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The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Introduction: Cardiovascular risk reduction can decrease morbidity and mortality in patients with diabetes mellitus; however, it is seldom optimally achieved with standard care. Methods: We herein report on the rationale and preliminary results of a clinic model using a multidisciplinary team approach to improve cardiovascular risk management in patients with diabetes mellitus. We assessed risk-factor management for glycemia, dyslipidemia, hypertension and lifestyle in a retrospective survey of patients followed for 1 year or longer, in comparison with cardiology practice patients in a separate clinic at the same institution. Results: We demonstrated that intervention by a team including a cardiologist, endocrinologist, certified diabetes educator, dietician, cardiovascular advanced practice nurses and an exercise physiologist resulted in a high percentage of patients at National Cholesterol Education Program goals for secondary prevention of coronary artery disease compared with standard care. A comparis...

BACKGROUND The prevalence of type 2 diabetes is increasing at an alarming rate in Latin America and in the Caribbean. We present evidence that a cost-effective and sustainable approach to lifestyle modification in underdeveloped countries can be implemented using community members as healthcare champions. METHODS Of 222 community members screened in the impoverished community of Villa Juana, Santo Domingo, 69% had prediabetes or diabetes and 79 of these were enrolled. In a 1-day session, trained lifestyle educators from the USA trained ten lay community members to lead groups oriented to lifestyle change. Community leaders met with assigned patient groups monthly for 1 year. Glycated hemoglobin (HbA1c; average plasma glucose concentration), blood pressure, weight and waist circumference were measured at baseline, 6 months and 1 year. RESULTS 59 individuals completed follow-up. Patients showed significant improvements after 6 months in systolic blood pressure (p=0.001), diastolic blood pressure (p=0.000002) and HbA1c (p=0.015). HbA1c improved further at 1 year (p=0.005). CONCLUSION Our pilot experience demonstrates the efficacy and feasibility of a novel, low-cost, community-based educational initiative to improve blood glucose control and reduce cardiovascular risk in individuals with type 2 diabetes or prediabetes. Replication of our model in other underserved areas could have a substantial impact on global health.

Dipetalonema odendhali sp. n., Family Onchocercidae, is described from the California sea lion (Zalophus c. californianus). Adult worms were found in the intermuscular fascia of four hosts, and in additional sites-but not the heart-in one of them. Formalinized blood of one host contained microfilariae which are described. Conspecific filarioid parasitism among the California and Steller sea lions, northern fur seal (Callorhinus ursinus), harbor seal (Phoca vitulina), and northern elephant seal (Mirounga angustirostris) is considered. The demonstration of unidentified microfilariae in formalinized blood of a Steller sea lion (Eumetopias jubata) establishes a new host record for filarioid nematodes. A critical review of the literature indicates that there is a lack of documentary evidence of the existence of an enzootic infection with Dirofilaria immitis in the California sea lion, or, indeed, in native California domestic dogs. Microfilariae were examined in stained blood films of a captive California sea lion. The R-cell pattern was different from that of microfilariae of D. immitis. At the School of Veterinary Medicine on 13 September 1965, a necropsy was performed on a California sea lion, Zalophus c. californianus (Lesson, 1828). The animal was found to be heavily parasitized with nematodes in the intermuscular fascia, and in the thoracic and abdominal cavities. Enough specimens were collected to justify the description of a new species of filarioid nematode based on both males and females. The worms were fixed in hot, 70% alcohol to which 1% glacial acetic acid was added, and subsequently preserved in 70% ethyl alcohol with 5% glycerin. The species name is in honor of Stewart Odend'hal, a veterinary medical student, for his discovery of the nematodes, and for his contributions in anatomical research on sea lions. In the following description measurements are in microns unless otherwise indicated. Dipetalonema odendhali sp. n. (Figs. 1-1 1)

Dipetalonema odendhali Perry, 1967, is reported from the northern fur seal (Callorhinus ursinus) from St. Paul Island (Pribilof Islands), Alaska, and compared with specimens taken from the California sea lion (Zalophus c. californianus). Microfilariae are described. Samples of blood were taken from 130 fur seals, including twelve, 8-week-old pups. Microfilariae were not found in samples from the pups, but were present in 83% of 118 samples from fur seals over 3 years of age. The species of filarioid nematode infecting the northern fur seal, Callorhinus ursinus (Linnaeus, 1758) has not been determined to date. V. B. Scheffer (1965, pers. comm.) wrote: "In 1949 I collected a fur seal (Callorhinus ursinus) spleen on St. Paul Island [Pribilof Islands], Alaska, and sent it to John T. Lucker, Bureau of Animal Industry, who found in it larval filariids which he could not identify. In 1950 I sent 100 fur seal hearts and 100 salted, dried diaphragms to the BAI to be examined for filariids and trichinids; none was found. We found microfilariae in blood of a fur seal killed in Seattle Zoo on 7 February 1958 .... In 1963, our veterinarian Mark C. Keyes found microfilariae in the blood of 35 of 40 subadult male fur seals on St. Paul Island." Anderson (1959) examined five poorly preserved adult filarioids-four from the USNM Helminthological Collection and one from Ontario Research Foundation-from Alaskan northern fur seals, and assigned them tentatively to Dipetalonema spirocauda (Leidy, 1858), pending examination of better specimens. Three were from subcutaneous tissue, one from the testicular sheath, and one from the upper colon. Delyamure (1961) reported microfilaremia in fur seals in Soviet waters. In 1961 E. T. Lyons (pers. comm.) found pieces of adult filarioids and microfilariae in samples of blubber, fur, and skin from fur seals-adult or subadult, and, also, immature-on St. Paul Island. In July and August 1967 the authors collected blood samples and adult filarioid worms from Received for publication 23 July 1970. * Present address: Department of Veterinary Science, University of Florida, Gainesville, 32601. fur seals killed on St. Paul Island, Alaska, during the summer harvest of the fur seals for their p lts by personnel of the Bureau of Commercial Fisheries, U. S. Fish and Wildlife Service. The identification of the species of filarial worm infecting the northern fur seal and the description of the morphology of the microfilaria were the objectives of this investigation. Information was also obtained on the incidence of infection among fur seals. MATERIALS AND METHODS A necropsy of 5 adult fur seals was performed for the collection of the adult filarioids. Also, 28 male gonads with scrotal skin but no bacula, and 25 bacula with some tissue and skin at the base of the prepuce were examined. Fur-seal skins from the previous day's harvest, after soaking in seawater 24 hr, were stripped of their blubber by the workers at the processing plant. The authors collected this blubber from about 250 3to 4-year-old bulls and 50 cows, and examined it for filarioids at the laboratory. Ninety female and 9 male adult filarioids were collected. These were refrigerated overnight in Ringer's solution, and then fixed in hot 70% isopropyl alcohol, ethyl alcohol being unavailable. For microscopic examination they were cleared and mounted in lactophenol. Samples of blood were obtained from 106 adult and subadult fur seals and 12 captive pups about 8 weeks old. Approximately 3 ml of blood from the heart of each fresh kill were collected into a vial containing EDTA. Peripheral blood was collected from the live pups. Two thick and 2 thin films were made from each sample within 3 hr of collection, and also 1 ml of blood from each sample was added to 10 ml of 2% formalin. Whole blood was used for films except for specimens from 10 bulls, for which serum from 10 ml of blood per animal was used (Coffin, 1953). One of the 2 slides per fur seal was fixed in absolute methyl alcohol within 3 hr after making the films. Stain