000-00004
  67. Thomas D.J., Platt H.S., Alberty K.G. Insulin-dependent diabetes during the peri-operative period. An assessment of continuous glucose-insulin-potassium infusion, and traditional treatment. Anaesthesia. 1984; 39: 629–37. DOI: 10.1111/j.1365-2044.1984.tb06469.x
  68. Dungan K., Chapman J., Braithwaite S.S., Buse J. Glucose measurement: confounding issues in setting targets for inpatient management. Diabetes Care. 2007; 30: 403–9. DOI: 10.2337/dc06-1679
  69. Brown G., Dodek P. Intravenous insulin nomogram improves blood glucose control in the critically ill. Crit Care Med. 2001; 29: 1714–9. DOI: 10.1097/00003246-200109000-00010
  70. Preiser J.C., Devos P., Ruiz-Santana S., et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009; 35: 1738–48. DOI: 10.1007/s00134-009-1585-2
  71. Gandhi G.Y., Nuttall G.A., Abel M.D., et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007; 146: 233–43. DOI: 10.7326/0003-4819-146-4-200702200-00002
  72. Chamberlain J.J., Rhinehart A.S., Shaefer Ch.F., et al. Clinical Guidelines. Diagnosis and Management of Diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med. 2016; 164(8): 542–52. DOI: 10.7326/M15-3016
  73. International Hypoglycaemia Study Group. Glucose Concentrations of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017; 40(1): 155–7. DOI: 10.2337/dc16-2215
  74. Avanzini F., Marelli G., Donzelli W., et al. Transition from intravenous to subcutaneous insulin: effectiveness and safety of a standardized protocol and predictors of outcome in patients with acute coronary syndrome. Diabetes Care. 2011; 34: 1445–50. DOI: 10.2337/dc10-2023
  75. Аметов А.С. Сахарный диабет 2-го типа. Проблемы и решения. 3-е изд., перераб. и доп. M.: ГЭОТАР-Медиа, 2017. Т. 7. [Ametov A.S. Type 2 diabetes mellitus. Problems and solutions. 3rd ed., reprint. and additional. M.: GEOTAR-Media, 2017. Vol. 7. (In Russ)]
  76. Willi C., Bodenmann P., Ghali W.A., et al. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2007; 298: 2654–64. DOI: 10.1001/jama.298.22.2654
  77. Mann J.I., De Leeuw I., Hermansen K., et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis. 2004; 14: 373–94. DOI: 10.1016/s0939-4753(04)80028-0
  78. Bantle J.P., Wylie-Rosett J., Albright A.L., et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008; 31(Suppl 1): S61–S78. DOI: 10.2337/dc08-S061
  79. Sacks F.M., Bray G.A., Carey V.J., et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009; 360: 859–73. DOI: 10.1056 /NEJMoa0804748
  80. Wing R.R. Longterm effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010; 170: 1566–75. DOI: 10.1001/archinternmed.2010.334
  81. Sluik D., Buijsse B., Muckelbauer R., et al. Physical activity and mortality in individuals with diabetes mellitus: a prospective study and meta-analysis. Arch Intern Med. 2012: 1–11. DOI: 10.1001/archinternmed.2012.3130
  82. Vanhees L., Geladas N., Hansen D., et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk ESC Guidelines Summary 161 factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012; 19: 1005–33. DOI: 10.1177/1741826711430926
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.