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INTRODUCTION

This topic will review the clinical presentation, diagnosis, and initial evaluation of diabetes in nonpregnant adults. Screening for and prevention of diabetes, the etiologic classification of diabetes mellitus, the treatment of diabetes, as well as diabetes during pregnancy are discussed separately.

● (See "Screening for type 2 diabetes mellitus" .)

● (See "Prevention of type 2 diabetes mellitus" and "Type 1 diabetes mellitus: Prevention and disease-modifying therapy" .)

● (See "Classification of diabetes mellitus and genetic diabetic syndromes" .)

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Diagnostic Tests for Diabetes

Classification, screening criteria for prediabetes and type 2 diabetes:, informal risk factor assessment for prediabetes and type 2 diabetes, additional screening guidelines, section 2: diagnosis and classification of diabetes.

This article is part of a special article collection available at https://diabetesjournals.org/collection/2018/2024-Abridged-Standards-of-Care .

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Section 2: Diagnosis and Classification of Diabetes. Clin Diabetes 15 April 2024; 42 (2): 183–185. https://doi.org/10.2337/cd24-a002

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There is insufficient evidence to support the use of continuous glucose monitoring for screening or diagnosing prediabetes or diabetes.

In the absence of unequivocal hyperglycemia (e.g., hyperglycemic crisis), diagnosis of type 2 diabetes requires confirmatory testing, which can be a different test on the same day or the same test on a different day.

Marked discordance between A1C and repeated blood glucose measurements should raise the possibility of a problem or interference with either test.

Classification of diabetes type is not always straightforward at presentation, and misdiagnosis is common.

Screening for prediabetes and type 2 diabetes should be performed in asymptomatic adults with an informal assessment of risk factors or a validated risk calculator .

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Presenting with impact

Use the following resources to design and deliver a compelling presentation that will have a real and lasting impact on your audience..

Giving a talk at a conference or event can be a powerful way of sharing your ideas and inspiring others to take action to improve diabetes prevention and care.

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How to: present with impact, Diabetes UK (August 2017) (PDF, 98KB)

This guide contains everything you need to know to design and deliver a presentation that will be remembered long after, including how to create key messages, build engaging content and improve your stage presence.

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The 20 habits of truly brilliant presenters (may 2016), 7 powerful public speaking tips from one of the most-watched ted talks speakers, entrepreneur website (november 2014), how to give a killer presentation, harvard business review website (june 2013), share this page.

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Healthy Living with Diabetes

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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General presentation

Diabetes mellitus (DM) is an important endocrine disorder that presents commonly in children and adolescents. There are two types of diabetes mellitus: type 1 and type 2. Type 1 DM is one of the most common chronic diseases in children and is characterized by insulin deficiency as a result of autoimmune destruction of pancreatic beta islet cells; whereas type 2 DM is the presence of high blood glucose with insulin resistance and relative insulin deficiency. Diabetes mellitus is a chronic condition that requires long-term follow-up and adequate patient (and parent) education to maintain good glycemic control to prevent long-term complications.

Epidemiology

Approximately 2/3 of all new diabetes diagnoses in patients less than 19 years of age in the United States are type 1 DM. Over 300,000 Canadians have type 1 DM, with a 3-5% increase each year; especially in children aged 5-9. Typically, the age of onset has a bimodal distribution, with the first peak in children 4-6 years old, and the second peak in children 10-14 years old (early puberty). Unlike other autoimmune diseases, the overall incidence appears to be equal in both genders. There is a higher risk of developing this condition in children with close relatives who have type 1 DM.

The incidence of type 2 DM has increased 10 fold in the last decade. There is an estimated 3600/100,000 cases of type 2 DM in Canadian adolescents and 1100/100,000 cases in Canadian children. This value may be as high as 1% in Canadian aboriginal youths and children. There is a strong association between increasing rates of obesity in the pediatric population and the development of type 2 DM.

Basic Physiology

In type 1 DM, there is autoimmune-mediated destruction of insulin-producing pancreatic beta cells that results in insulin deficiency. It is a progressive condition that occurs in genetically susceptible individuals. The autoimmune destruction can be triggered by various environmental agents. Some proposed environmental factors include pregnancy-related and perinatal influences, viruses, cow’s milk and cereals. There is a long latency period (where the patient is asymptomatic and euglycemic) between the onset of beta cell destruction and clinical presentation of diabetes mellitus. A large number of functional beta cells must be lost before clinical symptoms like hyperglycemia occurs.

Genetic polymorphisms in six genes have been shown to be associated with type 1 DM. Major Histocompatibility Complex genes and elsewhere in the genome all contribute to the risk, but only the HLA alleles seem to have a large effect.

The natural history has four stages:

• Preclinical autoimmune destruction of pancreatic beta cells
• Onset of clinical symptoms
• Transient remission
• Established diabetes with acute and chronic complications

Type 2 DM is a complex, multifactorial disease characterized by both relative insulin deficiency and insulin resistance with various environmental and behavioural risk factors. Increased hepatic glucose production, insulin resistance and progressive loss of glucose-stimulated insulin release all contribute to the development of hyperglycemia. In Type 2 DM, pancreatic beta cells retain the ability to produce insulin, but levels are not adequate to counteract the developing insulin resistance. The current theory is that insulin resistance develops first, followed and complicated by gradual destruction of beta cells. Insulin resistance worsens with obesity and physical inactivity; and improves with weight loss and increased physical exercise.

Puberty also plays a role in the development of type 2 DM in adolescents. During this period, insulin sensitivity is approximately 30% lower than that of preadolescents or adults, which results in hyperinsulinemia as a compensatory mechanism. In adolescents with both genetic predisposition and negative environmental contributors, this period of relative insulin resistance may result in a decompensated state (inadequate insulin secretion and glucose intolerance). The resulting hyperglycemic state may cause worsening abnormalities of insulin secretion and action, starting a vicious cycle that progress beyond the adolescent years.

Clinical Presentation

Childhood type 1 DM can present in the following ways:

Classic new onset:

Hyperglycemia without acidosis

Symptoms include:

• Can present as nocturia, bedwetting, daytime incontinence in a previously continent child
• Polydipsia – due to increased serum osmolality and hypovolemia
• Impaired glucose utilization in skeletal muscle and increased fat and muscle breakdown

Diabetic ketoacidosis

Similar symptoms but are usually more severe

• Clinical: polydipsia, polyuria, dehydration, hypotension, ketosis, etc.
• Metabolic: hyperglycemia, glycosuria, metabolic acidosis, ketonemia, etc.

Reported frequency varies between 15-67%

• Young children (<6) from low socioeconomic backgrounds are more likely to present with diabetic ketoacidosis

Silent Presentation

Diagnosis before onset of clinical symptoms

Typically occurs in children with a family member with type 1 DM (close monitoring)

Childhood type 2 DM can present in the following ways:

• Hyperglycemia, ketonuria, acidosis
• Frequency varies between 5-25%

Hyperosmolar hyperglycemic state

• Marked hyperglycemia (>33.3 mmol/L) and severe dehydration but no ketonuria
• Less common in adolescents

Symptomatic

• Due to hyperglycemia and include: polyuria, polydipsia, and nocturia
• Recent weight loss is less frequent
• Adolescent girls: vaginal discharge due to candida infection may be initial presentation

Asymptomatic

• Identified based on screening (for type 2 DM or urinalysis as part of a regular physical exam)

Questions to ask

Historical Investigation

Presenting condition:

• Have you been very thirsty? Do you drink a lot?
• Have you been urinating more than usual?
• Has the child had any bedwetting episodes?
• Has there been any recent weight loss?
• Have you been feeling tired lately?
• Have you noticed an increased appetite lately?
• Has the child had more frequent minor skin infections?

Predisposing factors:

• Have you had any viral infections recently?
• What kinds of exercise do you participate in on a regular basis? How frequent do you exercise? How long do you exercise each time?
• How many hours a day do you spend watching TV, using the computer, and play video games?
•  What do you normally eat? What is the portion size? How many meals do you have per day? Do you normally eat out or home cooked meals? Do you eat as a family? Do you eat at the table or in front of the tv?

Family history:

• Are there any family members with insulin-dependent diabetes mellitus?
• Are there any family members with autoimmune conditions?
• Does your mother or father have diabetes?
• Are there any other family members with diabetes? (grandparents, aunts, uncles, brothers, sisters, etc.)

Physical Examination

Do a complete physical exam with particular attention to the following:

• Assess hydration status
• Assess circulation: HR, BP, capillary refill
• Temperature: coexisting infection
• Use growth chart to check for weight loss
• Neck examination: look for thyroid abnormalities
• Respiratory: respiratory rate (hyperventilation – DKA), auscultation (respiratory infection), ketones on breath (DKA)
• Measure body weight and height, calculate BMI
• Measure lying and standing BP
• Inspect skin for acanthosisnigricans
• Examine feet to look for decreased sensation and circulation (pulses)
• Measure visual acuity

Differential diagnosis

• DM types 1 and 2
• Diabetes insipidus
• Urinary tract infection
• Malabsorption (e.g. Celiac disease)
• Secondary diabetes
• Maturity-onset diabetes of the young

Procedures for investigation

Diagnostic Criteria

• Fasting plasma glucose >7 mmol/L (no caloric intake for at least 8 hours)
• Symptoms of hyperglycemia, random venous plasma glucose >11.1 mmol/L
• Abnormal oral glucose tolerance test – plasma glucose >11.1 mmol/L measured 2 hours after a glucose load of 1.75 g/kg (max 75g)
• Glycated hemoglobin (A1C) ≥ 6.5%

Other Investigations

• Urinalysis for glucosuria and ketonuria
• Urinalysis for microalbuminemia
• Alemzadeh R, Wyatt DT. Section 6 – Diabetes mellitus in children. In: Kliegman: Nelson Textbook of Pediatrics. 18 th ed. Saunders, Pennsylvania. 2007
• Eisenbarth GS, McCulloch DK. Pathogenesis of type 1 diabetes mellitus. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Laffel L, Svoren B. Epidemiology, presentation, and diagnosis of type 2 diabetes mellitus in children and adolescents. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Levinson P, Nelson BA, Scherger JE. Diabetes mellitus type 1 in children. [Online]. 2007. Availabe from: FirstConsult, MDConsult. [cited 2011 Jan 15]
• Levitsky LL, Misra M. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• McCulloch DK, Robertson RP. Pathogenesis of type 2 diabetes mellitus. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Panagiotopoulos C. Type 2 diabetes in children and adolescents. BCMJ. 2004;46(9): 461-466
• Scherger JE, McIntire SDC, Escobar O, Heinzman DM. Diabetes mellitus type 2 in children. [Online]. 2007. Availabe from: FirstConsult, MDConsult. [cited 2011 Jan 15]

Acknowledgements

Written by: Ying Yao

Edited by: Dianna Louie

Last updated on November 10, 2011 @5:01 pm

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Diabetes Presentation Template

Customize the Diabetes presentation template for PowerPoint & Google Slides to present your diabetes awareness presentations comprehensively. Diabetes is a chronic disease that alters the normal glucose level of the body and can lead to various complications. The major cause of diabetes is the decreased production of insulin. The prevalence of this disease is more than ever, and it’s crucial to understand the causes and risk factors associated with diabetes. We have specifically designed this interactive PowerPoint template for social workers, healthcare experts, and doctors. So that they can create useful presentations for the audience while accomplishing diabetes awareness campaigns. November is National Diabetes Month, and it is important to educate the public about diabetes.

Our Diabetes presentation template can also be used in executive sessions to present support for diabetes funding, research, and awareness. The title slide contains the diagram of a glucometer connected with a blue diabetes support ribbon. The further slides contain human illustrations with a diagram of the glucometer, pricker, and test strips, which can help the audience understand safe sugar levels and risky conditions. Moreover, in the following slide, a weighing balance shows that the significance of fruits is higher than fast food. Some other slides are:

• Symptoms slide to describe the signs of the poor health condition
• Horizontal timeline slide with editable textboxes to demonstrate the history of diabetes and its futuristic details.
• Data-driven charts slide and column chart slides to mention the relevant data about the prevalence and occurrence of diabetes patients and the increasing number of patients.

This creative diabetes template is compatible with all versions of Microsoft PowerPoint, Google Slides, and Keynote. The users can change the slides’ colors, relevant graphical elements, icons, and theme according to their preferences. So, download this useful PPT template and make amazing presentations in the diabetes month of November. Alternatively, you can download the Diabetes PPT template design with other useful slides that you can use in your presentation on diabetes topics.

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Diabetes Presentations

This list of presentations is designed to be a resource for people with diabetes, health care professionals, diabetes educators, and students. These presentations can be downloaded but the original authors should be referenced if used elsewhere. To download, right-click the link and choose “Save Link As” to download the PDFs. Take a look at presentations by:

John Walsh PA, CDE – Physician assistant and diabetes clinical specialist at Advanced Metabolic Care and Research in Escondido, CA. The webmaster of Diabetesnet.com, co-author of Pumping Insulin , Using Insulin , and Stop the Rollercoaster.

Gary Scheiner MS, CDE – Certified diabetes educator and owner and operator of Integrated Diabetes Services , which specializes in intensive blood glucose control and lifestyle intervention for people with diabetes.

Andrea Gasper, MS, PA-C – Physician assistant who provides clinical care at the VA San Diego Department of Endocrinology and Metabolism.

Presentations by John Walsh

Full list of presentations, past and present

Novel and Basic Pump Ideas

A presentation John gave to 60 industry personnel on novel and basic ideas to improve glucose outcomes for insulin pump wearers.

New devices and research regarding Type 1 diabetes from the 2018 ADA Conference in Orlando

Presented to the San Diego Pump Club on July 9, 2018

Tried and True Tips and New Advances in Diabetes

These slides review pump tips and pump advances with new information on artificial pancreas projects, implanted CGMs, and faster insulins. This presentation was given at the San Diego Take Control of Your Diabetes (TCOYD) meeting and at the San Diego Pump Club meeting in late 2016.

Clinical Benefits of CGM

Scripps Whittier Diabetes Institute on May 3, 2016 and Canadian endocrinologists visiting Dexcom on April 29, 2016 This talk covers benefits of pumps and CGMs, the 5 paths to better readings, identification of glucose patterns, and lots of tips on how to use real time and downloaded CGM data.

Infusion Sets—The Weakest Link?

San Diego Pump Club in September 2015 Little attention has been paid over the years to the effectiveness of the infusion set in the push to improve insulin pumps and CGMs and connect them with an algorithm into an artificial pancreas. Not all infusion sets are delivering insulin well. Too often Unexplained High Glucose or UHG happens from a malfunctioning infusion set and the wearer misdiagnoses it as “I ate the wrong thing.” Is the problem coming from a mismatch between poor infusion set design, the user’s technique, or other physiology? See what the latest research and thinking has to say about the state of infusion sets, including a discussion of a reduction in silent occlusions with BD’s new FlowSmart infusion set.

Glucose Control With Today’s Insulin Pumps and CGMs

3rd Annual Diabetes Type 1 Conference at ANA Intercontinental Tokyo in May 2015 Great info on all the latest insulin pumps available. Also has information on CGMs, optimal TDDs and more.

Insulin Pumps Secrets and Settings and for Great Glucose Control

Type One Nation Presentation at the Sansum Clinic Support Group in March 2015 Tips on state-of-the-art pumping with a CGM, steps to optimize pump settings, plus things you never knew about pumping. Why your TDD and DIA are so important. Common causes for unwanted readings. How CGM downloads and trend lines can help you trouble-shoot frequent highs, frequent lows, roller-coaster readings, post-meal spikes, and more. Tips on when your bolus calculator or infusion set may be part of the problem.

Insulin Pump Settings and Secrets for Great Glucose Control (PDF 9.7 mb)

Presentation by John Walsh PA, CDTC at Type One Nation in March 2015 Learn the nuts and bolts of pumping and get an overview of today’s state-of-the-art insulin pumps and how to set them up for best results. Get ready to learn the things you never knew about pumps and pumping.

Troubleshooting Common Control Issues (PDF 12.3 mb)

Presentation by John Walsh PA, CDTC at Type One Nation in March 2015 Review common sources for failure on an insulin pump and how to solve them. Learn how to trouble shoot unexpected high or low patterns and learn clever tricks to get the most out of your pump and CGM.

Insulin Pump Tune Up (PDF 2.7 mb)

Presentation by John Walsh PA, CDTC and Chris Sadler MA, PA-C, CDE, CDTC for TCOYD

Latest on Pumps, CGMs, and Connectivity  (PDF 9.9 mb)

A presentation given in Ft Murray in November 2014

The Latest on Insulin Pumps and Glycemia (PDF 6.3 mb)

This Grand Rounds presentation, entitled “The Latest on Insulin Pumps and Glycemia” was given at the UCSD/VA Hospital in La Jolla, CA, on Feb. 12, 2014. Lots of tools, tips, and insights.

Advanced Pumping Techniques – TCOYD 2013 (PDF 6.8 mb)

A presentation on the latest in pumps and CGM, tips to achieve better glucose levels, and the latest breakthrough technologies in diabetes.

Exercise Tech – insulinINdependance Conference 2013 (PDF 7.2 mb)

John’s presentation at the Insulindependence Conference 2013 on the latest diabetes technology with a focus on insulin pumps and exercise.

The Latest on Insulin Pumps (PDF – 3.2 mb)

How to get the most out of an insulin pump for pump wearers. Includes lots of tips and tricks and how to remedy common mistakes.

Advanced Pump Workshop (PDF – 5.9 mb)

This half-day clinical workshop covers insulin pump therapy in great detail using results of the Actual Pump Practices Study. Topics include glucose management, how to tune the bolus calculator, BOB, DIA, insulin stacking, infusion set issues and solutions, and CGMs for better control.

Insulin Therapy – Taking it to the Next Level (PDF – 1.9 mb)

This presentation discusses insulin therapy and includes numerous tips on how to achieve the best results.

Glucose Management and the Actual Pump Practices Study

Presentation for St. Michael’s Hospital Staff for Medtronic of Canada, June 22, 2012

Slideshow (in parts) – #1-Glucose Management and Actual Pump Practices Study – #2-Bolus Calculator Settings – # 3 -DIA, BOB, and Insulin Stacking – # 4- Infusion Set Issues – # 5-CGMs for Better Control – or A PDF of all 5 Workshops

Advanced Pump Strategies – The Latest on Pumps and CGMs

Presentation at Toronto Congress Center for Animas Canada, June 23, 2012

2 Presentations- The Latests on Pumps & CGMs – or a PDF of Both Talks (4.6 mb)

Patch or Line Pump – Which Works Best?

Presentation at TCOYD Conference with Karmeen Kulkarni, RD, in San Diego, CA – November 12, 2011

Presentation on Patch and Line Pumps (PDF – 9.6 mb)

Evolution of Insulin Pumps & CGMs Toward An Artificial Pancreas

Presentation at Diabetes Technology Meeting in Burlingame, CA – Oct 27, 2011

Evolution of Insulin Pumps & CGMs – Toward An Artificial Pancreas (PDF – 9.4 mb)

Emerging Technologies: Bolus Calculators, Pumps And CGMs

Presentation to Children With Diabetes in Orlando, FL – July 2011

Web Presentation – Emerging Technologies (PDF – 12 mb)

Advanced Pumping Strategies That Work

Presentation to Children With Diabetes in Orlando, FL -July 2011

Web Presentation – PDF or Advanced Pumping Strategies (PDF – 9.8 mb)

Pumps and Sensors Practical Problem Solving

Presentation to Children With Diabetes in Charlotte, NC – September 2010

Web Presentation – PPT Presentation (8.5 mb ) – PDF (9.6 mb)

Advanced Pump Features And Their Use

Presentation to Children With Diabetes in La Jolla, CA- Oct 2009

Advanced Pump Features and Their Use provides information on special and future pump features, CGMs, pump settings, pumps for Type 2s, DIA and BOB. Please view the slideshow .

Pumping Basics: Start for Success

Pumping Basics provides information on reasons to use a pump, who’s a candidate, brands and features, CGMs, infusion set choices, pump start and the future of pumping. Please view the slideshow .

Management Tips For Insulin Use

Presentation to Diabetes Educators in Calgary, Alberta

Management Tips For Insulin Use covers why insulin is needed, what it does, and how to replace it when production is lost in Type 1a and Type 2 diabetes. Discusses long and rapid acting insulins, mixed insulin, insulin pens, use in Type 2 diabetes, causes for lows and highs, and new treatments in using insulin. Please view the slideshow or download a PDF version (2.6 MB) for easy viewing.

Future Insulin Pump Features

We have been developing new ideas for several years to make insulin pumps more helpful to wearers. You can see the full list of proposed insulin pump features as a slideshow or Powerpoint . Previous Versions: 12/18/08 – Slideshow , PDF

Proposed Insulin Pump Standards

This slideshow presents a preliminary set of Manufacturing Standards For Insulin Pumps designed to improve insulin pump use and medical outcomes. Comments and suggestions on these guidelines are welcomed. Please view the slideshow . Be patient — there are 29 proposed features presented over 157 slides. Previous versions: 12/03/08 ( Slideshow or Powerpoint ), 11/10/08 ( Slideshow or Powerpoint ) and 10/10/08 ( Slideshow or Powerpoint ).

Current & Emerging Technologies In Insulin Pumps & Continuous Monitors – May 2008

Learn about new trends in insulin pumps and continuous monitors in this web slideshow or downloadable Powerpoint presentation .

Introduction to Pumping – Starting and Success

August 2007 at the CWD Conference

Learn how to start pumping the right way with this helpful presentation. View the slideshow or download the Powerpoint Presentation .

Exercise, Pumps, & Continuous Monitors – June 2007 at the DESA Exercise Conference

Get the latest tips and tricks for combining insulin pumps and continuous monitors with your fitness plan from this slideshow or the downloadable Powerpoint presentation .

Insulin Pumps Give Different Bolus Recommendations When BOB Is Large – February 2007

Find out why differences in Bolus on Board calculations are important and when they will occur by viewing the BOB slideshow . You can also download the Powerpoint presentation .

Comparison Of The Two Currently Available Continuous Monitors – January 2007

The Dexcom STS and the Paradigm RT continuous monitors are currently available in the U.S. with a prescription. In this study, they are compared head to head while being worn by one person with Type 1 diabetes. Is one monitor better than the other? How close are the monitor readings to the Ultra fingerstick readings? Find out by viewing the comparison slideshow or downloading the Powerpoint presentation .

Smart Pumps & Tomorrow’s Intelligent Devices – July 2005

See how classic diabetes devices have improved and will continue to improve in this presentation. View the Slideshow or download the Powerpoint Presentation

Changes In Diabetes Care – September 2004

Learn about the history of insulin pumps in this slideshow

The Super Bolus and the Intelligent BG Alert – September 2004

This slideshow details new insulin pump ideas to improve glucose levels, avoid hypoglycemia, and speed correction of hyperglycemia.

Intelligent Devices – September 2004

This slideshow details the idea of a “Smart Pen” that demonstrates the possibilities for intelligent diabetes devices.

Simultaneous Device Wear May Disclose Disparate Continuous Glucose Monitoring Performance (PDF – 739 kb) by John Walsh PA CDE and Timothy Bailey MD FACE CPI Disparate Bolus Recommendations In Insulin Pump Therapy (PDF – 363 kb) by John Walsh PA CDE and Timothy Bailey MD FACE CPI Insulin Pump Settings A Major Source For Insulin Dose Errors (PDF – 507 kb) by John Walsh PA CDE, Dariusz Wroblewski PhD, and Timothy S. Bailey MD FACE CPI

Presentations by Gary Scheiner

Improving diabetes control with accurate carb counting.

One major advantage of carbohydrate counting is that it can improve your blood glucose levels. This slideshow details the best tips, tricks, and methods to accurately count carb. You can also download the Powerpoint Presentation .

Strategies for Combating After-Meal Highs

Learn how to measure and control after meal blood sugar levels in this helpful slideshow . You can also download the Powerpoint Presentation .

Hypoglycemia: Prevention and Treatment

This slideshow details a number of ways to prevent and treat hypoglycemia. You can also download the Powerpoint Presentation .

Presentations by Andrea Gasper

Pumps and dosing software: the latest advances.

Presented in 2007 at the ADA Diabetes Technology Clinical Focus Meeting

Read about the latest advances in insulin pump and dosing software in this helpful PDF presentation.

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Diabetes Mellitus Disease

Diabetes mellitus disease presentation, free google slides theme and powerpoint template.

Diabetes mellitus refers to a group of diseases that affects the way the body uses blood glucose. Glucose is vital for health, as it is an important source of energy for the cells that make up muscles and tissues. Understanding a disease thoroughly is the first step to being able to prevent it. We present this original template with which you can explain your knowledge about this important illness. With this presentation you will be able to talk about the disease, its diagnosis, pathology and treatment, recommendations and conclusions. Download it now and share your knowledge!

Features of this template

• 100% editable and easy to modify
• 29 different slides to impress your audience
• Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups
• Includes 500+ icons and Flaticon’s extension for customizing your slides
• Designed to be used in Google Slides and Microsoft PowerPoint
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Diabetes and peripheral artery disease: A review

David olubukunmi soyoye.

Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria

Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria. moc.oohay@eyoyoskb

Olugbenga Olusola Abiodun

Department of Medicine, Federal Medical Centre, Jabi 900211, Abuja, Nigeria

Rosemary Temidayo Ikem

Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria

Babatope Ayodeji Kolawole

Anthony olubunmi akintomide.

Corresponding author: David Olubukunmi Soyoye, FMCP, FACE, FACP, MBChB, Consultant Physician-Scientist, Senior Lecturer, Department of Medicine, Obafemi Awolowo University, Ife-Ibadan Expressway, Ile-Ife 220282, Osun State, Nigeria. moc.oohay@eyoyoskb

Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.

Core Tip: Peripheral arterial disease (PAD) is a major cause of nonhealing ulcers, lower limb amputation and mortality, especially in people with diabetes. The ominous association between PAD and diabetic foot disease is largely under-reported. Hence, it is under diagnosed and undertreated. This article reviews the impact of PAD in diabetes, its traditional and non-traditional risk factors, and pathophysiology, and examines some recent innovations in its management.

INTRODUCTION

Diabetes mellitus (DM) continues to assume pandemic proportions, affecting people across various socioeconomic groups in developed and developing nations. Globally, close to a half billion people are living with diabetes and it is expected to increase by more than 50% in the next 25 years[ 1 ]. The myriad of chronic complications attributable to the disease results in enormous physical, mental, and economic burdens. The complications are mainly vascular and lead to diabetes-specific microvascular sequelae in the retina, nerves and the glomerulus. Others are atherosclerotic macrovascular pathology in the brain, heart and lower limbs[ 2 ].

Lower extremity complications are common, showing a rising trend in many regions of the world and affecting about 131 million people worldwide, with an estimated global prevalence of 1.8%[ 3 ]. They significantly impact morbidity and mortality in people with DM, sometimes leading to leg ulcers and amputations, which are generally characterized by physical disability, reduced productivity and emotional disturbances. Although much emphasis has been laid on neuropathy as a cause, an equally important contributor to the occurrence of leg ulcers and amputations is peripheral arterial disease (PAD)[ 2 , 4 - 6 ]. Consequently, PAD is under-diagnosed and hence, may be undertreated.

PAD denotes a complete or partial occlusion of one or more of the noncardiac, non-intracranial, peripheral arteries of the upper and lower limbs, which may lead to reduced blood flow or tissue loss[ 7 ]. It usually results from atherosclerosis of the vessel wall, but may also arise as a result of embolism, thrombosis, fibromuscular dysplasia, or vasculitis[ 7 ]. Atherosclerotic PAD may be a pointer to systemic atherosclerosis in non-peripheral intra-cerebral and coronary arteries. In DM, the arteries of the lower limbs are the ones that are mostly involved; and most often the distal arteries, especially the dorsalis pedis artery[ 8 ]. This review discusses the pathophysiology of atherosclerotic PAD of the lower limbs, its epidemiology in DM, and its treatment. It also highlights recent advances in its management.

EPIDEMIOLOGY OF PAD IN DIABETES

The prevalence of PAD depends on the diagnostic measurement employed, cut-off values of the test, the limb assessed and the population studied[ 9 ]. It has been assessed using the presence of intermittent claudication (IC), palpation of the vessels of the lower limbs, and measurement of the ankle-brachial index (ABI). Prevalence generally increases with advancing age, irrespective of the measurement utilized. IC, the main symptom attributable to PAD, occurred in about 1.5% of the cohorts in the Framingham Heart Study. In all age groups, the rate in men was double that in women[ 10 ]. Also, in the Rotterdam study involving the elderly population, IC was reported by 1.6% of the participants, but the prevalence of PAD defined by an ABI < 0.9 in either leg was 19.1% in the same cohort[ 11 ]. The prevalence in men was higher in both studies. The rates of PAD using IC is generally lower compared with those obtained using ABI[ 11 - 13 ].

In community studies, the prevalence of PAD using ABI differs with the population, cut-off value, ankle vessel and the leg used, with values ranging from 4.3% to 9.0% in the general population[ 14 , 15 ]. In a systemic review assessing community-based studies of the global prevalence of PAD (using ABI ≤ 0.9) and its risk factors, prevalence differed based on the region studied and sex. It was higher among men in high-income countries, and in women in low- and middle-income countries[ 16 ]. Certain factors affect the accurate assessment of PAD in people with diabetes. PAD is often asymptomatic; the presence of peripheral neuropathy, which is a common complication of DM. may distort pain perception, and the presence of IC and absence of peripheral pulses are inadequate diagnostic indicators[ 8 ].

In hospital-based studies, PAD is two- to seven-fold more prevalent in people with diabetes than it is in those without it, with rates between 9% and 55% in people with diabetes[ 5 , 17 - 19 ]. In a national survey involving about 3000 adult Americans 40 years of age and above, PAD was two times more prevalent in people with diabetes compared with the general population[ 20 ]. Also, a systematic review of studies comparing PAD in diabetics and nondiabetics reported that PAD ranged between 20% and 50% in those with diabetes, compared with 10% and 26% in those without diabetes[ 21 ]. Also, as seen in the general population, the prevalence of PAD differed depending on the diagnostic method used (IC, palpation of vessels or ABI)[ 19 ].

Lower limb amputation resulting from foot ulcers is a major cause of disability, especially in diabetic patients. Patients with foot ulcers are more likely to present with PAD than those without ulcers, with the attendant increased mortality and lower limb amputations in those patient cohorts[ 22 - 25 ].

RISK FACTORS FOR PAD

The major risk factors for PAD such as DM, hypertension, smoking and hyperlipidaemia also contribute to coronary heart disease (CHD) and cerebrovascular disease (CVD). However, the influence exerted by those risks on vascular diseases is different[ 26 - 28 ]. In a recent systemic review that assessed community-based studies for global prevalence and risk factors of PAD, DM ranked next to smoking among the major risks and hypertension and hypercholesterolaemia followed[ 16 , 29 ]. In the National Health and Nutrition Examination Survey, cigarette smoking and DM were also the most significant risk factors for PAD, with a odds ratios of 4.5 and 2.7, respectively[ 14 ].

In other community-based studies, diabetes also ranked high as a risk factor for the occurrence and progression of PAD along with other traditional risks such as age, smoking, hypertension, hypercholesterolaemia and low kidney function)[ 11 - 13 , 30 , 31 ]. It hiked the rates of lower extremity amputation, hospital stay, and mortality[ 21 , 22 , 26 ]. While the major risk factors for PAD in people without DM remain significant even with it, other associations have also been identified in DM. They include longer duration of DM, high glycated haemoglobin (HBA1c) level, abdominal obesity, male sex and neuropathy[ 18 , 19 , 22 , 32 ].

The traditional risk factors do not fully explain the development of atherosclerosis in the peripheral or other vascular beds. Inflammation, abnormalities in haemostasis and blood viscosity are known to contribute to the evolution and propagation of atherosclerosis, and their markers have been studied[ 33 - 35 ]. High-sensitivity C-reactive protein, hyperuricaemia, and hyperhomocysteinaemia are some of the non-traditional risk factors associated with PAD in the general population and in people with DM[ 18 , 19 , 36 - 38 ].

PATHOPHYSIOLOGY

The central pathophysiological theme of PAD in DM is the process of atherosclerosis. It begins with atherogenesis, and progresses to the eventual obstruction and reduction of blood flow. In what is known as subclinical atherosclerosis, the pathological changes may predate the diagnosis of impaired fasting glucose and DM[ 39 ]. The changes are the same as those observed in other vascular beds in patients with DM. Several pathogenetic mechanisms have been identified in the initiation of atherosclerosis, including endothelial dysfunction, inflammation, platelet aggregation and vascular smooth muscle cell (VSMC) dysfunction[ 40 ]. Figure ​ Figure1 1 shows a schematic representation of these factors and how they lead to PAD.

Schematic representation of the pathophysiology of peripheral arterial disease in diabetes mellitus. Pathogenetic processes and their mechanisms are shown in black and white type, respectively. AGEs: Advanced glycation end products; DM: Diabetes mellitus; NO: Nitric oxide; PAD: Peripheral arterial disease; PAI-1: Plasminogen activator inhibitor-1; ROS: Reactive oxygen species; TGF-β: Transforming growth factor-beta; VSMC: Vascular smooth muscle cell.

Dysfunction of the vascular endothelium is the hallmark of atherosclerosis in DM, and it arises from a variety of inter-related pathogenetic factors. First, chronic hyperglycaemia activates the dormant polyol pathway. That results in increased oxidative stress from reactive oxygen species, caused by the consumption of cofactor nicotinamide adenine dinucleotide phosphate and reduced glutathione[ 41 , 42 ]. Chronic hyperglycaemia also causes the production of advanced glycation end products, which results in the elaboration of inflammatory cytokines and growth factors that cause vascular injury[ 42 ]. In addition, hyperglycaemia induces the activation of protein kinase C, which has various effects on gene expression. Protein kinase C is responsible for the activation of the nuclear factor κB, a transcription factor that activates a variety of proinflammatory genes[ 42 , 43 ]. The resultant effect is a reduction in the production of nitric oxide (NO), which is a potent vasodilator; transforming growth factor (TGF)-β and plasminogen activator inhibitor (PAI)-1. The production of the vasoconstrictor endothelin-1 is increased. NO reduces inflammation by modulating leucocyte-vascular wall interaction and inhibiting VSMC migration and platelet activation[ 40 ]. Those abnormalities in the absence of NO, result in increased endothelial permeability, leucocyte chemotaxis, adhesion and migration into the intima, thus causing inflammation. There is also low-density lipoprotein (LDL) migration into the intima where it is oxidized within monocytes to form foam cells, which are the earliest precursor of atheroma formation.

Endothelial injury and hyperglycaemia are activators of platelet adhesion, activation and aggregation. With hyperglycaemia, glucose uptake by platelets is left unchecked, resulting in platelet activation and increased oxidative stress through the release of reactive oxygen species[ 40 ]. Also, hyperglycaemia is associated with abnormalities of coagulation such as the decreased concentration of antithrombin and protein C, impaired fibrinolytic function and excess production of PAI-1[ 40 ]. Platelet activation and aggregation are therefore important elements in the development of atherosclerosis.

Hyperglycaemia is also associated with VSMC dysfunction through the effects of endothelial injury and intima inflammation. Proinflammatory mediators such as platelet-derived growth factors (PDGFs), vascular endothelial growth factors, and cytokines released in the inflammatory milieu of the intima result in VSMC migration and proliferation. The combination of VSMC and endothelial foam cells subsequently results in the development of fatty streaks that become remodelled into an atheromatous plaque. The plaque is the result of collagen production and an extracellular matrix by VSMC through the mediating effects of PDGF and TGF-β[ 40 , 44 ]. The increasing size of the atheromatous plaque, which causes obstruction and reduction of blood flow, is the hallmark of atherosclerosis as seen in PAD and other vascular beds in DM patients.

DIAGNOSTIC EVALUATION

History and physical examination.

History taking in all DM patients should entail asking for risk factors for PAD, such as hypertension, dyslipidaemia, cigarette smoking, obesity and the duration of DM. Patients who have been diabetic for more than 10 years are more prone to the risk of PAD[ 19 , 31 , 45 ]. Similarly, longer duration of, and exposure to higher levels of the other factors (hypertension, dyslipidaemia, smoking, obesity) potentiates the risk of PAD[ 31 ]. History taking should also focus on the presence of other macrovascular complications such as CVD and CHD because they are equivalents. Symptoms of PAD include IC in about 10% of patients; pain at rest, which is indicative of critical limb ischaemia, and about 50% of patients will be asymptomatic[ 46 ]. Examiners should search for differentials of PAD such as pseudo-claudication in spinal stenosis, peripheral neuropathy, nerve root compression, deep venous thrombosis, vasculitis and musculoskeletal causes such as arthritis[ 46 ]. Examination may reveal features of ischaemia such as dependent rubor, elevated pallor, and shiny and hairless skin. Also, peripheral pulses such as the femoral, popliteal, posterior tibial and dorsalis pedis arteries may be reduced. Some patients may present with trophic skin changes and gangrene.

The ABI is a sensitive and specific screening tool for PAD. It has a sensitivity of 90% and specificity of 98% in detecting PAD[ 47 ]. The European Society of Cardiology (ESC), and American Heart Association recommend the use of ABI to screen for PAD in all diabetics older than 50 years of age. Others include diabetics younger than 50 years of age with a DM duration of more than 10 years or with other risk factors for PAD such as smoking, hypertension, dyslipidaemia and PAD equivalents[ 45 , 48 ]. An ABI of < 0.9 is indicative of PAD, and is associated with a 2- to 4 -fold increase in mortality[ 45 ]. An ABI of > 1.3 is indicative of poorly compressible vessels resulting from vascular calcification, which is also associated with an increased risk of mortality and amputation (Table ​ (Table1 1 )[ 40 ].

Interpretation of ankle-brachial index

Duplex ultrasound

Duplex ultrasound is a combination of conventional and doppler ultrasonography. It is indicated as a first-line imaging method to detect the site and extent of severity of vascular lesions[ 45 ].

Computed tomography and magnetic resonance angiography

Angiography is indicated in patients with planned revascularization to guide optimal revascularization strategies. Computed tomography angiography is non-invasive, widely available, and has a high resolution. The disadvantages include exposure to irradiation, use of iodinated contrast agents and contrast nephrotoxicity, particularly in patients with chronic kidney disease (CKD)[ 45 ]. Magnetic resonance angiography has the advantage of being acceptable in mild to moderate CKD, with higher soft-tissue resolution. It is limited by frequent motion artefacts, claustrophobia, severe CKD, and in patients with magnetic resonance imaging noncompliant pacemakers or implantable cardioverter defibrillators[ 45 ].

The management of PAD in DM includes symptomatic control and reduction of the risk of cardiovascular (CV) events. Management includes CV risk factor treatment and lifestyle modifications such as regular physical exercise, promotion of a healthy diet, weight reduction and smoking cessation. If medical management fails because of disabling symptoms or in the presence of chronic life-threatening ischaemia, then revascularization is indicated.

Regular physical activity improves claudication distance in PAD. It also improves quality of life and reduces the risk of CV disease, which often accompanies PAD[ 49 , 50 ]. Home-based walking exercise is recommended for a minimum of 30 min, at least 3 d of the week[ 49 ]. Randomized controlled trials of 493 patients with PAD showed that home-based walking exercise improved walking ability in patients and also improved 6-min walk more than supervised treadmill exercise[ 51 ].

High-intensity statin therapy is recommended for all patients with PAD[ 52 , 53 ]. Observational and randomized clinical studies have shown that statin therapy reduced all-cause mortality and CV events in patients with PAD. The goal is to reduce LDL cholesterol (LDL-C) to < 1.8 mmol/L (70 mg/dL) or to reduce it by ≥ 50% if baseline values are 1.8-3.5 mmol/L (70-135 mg/dL)[ 45 ]. In statin-benefit groups such as PAD, ezetimibe is a reasonable and beneficial addition if LDL-C remains > 1.8 mmol/L (70 mg/dL) with maximally tolerated statin therapy[ 45 , 54 ]. If LDL-C remains > 1.8 mmol/L (70 mg/dL) on statins and ezetimibe, the addition of evolocumab, a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 is reasonable and beneficial to reduce CV events[ 45 , 55 ].

Antiplatelet therapy

Single antiplatelet therapy is indicated in all patients with symptomatic PAD and in those who have had revascularization[ 45 ]. Antiplatelet agents are effective in preventing limb-related and CV events[ 56 ]. A post hoc analysis of the CAPRIE (Clopidogrel vs Aspirin in Patients at Risk of Ischaemic Events) trial in 6452 patients with clinical lower extremity artery disease (LEAD) showed that at 3 years, clopidogrel was superior with significant reductions in CV mortality [hazard ratio (HR) 0.76 (95%CI: 0.64-0.91)] and major adverse cardiovascular events HR 0.78 (95%CI: 0.65-0.93)][ 57 ]. A similar benefit was seen in the subgroup of LEAD patients with DM[ 57 ]. In the randomized EUCLID (Effects of Ticagrelor and Clopidogrel in Patients with Peripheral Artery Disease) trial, ticagrelor did not show any difference compared to clopidogrel[ 58 ]. Clopidogrel is therefore the recommended antiplatelet drug in symptomatic PAD.

Vasodilators

Cilostazol, an oral phosphodiesterase type III inhibitor is useful in managing IC. It inhibits platelet aggregation and causes vasodilation. Randomized controlled trials have shown improved walking distance and quality of life with the use of cilostazol[ 59 ]. However, it has been suggested that improvement in walking distance is mild to moderate, with great variability.

Glycaemic control

There are no randomized controlled trials with arms comparing intensive or standard arm glucose lowering in those with DM and PAD. However, there is evidence that glucose control is associated with a reduction in microvascular and macrovascular complications. In type 1 DM, the DCCT (Diabetes Control and Complications Trial) showed a reduction in CV events in the intensive arm compared with the standard arm, both with long-term follow-up[ 60 ]. With long-term follow-up, intensive control showed a 57% reduction in nonfatal myocardial infarction (MI), stroke, CV death, as well as some reduction in all-cause mortality[ 61 ]. However, in type 2 DM, evidence of the benefit of intensive lowering of glycaemia was not as compelling. There is a need, therefore, for a general goal of a glycated haemoglobin level of < 7%, while individualizing the goal of treatment for each patient’s characteristics[ 62 ].

In the UKPDS (United Kingdom Prospective Diabetic Study), short-term follow-up did not show a significant benefit in the reduction of CV events of combined fatal and nonfatal MI, sudden death ( P = 0.052) and stroke[ 63 ]. However, after 10 years of follow-up, patients in the intensive glycaemia control arm showed significant reductions in MI and all-cause mortality[ 63 ]. The short-term and long-term results of the UKPDS are contradicted by those of ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial and the VADT (Veterans Affairs Diabetic Trial[ 64 ]. In those trials, short-term follow-up of 3.5 to 5.6 years did not show any reduction in CV events in those in the intensive arm. Long-term follow-up in the ADVANCE trial showed no evidence of CV benefit or harm[ 65 ]. In the ACCORD trial, the glycaemic control comparison was stopped early because of increased mortality in the intensive (1.41% per year) compared with the standard (1.14% per year) treatment arms [HR 1.22 (95%CI: 1.01-1.46)]. But the long-term follow-up at 10 years in the VADT showed a reduction in CV events in the intensive arm[ 66 , 67 ]. In those three trials, the patients had high CV risks, longer DM duration, and were relatively older than patients in UKPDS. Also, severe hypoglycaemia was more likely in the intensive arms, hence the importance of individualizing control for those groups of patients to reduce the high risk of CV events and mortality because of hypoglycaemia.

Blood pressure control

The ESC/European Society of Hypertension recommends that systolic blood pressure (SBP) be targeted to < 130 mmHg and that the diastolic blood pressure should < 80 mmHg and that the SBP should not be < 120 mmHg in patients with DM[ 68 ]. This is supported by evidence from the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and ACCORD trials showing an overall reduction in CV events with intensive SBP lowering to < 130 mmHg[ 69 , 70 ]. Diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and beta-blockers can all be used in PAD. However, the HOPE (Heart Outcomes Prevention) and ONTARGET studies have shown that ACEIs and ARBs reduce CV events in PAD and should therefore be considered in treating patients with PAD and hypertension with or without DM[ 69 , 71 ]. Care should be taken with the use of beta-blockers in patients with chronic limb-threatening ischaemia[ 68 ].

Revascularization

Revascularization is indicated if claudication impairs quality of life after the failure of exercise therapy and pharmacotherapy in patients whose general condition allows invasive treatment. Strategies include endovascular therapy, open surgery, or a combination of the two. Endovascular therapy is generally recommended for short (< 25 cm) occlusive lesions, and in those with high surgical risk. It includes balloon dilation (angioplasty), stents, and atherectomy[ 72 ]. Open surgery is recommended for patients with long (≥ 25 cm) lesions who are young and fit[ 45 ].

RECENT INNOVATIONS IN THE MANAGEMENT OF PAD

Endovascular therapy has continued to evolve with the modification and development of new technologies, including drug-eluting stents, self-expanding stents, cutting balloons (CBs), and cryoplasty balloons. Other interventions are focal pressure balloons and drug-coated balloons (DCBs). These reduce post-treatment cell proliferation or restenosis, thereby improving patency, and new atherectomy systems, especially for calcified lesions[ 72 - 74 ]. CBs and cryoplasty balloons are modifications of standard percutaneous transluminal angioplasty (PTA). PTA is done by placing a wire within the artery beyond the target lesion and then expanding the inserted balloon with appropriate pressure. That leads to fracture of the lesion and stretching of the arterial wall[ 73 ]. Cryoplasty balloons induce an inflammatory response and dilate plaques by utilizing a combination of hypothermia and pressure. DCBs inhibit hyperplasia by including medication (usually paclitaxel) after performing a standard PTA[ 73 ].

Lithoplasty (Shockwave Medical) is an atherectomy device that combines a balloon angioplasty catheter with sound waves that break up calcifications that otherwise would not be broken with the use of DCBs and stents[ 74 ]. The Pantheris Lumivascular Atherectomy System (Avinger, Inc.) is a directional atherectomy system that includes optical coherence tomography. It utilizes light to provide three-dimensional visual guidance rather than two-dimensional X-ray images with fluoroscopy. It aids better navigation for removal of plaque, reduces damage to the artery and may reduce exposure to radiation from fluoroscopic imaging procedures[ 74 ].

DM is a major risk for PAD, resulting in increased morbidity and mortality. Morbidity is characterized by an increased risk of other cardiovascular complications, increased hospital admissions, disability from leg ulcers and amputation, reduced productivity and reduced quality of life.

Early detection of PAD in diabetic patients at risk is imperative to reduce morbidity and mortality. At-risk diabetics include older patients, those with a DM duration longer than 10 years, high HBA1c, obesity and neuropathy. The ABI is a highly sensitive and specific simple tool to screen for PAD in DM. It is also valuable as a follow-up tool, and also for stratifying CV risk[ 45 ].

Prevention of CV events and symptom control in symptomatic patients are the paramount pillars of the treatment of PAD in DM. They should include treatment of CV risk factors, and treatment of PAD, including pharmacological and nonpharmacological interventions and revascularization if medical treatment fails.

Open surgery used to be the mainstay of revascularization, endovascular therapy has however evolved recently to improve outcomes, with the development of new innovations, such as the DES, CBs, self-expanding stents, and cryoplasty balloons. More studies are needed to evaluate quality of life and wound healing using these newer endovascular modalities and to compare surgical and endovascular revascularization in symptomatic patients[ 45 ].

Conflict-of-interest statement: The authors have no competing interests to declare.

Manuscript source: Invited manuscript

Corresponding Author's Membership in Professional Societies: American Association of Clinical Endocrinologists; Society for Endocrinology United Kingdom; and Endocrine and Metabolism Society of Nigeria.

Peer-review started: February 13, 2021

First decision: March 16, 2021

Article in press: May 7, 2021

Specialty type: Endocrinology and metabolism

Country/Territory of origin: Nigeria

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Yuan B S-Editor: Fan JR L-Editor: Filipodia P-Editor: Ma YJ

Contributor Information

David Olubukunmi Soyoye, Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria. Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria. moc.oohay@eyoyoskb .

Olugbenga Olusola Abiodun, Department of Medicine, Federal Medical Centre, Jabi 900211, Abuja, Nigeria.

Rosemary Temidayo Ikem, Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria. Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria.

Babatope Ayodeji Kolawole, Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria. Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria.

Anthony Olubunmi Akintomide, Department of Medicine, Obafemi Awolowo University, Ile-Ife 220282, Osun State, Nigeria. Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220282, Osun State, Nigeria.

• Novo Nordisk Arms Wegovy to Be a Triple Threat

O zempic usage for weight loss has gone viral, making it the highest revenue-generating drug for Novo Nordisk AV/S (NYSE: NVO) . Originally purposed for Type 2 diabetes, the skyrocketing off-label use for weight loss led Novo to create Wegovy, a stronger version of Ozempic (generic name: semaglutide) for obesity.

There seems to be a GLP-1 gold rush in the medical sector . Novo competitor Ely Lilly & Co. (NYSE: LLY ) is experiencing such unprecedented demand for its GLP-1/GIP dual agonist drugs Mounjaro and Zepbound that they're constructing a $2.5 billion manufacturing plant to handle the demand. Both drugs are breaking records, and the demand has made it difficult to keep them stocked.

Ozempic, Mounjaro and Zepbound are all used to manage Type 2 diabetes but differ in their mechanisms and manufacturers. This competition drives innovation and gives patients options for diabetes management.

Expanding the Indications

Due to its costs, many health insurers and employers have restricted reimbursements for using Ozempic for weight-loss purposes. Novo is taking steps to expand the coverage for Wegovy to include more indications in areas of chronic disease treatment, including obesity-related pulmonary and cardiovascular diseases, and potentially neurological disorders.

Semaglutide for Cardiovascular Disease

Novo Nordisk released a study indicating improved symptoms for patients with obesity, diabetes and heart failure. The study called "Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes" was published in the New England Journal of Medicine and presented at the American College of Cardiology conference. Novo completed two trials and wants to attain a new indication of heart failure with preserved ejection fraction (HFpEF).

Ejection fraction is a measure of how the left ventricle, which is the main pumping chamber, can squeeze with every beat. Normal ejection fracture should be above 50%. However, preserved ejection fracture (HFpEF) tends to be above 50%, but the function of the heart is still impaired.

What the Study Entails

Novo states that there are no approved therapies that target obesity-related heart failure with preserved ejection fraction in persons with Type 2 diabetes. This indicates a need.

The study of 616 participants was comprised of random patients who have had heart failure with preserved ejection fraction and a bodyweight mass index (BMI) above 30 with Type 2 diabetes. Each patient received a weekly 2.4 mg or a placebo dose for 52 weeks.

The primary endpoint was the change in their Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS). The scores range from 0 to 100, with higher scores indicating fewer symptoms phy, physical limitations and body weight change. Secondary endpoints were changes in the six-minute walk distance, heart failure events and hierarchical composite endpoints.

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The study results.

Of the 616 participants, those who took the semaglutide had superior improvements in weight loss (9.8% versus 3.4% in the placebo) and heart-related quality of life than placebo participants (13.7 points versus 6.4 points with placebo). Semaglutide also improved inflammation and walking distances. Surprisingly, serious adverse events were reported by 55 participants or 17.7%, in the semaglutide group versus 88 participants or 28.8%, in the placebo group.

The Conclusion

The study concluded that patients with obesity-related heart failure (HFpEF) and Type 2 diabetes who took semaglutide experienced larger reductions in heart failure-related symptoms, greater weight loss and physical limitations than the placebo in one year.

GLP-1 and Parkinson's Disease

Barclay noted a recent study that GLP-1 agonists appeared to benefit patients with Parkinson's Disease. A 156-patient study was performed with patients using a GLP-1 medication by Sanofi (NASDAQ: SNY) called lixisenatide. The participants taking lixisenatide experienced no worsening of motor disabilities at the one-year mark, indicating the effects of Parkinson's were slowed down.

Novo Nordisk is also exploring the effects of GLP-1 on Alzheimer's Disease. The potential for off-label use could be a boon to the company.

Novo Nordisk analyst ratings and price targets are at MarketBeat.  

Daily Descending Triangle Pattern

The daily candlestick chart on NVO illustrates a descending triangle pattern . The descending trendline formed at the $137.57 swing high, capping bounces at lower highs. The flat-bottom lower trendline is at $123.77. NVO is trading close to the apex point indicating an imminent breakout through the upper trendline or breakdown through the flat-bottom trendline will develop. The daily relative strength index (RSI) is chopping flatly around the 50-band. Pullback support levels are at $123.77, $120.10, $117.70 and $114.01.

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Stark County roundup: News from around the Canton region

Coffee with a Cop set Thursday

ALLIANCE – The public is invited to the next Coffee with a Cop event at 10 a.m. Thursday at the Alliance Area Senior Center, 602 W. Vine St. The program provides an opportunity for community members to ask questions and to learn more about how the Stark County Sheriff’s Office serves the community.

Community members are invited to ask questions, bring concerns, or simply get to know the members of the Sheriff’s Office better.

For more information, contact the Stark County Sheriff’s Office’s director of community engagement at 330-430-3889.

Swiss steak dinner Saturday

BEACH CITY − Beach City American Legion Hall Post 549, 125 Third Ave. NE, is having a drive-thru, carryout-only Swiss steak dinner from 4 to 7 p.m. Saturday or when the food runs out. Watch for signs where to enter. Meal includes three-bean salad, applesauce, mashed potatoes with homemade gravy, corn, bread and dessert for $12.

Presentation about Tuskegee Airmen at library Saturday

CANAL FULTON – From 2 to 3 p.m. Saturday at the Canal Fulton Public Library, 154 Market St. NE, Reed Kimball from the MAPS Air Museum will discuss the establishment of the Tuskegee Airmen (332nd Fighter Group), and the many roadblocks they faced along the way. For more information, call 330-854-4148 or visit www.canalfultonlibrary.org.

Diabetes awareness fundraiser is Saturday

CANTON – The Tyler Scott Lancaster Black Tie Gala will be 5 to 8 p.m. Saturday at the Metropolitan Event Centre, 601 Cleveland Ave. NW.

The Tyler Scott Lancaster Foundation is a nonprofit organization whose goal is to educate and create awareness about diabetes through support groups, advocacy, and public awareness to individuals and family members who have been impacted by diabetes.

The special guest will be Charles Harris of the Detroit Lions. Nicole Selinsky of Cleveland Clinic Mercy Hospital will speak on the crucial need for education and awareness to fight diabetes. Individual tickets are $75 each. To buy tickets or for more information, visit www.tslfoundation.org/events.

Hunger Task Force charity art auction is Saturday

CANTON – Stark County Hunger Task Force will hold its ninth annual charity art auction, Palette 2 Palate, from 7 to 11 p.m. Saturday at the Zimmermann Symphony Center, 2331 17th St NW. Bid on donated works of art by local artists as well as silent and live auction items and enjoy complimentary hors d'oeuvres and desserts with a cash bar. All proceeds will support the organization's local hunger-fighting initiatives.

To purchase tickets, visit starkhunger.org/p2p. For more information, call 330-455-6667 or email [email protected].

Last night of 'Golden Girls' tribute dinner theater show Saturday

JACKSON TWP. − Stardust Dinner Theatre’s closing night of the "Golden Girls" tribute dinner theater show will be Saturday at La Pizzaria, 3656 Dressler Road NW, with area actors portraying the iconic TV characters.

Dinner will be Parmesan crusted chicken, penne pasta in marinara, and roasted potatoes, bread, salad with house dressing, coffee, pop, tea and a dessert. There will be a cash bar.

Doors will open at 6:30 p.m. Early arrivals may wait in the bar while sound and equipment checks and safety precautions are being conducted.

Tickets for the dinner and show are $45. VIP seating for the dinner and show is $55. Seating is reserved, and reservations are required.

Canton Preservation Society fundraiser April 25

JACKSON TWP. − The Canton Preservation Society, a nonprofit, is hosting a fundraiser called “It’s In The Bag” from 4 to 8 p.m. April 25 at Glenmoor Country Club. The fundraiser will offer dinner, a program by Janet Creighton, a live and silent auction along with a 50/50 raffle.

More than 60 new and estate handbags, along with jewelry and gift baskets, will be auctioned. Designer bags are by designers including Louis Vuitton, Burberry, Coach, Michael Kors, Kate Spade, Calvin Kline, Judith Leiber, as well as Mercedes Jackets, auto detailing, wine, gift certificates, Chanel sunglasses and jewelry.

Reservations are $70 per person, which includes sit-down dinner and a cash bar. For reservations, contact the Canton Preservation Society at 330-452-9341, 330-456-6881 or [email protected].

Free safe-driving event for senior citizens April 25

LOUISVILLE − The Stark County Sheriff's Office Safe Communities Coalition plans a free safe-driving event for senior citizens from 9 a.m. to 2 p.m. April 25 at the Fraternal Order of Eagles, 306 W. Main St. The event is designed for senior citizens to review traffic safety, including changes in traffic laws, changing road structures and health conditions that may interfere with driving.

The event will include a question-and-answer period, free light breakfast and lunch, free vision screenings and blood-pressure checks, and free vendors, such as AARP, YMCA and Stark Parks. The event will start with registration and breakfast, and opening remarks from Mayor Pat Fallot. Next will be educational speaker Julie Dominik, then the featured panelist Sheriff George Maier. Space is limited, and reservations are required. Contact Laura Miller at 330-430-3835 or email [email protected] to register.

Massillon Museum to host 'Homegoing' book discussion

MASSILLON − Retired middle-school teacher Christina Haas will host a book talk at 11 a.m. Tuesday at the Massillon Museum. The free discussion of “Homegoing” by Yaa Gyasi is part of the Massillon Museum’s 2024 NEA Big Read program.

The event is open to the public. Registration should be made atMassMu.org/Tickets. Haas has led several book discussions for the museum over the years. The Massillon Museum and Massillon Public Library are distributing 1,100 copies of “Homegoing.”

Chicago tribute concert Saturday 

MASSILLON − Lions Lincoln Theatre, 156 Lincoln Way E, will host "Brass Metropolis: A Tribute to Chicago" from 7:30 to 9:30 p.m. Saturday. VIP seating is $35, main floor seating is $30, and balcony and wheelchair/companion seating is $25. For tickets or more information, visit lionslincolntheatre.org or call 330-481-9105. 

Earth Day Recycle Fair is Saturday

NORTH CANTON – The North Canton Public Library, 185 N. Main St., will hold an Earth Day Recycle Fair from 11 a.m. to 2 p.m. Saturday. Ecycle Solutions of Ohio says “if it plugs in, we’ll recycle it.” This electronic recycling service is offered free except for CFL bulbs (50 cents each) and tube-style fluorescent bulbs (25 cents per foot). Tube TVs and monitors will not be accepted.

Goodwill will have a collection truck on-site to take almost anything that’s in useful condition. Goodwill and eCycle collections will take place in the Ream Street-facing parking lot of the North Canton Primary School.

Paper shredding will be available. Bring up to three boxes of paper per household. This program is sponsored by the city of North Canton. Organically grown plants from Know Your Roots will be for sale behind the library by the lockers.

Celebrate Earth Day at Beech Creek

WASHINGTON TWP. – Celebrate Earth Day by uniting with others from the local community from 2 to 4 p.m. Sunday at Beech Creek Botanical Garden & Nature Preserve, 11929 Beech St. NE, to do something meaningful for the environment and the planet.

There will be volunteer opportunities for all ages. Projects may include trail maintenance, garden cleanup, native garden conservation, and picnic-table building. Meet at the Visitor Center, dress for the weather, and bring work gloves. Scout troops and groups are welcome to participate.

Registration is not required, but is appreciated, especially for groups. For more information about volunteering at Beech Creek Gardens, visit beechcreekgardens.org or call 330-829-7050.

Donate blood

Vitalant will hold the following blood drives in Stark County. Make an appointment to give at vitalant.org, download and use the Vitalant app or call 877-258-4825. Scheduled are drives in:

• Canton Township: 8:30 a.m. to 12:30 p.m. Wednesday, Canton South High School, 600 Faircrest St. SW; noon to 3 p.m. Friday, Barbco, 315 Pekin Dr. SE.
• Nimishillen Township: 11:30 a.m. to 3 p.m. April 28, Beech Mennonite Church, 10037 Easton St. NE.