XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Importance More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010. Objective To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults. Design, Setting, and Participants Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey. Main Outcomes and Measures In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). Results In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children ( P  = .03) and women ( P  = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P  = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P  = .006). Conclusions and Relevance Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.

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Prevalence of childhood and adult obesity in the United States, 2011-2012.

Principles and Practice of Structural Equation Modeling (2nd ed.)

Although the Internet has transformed the way our world operates, it has also served as a venue for cyberbullying, a serious form of misbehavior among youth. With many of today's youth experiencing acts of cyberbullying, a growing body of literature has begun to document the prevalence, predictors, and outcomes of this behavior, but the literature is highly fragmented and lacks theoretical focus. Therefore, our purpose in the present article is to provide a critical review of the existing cyberbullying research. The general aggression model is proposed as a useful theoretical framework from which to understand this phenomenon. Additionally, results from a meta-analytic review are presented to highlight the size of the relationships between cyberbullying and traditional bullying, as well as relationships between cyberbullying and other meaningful behavioral and psychological variables. Mixed effects meta-analysis results indicate that among the strongest associations with cyberbullying perpetration were normative beliefs about aggression and moral disengagement, and the strongest associations with cyberbullying victimization were stress and suicidal ideation. Several methodological and sample characteristics served as moderators of these relationships. Limitations of the meta-analysis include issues dealing with causality or directionality of these associations as well as generalizability for those meta-analytic estimates that are based on smaller sets of studies (k < 5). Finally, the present results uncover important areas for future research. We provide a relevant agenda, including the need for understanding the incremental impact of cyberbullying (over and above traditional bullying) on key behavioral and psychological outcomes.

Bullying in the Digital Age: A Critical Review and Meta-Analysis of Cyberbullying Research Among Youth

Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants.

School Bullying Among Adolescents in the United States: Physical, Verbal, Relational, and Cyber

Cyber and traditional bullying: differential association with depression.

Objective To examine co-occurrence of five subtypes of peer victimization. Methods Data were obtained from a national sample of 7,475 US adolescents in grades 6 through 10 in the 2005/2006 Health Behavior in School-Aged Children (HBSC) study. Latent class analyses (LCA) were conducted on victimization by physical, verbal, social exclusion, spreading rumors, and cyber bullying. Results Three latent classes were identified, including an all-types victims class (9.7% of males and 6.2% of females), a verbal/ relational victims class (28.1% of males and 35.1% of females), and a nonvictim class (62.2% of males and 58.7% of females). Males were more likely to be all-type victims. There was a graded relationship between the three latent classes and level of depression, frequency of medically attended injuries, and medicine use, especially among females. Conclusions Increased co-occurrence of victimization types put adolescents at greater risks for poorer physical and psychological outcomes.

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Jing Wang

Papers

School Bullying Among Adolescents in the United States: Physical, Verbal, Relational, and Cyber

Cyber and traditional bullying: differential association with depression.

Co-occurrence of Victimization from Five Subtypes of Bullying: Physical, Verbal, Social Exclusion, Spreading Rumors, and Cyber

Dating violence perpetration and victimization among U.S. adolescents: prevalence, patterns, and associations with health complaints and substance use

The effect of passengers and risk-taking friends on risky driving and crashes/near crashes among novice teenagers