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      The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

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          Abstract

          The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              The PHQ-9

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                Author and article information

                Contributors
                righ@soton.ac.uk
                Journal
                Diabetologia
                Diabetologia
                Diabetologia
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0012-186X
                1432-0428
                30 September 2021
                : 1-44
                Affiliations
                [1 ]GRID grid.5491.9, ISNI 0000 0004 1936 9297, Human Development and Health, Faculty of Medicine, , University of Southampton, ; Southampton, UK
                [2 ]GRID grid.430506.4, Southampton National Institute for Health Research Biomedical Research Centre, , University Hospital Southampton NHS Foundation Trust, ; Southampton, UK
                [3 ]GRID grid.7177.6, ISNI 0000000084992262, Amsterdam UMC, Internal Medicine, , University of Amsterdam, ; Amsterdam, the Netherlands
                [4 ]GRID grid.418757.8, ISNI 0000 0001 0669 446X, Profil Institute for Metabolic Research, ; Neuss, Germany
                [5 ]GRID grid.170205.1, ISNI 0000 0004 1936 7822, Kovler Diabetes Center, , University of Chicago, ; Chicago, IL USA
                [6 ]GRID grid.34477.33, ISNI 0000000122986657, UW Medicine Diabetes Institute, ; Seattle, WA USA
                [7 ]GRID grid.10698.36, ISNI 0000000122483208, University of North Carolina School of Medicine, ; Chapel Hill, NC USA
                [8 ]GRID grid.5522.0, ISNI 0000 0001 2162 9631, Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, , Jagiellonian University Medical College, ; Kraków, Poland
                [9 ]GRID grid.412282.f, ISNI 0000 0001 1091 2917, University Hospital Carl Gustav Carus, Technische Universität Dresden, ; Dresden, Germany
                [10 ]GRID grid.419658.7, ISNI 0000 0004 0646 7285, Steno Diabetes Center Copenhagen, ; Gentofte, Denmark
                [11 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, University of Copenhagen, ; Copenhagen, Denmark
                [12 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, University of California, ; San Diego, CA USA
                [13 ]GRID grid.157868.5, ISNI 0000 0000 9961 060X, Montpellier University Hospital, ; Montpellier, France
                [14 ]GRID grid.121334.6, ISNI 0000 0001 2097 0141, Institute of Functional Genomics, , University of Montpellier, CNRS, Inserm, ; Montpellier, France
                [15 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, University of Miami Miller School of Medicine, ; Miami, FL USA
                [16 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Amsterdam UMC, Medical Psychology, , Vrije Universiteit, ; Amsterdam, the Netherlands
                [17 ]GRID grid.411023.5, ISNI 0000 0000 9159 4457, SUNY Upstate Medical University, ; Syracuse, NY USA
                [18 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Keck School of Medicine of USC, ; Los Angeles, CA USA
                Article
                5568
                10.1007/s00125-021-05568-3
                8481000
                34590174
                87694cce-a742-4e5a-ab9e-4aacf473d68d
                © European Association for the Study of Diabetes and American Diabetes Association 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Categories
                Consensus Report

                Endocrinology & Diabetes
                adjunctive therapy,diabetic ketoacidosis,diagnosis,exercise,glucose monitoring,hypoglycaemia,insulin,nutrition,psychosocial care,schedule of care,transplantation,type 1 diabetes

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