James J. Chamberlain, MD; Kacie Doyle-Delgado, RN, ARNP; Lacie Peterson, MS, RDN, CDE; Neil Skolnik, MD
Note: The complete Standards of Medical Care in Diabetes—2019 was developed by the ADA's Professional Practice Committee: Joshua J. Neumiller, PharmD, CDE (Chair); Christopher Cannon, MD; Ian de Boer, MD, MS; Jill Crandall, MD; David D'Alessio, MD; Mary de Groot, PhD; Judith Fradkin, MD; Kathryn Kreider, DNP, APRN, FNP-BC, BC-ADM; David Maahs, MD, PhD; Nisa Maruthur, MD, MHS; Melinda Maryniuk, Med, RD, CDE; Medha N. Munshi, MD; Maria Jose Redondo, MD, PhD, MPH; Guillermo E. Umpierrez, MD, CDE; and Jennifer Wyckoff, MD. Staff support at the ADA includes Erika Berg, PhD; William T. Cefalu, MD; Matt Petersen; Shamera Robinson; Mindy Saraco, MHA; and Sacha Uelmen, RDN, CDE.
Acknowledgment: The authors thank Sarah Bradley; Jennifer Wyckoff, MD; and Mindy Saraco, MHA, for their invaluable assistance in reviewing and editing this manuscript.
Disclosures: Dr. Chamberlain reports other support from Janssen, Merck, Novo Nordisk, Sanofi, and Dexcom outside the submitted work. Ms. Doyle-Delgado reports that she is a stockholder of Dexcom and Tandem Diabetes Care outside the submitted work. Dr. Skolnik reports personal fees and nonfinancial support from AstraZeneca, Boehringer Ingelheim, and Sanofi and personal fees from Teva, Lilly, Janssen, Intarcia, Mylan, GSK, and Merck outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1638.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: James J. Chamberlain, MD, St. Mark's Hospital and St. Mark's Diabetes Center, Internal Medicine at St. Mark's, 1160 East 3900 South, Suite 1200, Salt Lake City, UT 84124; e-mail, email@example.com.
Current Author Addresses: Dr. Chamberlain and Ms. Doyle-Delgado: St. Mark's Hospital and St. Mark's Diabetes Center, Internal Medicine at St. Mark's, 1160 East 3900 South, Suite 1200, Salt Lake City, UT 84124.
Ms. Peterson: Utah State University, 920 West Levoy Drive, Taylorsville, UT 84123.
Dr. Skolnik: Abington Family Medicine, 500 Old York Road, Suite 108, Jenkintown, PA 19046.
Author Contributions: Conception and design: J.J. Chamberlain, L. Peterson, N. Skolnik.
Analysis and interpretation of the data: J.J. Chamberlain.
Drafting of the article: J.J. Chamberlain, K. Doyle-Delgado, L. Peterson, N. Skolnik.
Critical revision of the article for important intellectual content: J.J. Chamberlain, L. Peterson, N. Skolnik.
Final approval of the article: J.J. Chamberlain, K. Doyle-Delgado, L. Peterson, N. Skolnik.
Administrative, technical, or logistic support: J.J. Chamberlain.
Collection and assembly of data: J.J. Chamberlain.
The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.
The ADA Professional Practice Committee comprises physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts. To develop the 2019 standards, the committee continuously searched MEDLINE through November 2018 to consider and review studies, particularly high-quality trials including persons with diabetes, for potential incorporation into recommendations. It also solicited feedback from the larger clinical community.
This synopsis focuses on selected guidance relating to use of diabetes technology in adults with diabetes. Recommendations address self-monitoring of blood glucose, continuous glucose monitors, and automated insulin delivery systems.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
August 13, 2019
Technology can prevent type 1 diabetes; Why is no one talking about that?
Type 1 diabetes (T1D) is caused by animal proteins such as GAD65 in chick cell culture derived vaccines and bovine insulin in cow’s milk protein derived vaccines. Numerous animal and plant proteins are used to manufacture vaccines. Residual animal and plant proteins remain in the vaccine. Removing these residual proteins costs money. Vaccine makers have chosen profits over safety.
In the ~40 year history of the measles, mumps, rubella (MMR) vaccine, with no safety improvements, I was the first to point out the mechanism by which this GAD65 protein contaminated chick embryo cell culture derived vaccine causes the development of T1D.
https://www.researchgate.net/publication/318305895 Role of MMR_ I vaccine contamination with_GAD65_containing chick embryo cell culture in the etiology of type 1 diabetes
My technical report above with more than 20,000 reads is among the most read articles on ResearchGate. It was recommended by 3 diabetes experts and another diabetes expert, Dr. Joseph Cantor of the University of California San Diego added a comment in support. We have since described the novel immunological mechanisms involved in autoimmunity induced by immunization with homologous xenogeneic antigens (1).
And that is not even the whole story. T1D patients depend on injected insulin. Insulin for injections is derived from yeast (Saccharomyces cerevisiae). Insulin makers do not completely remove the yeast proteins from insulin either, to save money. The result is T1D patients develop anti-saccharomyces cerevisiae antibodies (ASCA) (2). ASCA cause numerous autoimmune disorders such as SLE, hypothyroidism, rheumatoid arthritis, narcolepsy, vitiligo, Crohn’s and celiac disease (3).
All these iatrogenic diseases can be prevented by immediately removing all non-target antigens from vaccines and injections, using technologies such as affinity chromatography (4).
1. Arumugham V. Correlation of type 1 diabetes trends in European countries to the number of bovine insulin and GAD65 contaminated chick embryo cell culture containing vaccines in the schedule, as predicted by the autoimmunity mechanism involving immunization with homolo [Internet]. 2018. Available from: https://doi.org/10.5281/zenodo.1870364
2. Sakly W, Mankaï A, Sakly N, Thabet Y, Achour A, Ghedira-Besbes L, et al. Anti-Saccharomyces cerevisiae Antibodies are Frequent in Type 1 Diabetes. Endocr Pathol. 2010 Jun 13;21(2):108–14.
3. Arumugham V. Vaccines and Biologics injury table based on mechanistic evidence – Mar 2019 [Internet]. 2019 [cited 2019 May 16]. Available from: https://zenodo.org/record/2582635/files/viittoc0302http.pdf?download=1
4. Zhao M, Vandersluis M, Stout J, Haupts U, Sanders M, Jacquemart R. Affinity chromatography for vaccines
No iinstitutional affiliation
August 19, 2019
Prevention of type 2 diabetes
Is there a corresponding standard from the ADA for preventing or delaying the onset of type 2 diabetes? Such a standard would rely more on potential patients following the recommendations, with the encouragement of their PCPs. In this situation, an ounce of prevention may really be worth more than a pound of cure.
Chamberlain JJ, Doyle-Delgado K, Peterson L, et al. Diabetes Technology: Review of the 2019 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med. [Epub ahead of print 13 August 2019]171:415–420. doi: 10.7326/M19-1638
Download citation file:
Published: Ann Intern Med. 2019;171(6):415-420.
Published at www.annals.org on 13 August 2019
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Guidelines.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use