There are many different types ofdiabetes. How they are treated differs, but the end goal is the same: achieving adequate blood sugar control to prevent or delaycomplications of diabetes. These range from vision loss to kidney damage.
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Complications of Diabetes
The complications of diabetes fall into two categories:
These types of complications typically occur as a result of chronically elevated blood sugar (hyperglycemia).
Elevated blood sugar can also cause an acute condition, such asdiabetic ketoacidosis(most common in people with type 1 diabetes) orhyperglycemic hyperosmolar nonketotic syndrome(HHNS). These complications can occur at any point. However, they are often associated with illness, insufficient insulin dosing, or insulin omission, and they can be prevented.
Hypoglycemia(low blood sugar) is also an acute condition that can be prevented and treated. Treating low blood sugar promptly will prevent a potentially dangerous situation.
Hypoglycemia typically presents as shakiness, sweatiness, and confusion, and should be treated promptly with a fast-acting carbohydrate, such as 4 ounces of juice, glucose tablets, or gel. Severe hypoglycemia can result in coma and, in severe instances, death. Therefore, understanding the signs, symptoms, and treatment of hypoglycemia is especially important.
The risk of developing chronic complications of diabetes will depend on the duration of the disease and the severity of hyperglycemia. Long-term complications of diabetes can be managed and prevented, but sometimes if complications are too advanced, they may develop into another chronic condition.
Microvascular Complications of Diabetes
Damage can occur in the eyes, kidneys, or nerves from high blood glucose levels.
Retinopathy
There are two different kinds of retinopathy—nonproliferative and proliferative. Extreme proliferative retinopathy can cause blindness if it is not detected and treated. People with diabetes are also at increased risk of developing glaucoma and cataracts.
With regular screenings, early detection, and adequate blood sugar control, problems of the eyes can be prevented. Also, advancements in treatments have made treating eye disease in people with diabetes successful.
The American Diabetes Association recommends that all people newly diagnosed with type 2 diabetes receive an eye exam shortly after diagnosis and every year thereafter. People with type 1 diabetes should receive a dilated eye exam within five years of diagnosis and every year after that.
Nephropathy
Nephropathy(or kidney damage) can occur when blood glucose levels have been elevated for an extended period. People with diabetes who develop kidney disease may have a genetic predisposition to kidney disease and blood pressure issues.
When diabetes damages the kidneys, it can cause protein to spill over into the urine (known asmicroalbuminuria).
When kidney disease is identified early, further complications can be prevented. However, people may need dialysis or a kidney transplant to stay healthy when kidney disease is discovered in later stages.
Keeping blood sugars in tight control can prevent kidney disease and, in some instances of mild kidney disease, even reverse it.
Neuropathy
Chronically elevated blood sugars can cause damage to the nerves. Different types of neuropathy includeperipheral neuropathy(which is the most common, affecting the feet, hands, legs, and arms) and autonomic neuropathy.
Peripheral neuropathy can lead to numbness, burning, pain, tingling, loss of feeling, difficulty in wound healing, and susceptibility to infections and ulcers in the extremities. Autonomic neuropathy refers tonerve damagethat can affect the stomach (as in gastroparesis, which is when the stomach cannot properly empty itself) and sex organs.
Problems with the nerves can affect most organ systems and present differently depending on the organ they have damaged. Some of these symptoms include gastroparesis, constipation,diarrhea, bladder control issues, problems with sex organs (such as erectile dysfunction), lightheadedness, and irregular heartbeat.
Cardiovascular autonomic dysfunction is associated with an increased risk of silent myocardial ischemia and mortality.
Macrovascular Complications
Cardiovascular Disease
Diabetes is one of the leading causes ofcardiovascular disease(heart disease), the leading cause of death in people with diabetes. In fact, the American Diabetes Association suggests that two-thirds of deaths in people with diabetes are from heart disease.
Some different types of cardiovascular disease are atherosclerosis, arrhythmias, and heart failure. People with poorly controlled diabetes who are overweight, have a family history of heart disease, and have high blood pressure, elevated cholesterol, and high triglycerides are at increased risk of developing heart disease.
Heart disease can cause heart attacks and strokes. Weight loss (if indicated), a healthy diet, exercise, and blood glucose control can reduce the risk of developing heart disease in the first place. Having thorough checkups can also help prevent disease through early detection and treatment.
Peripheral Vascular Disease
Symptoms of PAD include intermittent claudication (cramping or pain when walking that stops at rest), weakness in the lower extremities, pain, lack of pulses in the legs and feet, cold toes, sores, or ulcers in the legs or feet that don’t heal.
Stroke
A stroke occurs when blood flow to the brain is interrupted. People with diabetes are almost twice as likely to have astrokeas those who do not have diabetes.
You can take steps to reduce your risk. Keeping your blood sugar in good control, quitting smoking (if you smoke), and keeping blood pressure stable are just some of the things that can reduce your risk.
Steps to Take to Prevent Complications
The primary objective is good blood sugar control. But it is important to understand that many factors contribute to good blood sugar control. Getting educated, finding support, and having a trustworthy medical team to help you set and achieve goals are important to living a healthy life with diabetes.
7 Ways to Use Technology for Diabetes Management
Keep Blood Sugars in Good Control
Controlling blood sugars is the number one objective of diabetes management, but it involves many layers. Your blood sugar targets will depend on your age, activity level, the risk for hypoglycemia, and other medical conditions.
If you are not sure what your blood sugar targets are, it’s important to have a discussion with your medical team. For most people with diabetes,fasting blood sugarsshould be around 80 to 130 mg/dL; two hours after a meal they should be less than 180 mg/dL.
These numbers will be different if you are pregnant. Also, children with type 1 diabetes and older adults often have different target blood sugars. Many factors contribute to blood sugar control, such as diet, exercise, stress, sleep, and medication management.
When you have diabetes, healthy eating is an important part of treatment. People with diabetes should understand how carbohydrates (a macronutrient the body needs for fuel) impact blood sugar.
It is important to learn how to integrate healthy and safe eating patterns that are sustainable, ensure that you maintain the pleasure of eating, and help you reach your health goals. Both the Academy of Nutrition and Dietetics (AND) and the American Diabetes Association support an evidence-based approach to individualized meal planning.
Registered dietitian nutritionists (RDNs) can help people with diabetes focus on macronutrient quality while taking in cultural considerations, food preferences, metabolic goals, and eating patterns.
Some people with diabetes may benefit from counting carbohydrates, while others will take an interest in a low-carbohydrate or ketogenic diet. In some instances, simply following theplate methodand eating more plants (a Mediterranean-style diet) can help blood sugar management.
Understanding where carbohydrates come from, reading food labels, measuring portions, and accurately counting carbs will be valuable tools for achieving dietary goals.
There is no “one-size-fits-all” eating plan. What works for you may not work for someone else.
Exercise
Many adults struggle with consistent exercise due to perceived lack of time, lack of enjoyment, or inability to ease into it. Sometimes, people burn out if they start at too high of an intensity.
Other barriers to starting exercise include fear of low blood sugar, particularly for people who take insulin or other glucose-lowering medications, as well as other related health conditions. If you have diabetes, consult with your healthcare team before starting a new activity.
Find something you love to do and set short-term and long-term goals to keep you motivated and focused. Simply doing a few minutes daily and working your way up can have a big impact.
Lose Weight, If Needed
Researchers have found that a 5% weight reduction can improve insulin secretion and insulin sensitivity, with larger relative weight losses leading to improvements in fat tissue distribution.
A 5% to 10% reduction from starting weight is associated with clinically meaningful improvements in obesity-related metabolic risk factors.
If you have diabetes and struggle with your weight, losing weight will help improve blood sugars. In some instances, significant weight loss can help to reduce or stop medications. If you also struggle with elevated cholesterol, triglycerides, or blood pressure, losing weight can also help to improve those numbers.
Weight loss can be difficult, especially for people who have tried different “diets” and regained weight. The key to sustainable weight loss is to have continued support and education, and change behaviors slowly and steadily without feelings of deprivation and hunger.
Strategies such as carbohydrate counting, individualized meal planning, the plate method, and portion control can all be effective in weight loss. Losing weight doesn’t look the same for everyone; sometimes, medical nutrition therapy should focus on maintaining weight loss or preventing weight gain.
If you haven’t met with a registered dietitian, now might be the time to get started.
Take Medication As Prescribed
Medication management in combination with diet and exercise is often an essential part of reaching therapeutic goals. Timing, dosing, frequency, and specifications of use are important factors to consider when taking a medication.
If you are skipping medication dosages because of inconvenience or financial issues, it is important to raise your concerns with your medical team. Today, there are so many different classes ofdiabetes medicationsthat clinicians can take an individualized approach to diabetes care.
The best medication regimen is one that is simple, effective, and minimizes side effects. Share your thoughts and concerns with your healthcare team so they can provide you with education, help you overcome barriers, or prescribe a new medication to help control blood sugar.
If you are taking your medication as prescribed and notice that your blood sugar levels are above goal for a few days in a row despite your efforts to take your medicine, exercise, and eat healthily, you may need a medication change. Never stop taking anything you’ve been prescribed without first checking with your provider.
Test Your Blood Glucose
Monitoring your blood sugar can help you pattern and identify triggers that can cause blood sugar to fluctuate. For example, if your blood sugar is elevated two hours after dinner, you may be able to reduce your portion of carbohydrates at that meal to help reduce your blood sugar next time.
Blood glucose testing and logging, whether you use an app or a continuous glucose monitor, can help you tighten your diabetes control.
Get Preventive Care and Screenings
Knowing your blood glucose, blood pressure, and cholesterol levels can be an effective way to prevent complications of diabetes that are related to your heart, eyes, nerves, and kidneys. Your hemoglobin A1C (a three-month average of blood sugar), blood pressure, and cholesterol are important numbers that you should understand.
Keeping these numbers in a healthy range can help protect you from developing diabetes complications.
Meet With a Certified Diabetes Care and Education Specialist
Certified diabetes care and education specialists (CDCES) are experts in all aspects of diabetes self-management education and support (DSMES).
The American Diabetes Association notes four critical timepoints when the medical care provider and/or multidisciplinary team should evaluate the need for DSMES:
CDCESs can help people make behavior modifications that are necessary for having good diabetes control and health.
If you haven’t met with one of these specialists, ask your medical team for more information or contact your insurance company for a list of referrals. Many CDCESs offer virtual sessions, so you might be able to receive your education in the comfort of your own home.
Consider Intermittent Fasting
Intermittent fastingalternates times of eating and times of fasting. There are many different intermittent fasting approaches: some people alternate fasting days, while others restrict food for a certain number of hours per day.
Modified fasting includes limiting calories on fasting days to roughly 20% to 25% of your daily needs. Because there is no clear, universal definition of fasting, this type of dietary strategy is not meant for everyone.
The research is still emerging, but some studies suggest that intermittent fasting may help to improve insulin sensitivity and have other beneficial health effects.However, long-term research is lacking, and many of the studies are done on animals, small groups, and for short periods of time.
It’s important to note that if you take glucose-lowering medication such as insulin or oral glucose medications, you should contact your healthcare providers before starting any fasting, as it could cause hypoglycemia.
2:01Click Play to Learn About Diabetes and Intermittent Fasting
2:01
Click Play to Learn About Diabetes and Intermittent Fasting
Get Better Sleep
Poor sleep quality and inadequate sleep have been identified as risk factors for poor glycemic control or elevated blood sugar.Sleep-related issues are also associated with restless legs syndrome and sleep apnea. If you or someone you love is having issues sleeping, talk to your medical healthcare provider.
Helpful strategies you can start at home include avoiding technology or blue lights 30 minutes before sleep; keeping your room dark, cool, and quiet; sleeping in comfortable, loose-fitting clothing; and avoiding stimulants like coffee and chocolate before bedtime.
Most adults benefit from sleeping seven or more hours per night.
Encourage Good Gut Health
There is an association between gut dysbiosis and diabetes.Dysbiosis occurs when there is an unhealthy balance between good bacteria and bad bacteria.
Eating foods containing prebiotics and probiotics, including fibrous and fermented foods such as fruits, vegetables, whole grains, fermented vegetables, yogurt, and kefir, may helpbalance gut bacteria.
Some people with diabetes benefit from taking a probiotic.There are also certain supplements geared toward gut health and diabetes. Ask your healthcare provider about the different probiotic strains and if they would be helpful to you.
Take Care of Your Feet
Practice good hygiene and inspect your feet regularly, checking between the toes.
Do notwalk around barefoot, especially if you have neuropathy.Special footwearmay be needed to properly support your feet.
Don’t Forget About Mental Health
Taking care of your mental health is just as important as taking care of your physical health. Too much stress can lead to depression, and people with diabetes are at an increased risk of being depressed.
Some studies have shown that people who are insulin resistant may also have an increased risk of developing depression.If you are experiencingsigns of depression—such as feelings of sadness, worthlessness, fatigue, lack of interest in doing the things you love, or sleep disruption—it’s important to contact your healthcare provider right away.
Simplify Your Regimen
Forgetting to take your medicines daily? Having trouble following your meal plan due to your work schedule? Skipping medication doses or a change in diet can influence your blood sugars.
If you are having trouble following your regimen, you may need to make some adjustments. It’s important to know that you are supported. By expressing your needs, your medical team can help you achieve your goals and get your blood sugars in a good range.
Simplifyingmay mean sharing your blood glucose values with your medical team via technology or using certain applications to help you count carbohydrates. Others may define simplifying as something different.
Smoking Cessation
The Centers for Disease Control and Prevention (CDC) advise that, regardless of which diabetes type you’ve been diagnosed with, smoking will make your diabetes harder to control. So, if you have diabetes and you smoke, you are more likely to have serious health problems related to your diabetes.
Quitting may appear to be an exceedingly difficult task, but many healthcare providers and hospitals have access to smoking cessation programs that support the individual behaviorally, emotionally, and physically.
The CDC also offers free assistance. For free smoking cessation, call 1-800-784-8669 or visit theagency’s website.
Keep Up With Appointments
Some healthcare providers should be seen routinely, and other types of practitioners may need to be seen when something in your health changes. Your primary care physician, certified diabetes care and education specialist, or your endocrinologist can help find specialists.
Some healthcare providers you might be referred to include:
Ophthalmologist: An ophthalmologist specializes in eye health. Early detection of eye disease can prevent complications of diabetes.
Vascular specialist: If you have experienced peripheral arterial disease symptoms, you may be referred to a vascular specialist. They can examine you and conduct specific tests to assess your health.
Nephrologist: A nephrologist specializes in kidney disease. Most of the time, your primary healthcare provider will conduct tests to assess your kidney function, but a nephrologist may be recommended if there are any indicators of kidney disease. Early detection and treatment can prevent further complications.
Cardiologist: A cardiologist specializes in the heart. Because people with diabetes are at increased risk of developing heart disease, they are often referred to a cardiologist.
Endocrinologist: Anendocrinologistis a healthcare provider that specializes in hormonal glands and the diseases that affect them. You may be referred to an endocrinologist for medication management or assessment of diseases related to diabetes.
Because endocrinology is such a vast and diverse field, some endocrinologists will choose to limit their practice to specific conditions, populations, or procedures. You may hear of an endocrinologist being referred to as a “diabetes healthcare provider.”
If you are referred to an endocrinologist, it doesn’t mean you’ve “failed” diabetes management. It may simply mean that you need some additional assistance in getting your blood sugar stabilized.
A Word From Verywell
Diabetes is a complicated disease that requires daily self-management to keep blood sugars at goal. While there are certain variables you may not be able to control, there are also many variables that you can.
Keeping your blood sugars at a healthy range will help to prevent or delay complications of diabetes. In some instances, getting control of your blood sugar can reverse certain complications. The key is getting into a routine that works for you and finding your support.
Steps that can help you take control of your health are within reach. Start with small, realistic, and tangible goals, and build on your progress over time.
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24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Diabetes Association.Complications: Eye complications.American Diabetes Association.What can you do to protect your eyes?American Heart Association.The connection between diabetes, kidney disease and high blood pressure.American Diabetes Association.Chronic kidney disease (nephropathy).National Institute of Neurological Issues and Stroke.Peripheral neuropathy.Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1American Diabetes Association.Cardiovascular disease.American Diabetes Association.Get serious about stroke prevention.American Diabetes Association.Blood glucose meters can play an important role in diabetes care.Evert AB, Dennison M, Gardner CD, et al.Nutrition therapy for adults with diabetes or prediabetes: a consensus report.Dia Care.2019;42(5)731-754. doi:10.2337/dci19-0014American Diabetes Association.Blood sugar and exercise.Franz MJ.Weight management: Obesity to diabetes.Diabetes Spectr. 2017;30(3):149-153. doi:10.2337/ds17-0011American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: Standards of Care in Diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010Association of Diabetes Care and Education Specialists.Diabetes self-management education & support (DSMES).American Diabetes Association Professional Practice Committee.5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes-2024[published correction appears in Diabetes Care. 2024 Feb 05;:].Diabetes Care. 2024;47(Suppl 1):S77-S110. doi:10.2337/dc24-S005de Cabo R, Mattson MP.Effects of intermittent fasting on health, aging, and disease.N Engl J Med. 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136Gordon B.What is intermittent fasting? Academy of Nutrition and Dietetics.Brouwer A, van Raalte DH, Rutters F, et al.Sleep and HbA1c in patients with type 2 diabetes: Which sleep characteristics matter most?Dia Care.2020;43(1):235-243. doi:10.2337/dc19-0550Centers for Disease Control and Prevention.About sleep.Sharma S, Tripathi P.Gut microbiome and type 2 diabetes: Where we are and where to go?J Nutr Biochemistry.2019(63):101-108. doi:10.1016/j.jnutbio.2018.10.003Kesika P, Sivamaruthi BS, Chaiyasut C.Do probiotics improve the health status of individuals with diabetes mellitus? A review on outcomes of clinical trials.Biomed Res Int. 2019;2019:1531567. doi:10.1155/2019/1531567Diabetes Teaching Center at the University of California, San Francisco.Blood sugar and stress.American Diabetes Association.Are you experiencing depression?Centers for Disease Control and Prevention.Smoking and diabetes.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Diabetes Association.Complications: Eye complications.American Diabetes Association.What can you do to protect your eyes?American Heart Association.The connection between diabetes, kidney disease and high blood pressure.American Diabetes Association.Chronic kidney disease (nephropathy).National Institute of Neurological Issues and Stroke.Peripheral neuropathy.Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1American Diabetes Association.Cardiovascular disease.American Diabetes Association.Get serious about stroke prevention.American Diabetes Association.Blood glucose meters can play an important role in diabetes care.Evert AB, Dennison M, Gardner CD, et al.Nutrition therapy for adults with diabetes or prediabetes: a consensus report.Dia Care.2019;42(5)731-754. doi:10.2337/dci19-0014American Diabetes Association.Blood sugar and exercise.Franz MJ.Weight management: Obesity to diabetes.Diabetes Spectr. 2017;30(3):149-153. doi:10.2337/ds17-0011American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: Standards of Care in Diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010Association of Diabetes Care and Education Specialists.Diabetes self-management education & support (DSMES).American Diabetes Association Professional Practice Committee.5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes-2024[published correction appears in Diabetes Care. 2024 Feb 05;:].Diabetes Care. 2024;47(Suppl 1):S77-S110. doi:10.2337/dc24-S005de Cabo R, Mattson MP.Effects of intermittent fasting on health, aging, and disease.N Engl J Med. 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136Gordon B.What is intermittent fasting? Academy of Nutrition and Dietetics.Brouwer A, van Raalte DH, Rutters F, et al.Sleep and HbA1c in patients with type 2 diabetes: Which sleep characteristics matter most?Dia Care.2020;43(1):235-243. doi:10.2337/dc19-0550Centers for Disease Control and Prevention.About sleep.Sharma S, Tripathi P.Gut microbiome and type 2 diabetes: Where we are and where to go?J Nutr Biochemistry.2019(63):101-108. doi:10.1016/j.jnutbio.2018.10.003Kesika P, Sivamaruthi BS, Chaiyasut C.Do probiotics improve the health status of individuals with diabetes mellitus? A review on outcomes of clinical trials.Biomed Res Int. 2019;2019:1531567. doi:10.1155/2019/1531567Diabetes Teaching Center at the University of California, San Francisco.Blood sugar and stress.American Diabetes Association.Are you experiencing depression?Centers for Disease Control and Prevention.Smoking and diabetes.
American Diabetes Association.Complications: Eye complications.
American Diabetes Association.What can you do to protect your eyes?
American Heart Association.The connection between diabetes, kidney disease and high blood pressure.
American Diabetes Association.Chronic kidney disease (nephropathy).
National Institute of Neurological Issues and Stroke.Peripheral neuropathy.
Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1
American Diabetes Association.Cardiovascular disease.
American Diabetes Association.Get serious about stroke prevention.
American Diabetes Association.Blood glucose meters can play an important role in diabetes care.
Evert AB, Dennison M, Gardner CD, et al.Nutrition therapy for adults with diabetes or prediabetes: a consensus report.Dia Care.2019;42(5)731-754. doi:10.2337/dci19-0014
American Diabetes Association.Blood sugar and exercise.
Franz MJ.Weight management: Obesity to diabetes.Diabetes Spectr. 2017;30(3):149-153. doi:10.2337/ds17-0011
American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: Standards of Care in Diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010
Association of Diabetes Care and Education Specialists.Diabetes self-management education & support (DSMES).
American Diabetes Association Professional Practice Committee.5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes-2024[published correction appears in Diabetes Care. 2024 Feb 05;:].Diabetes Care. 2024;47(Suppl 1):S77-S110. doi:10.2337/dc24-S005
de Cabo R, Mattson MP.Effects of intermittent fasting on health, aging, and disease.N Engl J Med. 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136
Gordon B.What is intermittent fasting? Academy of Nutrition and Dietetics.
Brouwer A, van Raalte DH, Rutters F, et al.Sleep and HbA1c in patients with type 2 diabetes: Which sleep characteristics matter most?Dia Care.2020;43(1):235-243. doi:10.2337/dc19-0550
Centers for Disease Control and Prevention.About sleep.
Sharma S, Tripathi P.Gut microbiome and type 2 diabetes: Where we are and where to go?J Nutr Biochemistry.2019(63):101-108. doi:10.1016/j.jnutbio.2018.10.003
Kesika P, Sivamaruthi BS, Chaiyasut C.Do probiotics improve the health status of individuals with diabetes mellitus? A review on outcomes of clinical trials.Biomed Res Int. 2019;2019:1531567. doi:10.1155/2019/1531567
Diabetes Teaching Center at the University of California, San Francisco.Blood sugar and stress.
American Diabetes Association.Are you experiencing depression?
Centers for Disease Control and Prevention.Smoking and diabetes.
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