A wide scatter of absolute levels of pancreas triacylglycerol has been reported, with a tendency for higher levels in people with diabetes (57). This large population study showed overlap between diabetic and weight-matched control groups. These findings were also observed in a more recent smaller study that used a more precise method (21). Why would one person have normal β-cell function with a pancreas fat level of, for example, 8%, whereas another has type 2 diabetes with a pancreas fat level of 5%? There must be varying degrees of liposusceptibility of the metabolic organs, and this has been demonstrated in relation to ethnic differences (72). If the fat is simply not available to the body, then the susceptibility of the pancreas will not be tested, whereas if the individual acquires excess fat stores, then β-cell failure may or may not develop depending on degree of liposusceptibility. In any group of people with type 2 diabetes, simple inspection reveals that diabetes develops in some with a body mass index (BMI) in the normal or overweight range, whereas others have a very high BMI. The pathophysiologic changes in insulin secretion and insulin sensitivity are not different in obese and normal weight people (73), and the upswing in population rates of type 2 diabetes relates to a right shift in the whole BMI distribution. Hence, the person with a BMI of 24 and type 2 diabetes would in a previous era have had a BMI of 21 and no diabetes. It is clear that individual susceptibility factors determine the onset of the condition, and both genetic and epigenetic factors may contribute. Given that diabetes cannot occur without loss of acute insulin response to food, it can be postulated that this failure of acute insulin secretion could relate to both accumulation of fat and susceptibility to the adverse effect of excess fat in the pancreas.

The ripe fruit of this cactus has been shown in some small studies to lower blood sugar ­levels. You may be able to find the fruit in your grocery store, but if not, look for it as a juice or powder at health food stores. Researchers speculate that the fruit may possibly lower blood sugar because it contains components that work similarly to insulin. The fruit is also high in fiber. Try these foods for the best diabetic diet.
The prevalence of prediabetes is also on the rise, as it’s estimated that almost 34 million U.S. adults were prediabetic in 2015. People with prediabetes have blood glucose levels that are above normal but below the defined threshold of diabetes. Without proper intervention, people with prediabetes are very likely to become type 2 diabetics within a decade.
If you are interested in trying a natural treatment in addition to standard treatment, be sure do so only under the close supervision of your physician. If diabetes is not properly controlled, the consequences can be life-threatening. Also, inform your physician about any herbs, supplements, or natural treatments you are using, because some may interact with the medications you are taking and result in hypoglycemia unless properly coordinated. 
A success story? Perhaps. But experts advise caution. For one thing, because Sweet Eze contains six different ingredients -- and because the severity of diabetes symptoms can fluctuate on their own -- it's hard to say what exactly is responsible for Cottingham's improvement. For another, supplements carry their own risks. Some products don't contain the ingredients listed on their labels. Others come mixed with dangerous -- and unlisted -- ingredients. And scientists are just beginning to verify which ones actually work.

Now mineral X shall be 4% of total body fluids and kidneys will be removing the excess more efficiently. So in another 12 hours the kidneys will bring down the mineral X from 300 units to 200 unit which is exactly 4% of the total fluid. But the body tends to remain in the same condition over a small period of time. Over consumption of X will soon cause build up of X in the body.


The extent of weight loss required to reverse type 2 diabetes is much greater than conventionally advised. A clear distinction must be made between weight loss that improves glucose control but leaves blood glucose levels abnormal and weight loss of sufficient degree to normalize pancreatic function. The Belfast diet study provides an example of moderate weight loss leading to reasonably controlled, yet persistent diabetes. This study showed that a mean weight loss of 11 kg decreased fasting blood glucose levels from 10.4 to 7.0 mmol/L but that this abnormal level presaged the all-too-familiar deterioration of control (87).

If I could only prescribe one supplement for a diabetes patient, I would prescribe R-alpha-lipoic acid. Alpha-lipoic acid has numerous benefits to the diabetic patient. It is a water- and fat-soluble antioxidant and has been shown to protect patients with fatty liver from liver disease progression. It can help reduce insulin resistance and has been shown to protect people with diabetes from developing complications in their nerves, eyes, and kidneys. R-ALA can prevent glycosylation of proteins, which reduces the A1C level. It is safe, although very rarely it can cause stomach upset. Alpha-lipoic acid is listed either as ALA or R-ALA. When listed as ALA, this means it contains two forms—the S isomer form and the R isomer form, in a 50:50 ratio. The key is to find a product that says it contains “R-ALA” instead of just “ALA.” A good daily working dose of R-ALA is 300 to 1,200 mg a day, which is the equivalent of 600 to 2,400 mg a day of regular ALA, if you buy a regular ALA listed product.
With that in mind, let’s take a look at some of the best herbs that lower blood sugar, along with a few spices thrown in, to give you a more comprehensive list. Please note that while we normally do not use animal studies to support any dietary supplement, several herbs like garlic and ginger are considered ‘food’ and so, are used traditionally by cultures across the world in their daily diet for their additional medical benefits. So human lab research studies on these are not always available. You can check all available studies under ‘References’ at the end of the article.

About Diabetes, Type 2:  Type 2 diabetes is characterized by "insulin resistance" as body cells do not respond appropriately when insulin is present. This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, and coronary artery disease. Type 2 diabetes was formerly known by a variety of partially misleading names, including "adult-onset diabetes", "obesity-related diabetes", "insulin-resistant diabetes", or "non-insulin-dependent diabetes" (NIDDM). It may be caused by a number of diseases, such as hemochromatosis and polycystic ovary syndrome, and can also be caused by certain types of medications (e.g. long-term steroid use). About 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 is a type 2 diabetic. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 is a considerable risk factor for developing type 2 diabetes. The majority of patients with type 2 diabetes mellitus are obese - chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of chemical signals (hormones and cytokines).

Diabetes is a disease characterized by a person’s inability to process carbohydrates, a condition that if untreated can lead to often-catastrophic health consequences: lethargy, diminished eyesight, heart attacks, strokes, blindness and a loss of circulation in the feet that could lead to amputation. The Centers for Disease Control and Prevention estimate that in 2014, about 29 million Americans – almost 1 in 10 – had diabetes.
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Depending on the severity of diabetes, an individual can keep control on his/her disease using diet alone, diet & oral hypoglycemic drugs, and diet & insulin. While a mild diabetic can practice disease control with diet alone, a severe diabetic might need to practice diet control along with insulin administration. Whatever the method of controlling diabetes, routine and reliability should be strictly pursued. A person suffering from diabetes should have limited amount of carbohydrates and fats along with moderate amount of protein in the diet. High-fiber diet like vegetables, whole wheat products, oats, whole legumes prove to be more beneficial. Let us have a look at what all should be had and what all should be avoided.

If I could only prescribe one supplement for a diabetes patient, I would prescribe R-alpha-lipoic acid. Alpha-lipoic acid has numerous benefits to the diabetic patient. It is a water- and fat-soluble antioxidant and has been shown to protect patients with fatty liver from liver disease progression. It can help reduce insulin resistance and has been shown to protect people with diabetes from developing complications in their nerves, eyes, and kidneys. R-ALA can prevent glycosylation of proteins, which reduces the A1C level. It is safe, although very rarely it can cause stomach upset. Alpha-lipoic acid is listed either as ALA or R-ALA. When listed as ALA, this means it contains two forms—the S isomer form and the R isomer form, in a 50:50 ratio. The key is to find a product that says it contains “R-ALA” instead of just “ALA.” A good daily working dose of R-ALA is 300 to 1,200 mg a day, which is the equivalent of 600 to 2,400 mg a day of regular ALA, if you buy a regular ALA listed product.
Remember that a healthy diet, regular exercise, and the right medication are all critical to managing type 2 diabetes. Taking the medication your doctor has prescribed for you is key. “Medication adherence can help with glycemic control and A1C reduction, which we know helps with decreasing diabetic complications, like neuropathy, as well as kidney disease,” Gupta says.

In medical world, diabetes is known more commonly by the name of diabetes mellitus. In simpler and day-to-day language, it is referred as diabetes. It is a group of metabolic diseases in which a person has high blood sugar, either because cells do not respond to the insulin that is produced, or the body does not produce enough insulin. In both the conditions, the body is not able to get enough amount of insulin to function properly.
There are two medicines in this group: repaglinide and nateglinide. Both of these lower your blood glucose by prompting the pancreas to release more insulin. These drugs work quickly and do not stay in your system long. So they are a good option if your meal schedule varies or is unpredictable. They also cause less weight gain that other oral diabetes medicines.
"You only need 10 percent of your beta cells to supply sufficient insulin," Roep said. He said there have been a couple of rare cases where a patient had typical type 1 diabetes but could go through long periods without insulin injections. "Insulin needs can be a moving target, and if you have a lifestyle change it's very plausible that you have a lesser need for insulin, and you can deal with [diabetes] with the beta cells you have," Roep said.
In addition, as early as in 2008, the Swedish Board of Health and Welfare examined and approved advice on LCHF within the health care system. Advice on LCHF is, according to the Swedish Board of Health and Welfare’s review, in accordance with science and proven knowledge. In other words, certified healthcare professionals, who give such advice (for example myself) can feel completely confident.
Because TCM defines diabetes as a disease characterized by Yin deficiency and excess internal heat, an example of a dietary prescription would be to consume spinach, which is cooling, “strengthens all the organs, lubricates the intestines, and promotes urination.”7 A recommendation might be to boil tea from spinach and drink 1 cup three times/day. Other foods considered to be cooling and beneficial for diabetes include vegetables and grains, such as celery, pumpkin, soybeans (i.e., tofu, soymilk), string beans, sweet potato/yam, turnips, tomato, wheat bran, and millet. Fruit remedies, which act in specific therapeutic ways, include crab apple, guava, plum, strawberry, and mulberry.7 It is generally recommended that patients eat a wide variety of seasonal foods and avoid or minimize consumption of sweets and fruits. Meals should be smaller, eaten more frequently, and eaten at regular times each day.

Neem tree leaves have ingredients and compounds that lower blood glucose considerably. This property of neem makes it an excellent home remedy for diabetes. A glassful of neem leaves' juice when consumed first thing in the morning can benefit considerably. Regular and prolonged consumption can even trigger production of insulin and subside diabetes completely.


After two months under the care of the naturopath, John returned to his primary care doctor to discover that his hemoglobin A1c had dropped from 8.9% to 4.9%—a nondiabetic range. For eight months and counting, he’s been off all his diabetes medication. His last A1c reading was 5.1%. With the help of his naturopath, John seems to have reversed his diabetes.
Qigong (pronounced “chi gong”) is literally translated as “function of Qi.” It emphasizes the connection between the mind and body. It is a meditative method that consists of breathing techniques that can be combined with body movements in order to regulate, harness, and enhance Qi. Qigong is used as a means of promoting health, healing, spiritual growth, and overall well-being. While Qigong is not typically used as a major treatment modality for diabetes, it has been found to be a valuable adjunctive therapy for this condition. There are specific Qigong exercises for diabetes.15

Anecdotally, Cummings knows at least one person in the US who got their surgery paid for through their partner’s employer insurance, despite only having a BMI of 31. And he notes that many countries with a robust public health care system have already lowered their BMI limits to mirror the DSS-II guidelines, such as the UK and Saudi Arabia. He also believes that Medicare and Medicaid officials are deliberating whether to adopt the DSS-II guidelines, based on discussions he’s had. “I don’t know how long it’ll take, but we’re crossing our fingers and hoping,” he said.
Researchers are discovering more about the causes of type 2 diabetes but as yet there are no clear avenues for a cure. With this said, there has been success in reversing the development of type 2 diabetes. Methods which result in a significant loss of weight have been successful in helping people to control blood glucose levels and have allowed some people to come off their diabetic medication. Methods such as bariatric surgery and very low calorie diets have been successful in allowing patients to reduce dependency on medication.

Another factor to consider when determining when to take your diabetes medicines is how well you can follow the regimen your doctor recommends. For any drugs to be effective, you have to take them. Ideally, your medication schedule should be incorporated into your daily routine; only having to remember to take your diabetes pills once a day may make things easier for you. Not much evidence is available that taking saxagliptin and glipizide at different times will provide a better blood-glucose-lowering effect. The most important thing is to take them regularly and without missing any doses. In addition to taking the diabetes medicines you’ve been prescribed, other ways to help improve your blood glucose levels are to engage in healthy lifestyle habits, such as regular physical activity and a healthy diet.
Natural herbs have cure so many illness that drugs and injection can’t cure.I have seen the great importance of natural herbs and the wonderful works they have done in peoples lives.I read people’s testimonies on line on how they were cured of herpes,HIV, diabetics etc by Dr Akhigbe.herbal medicines,so I decided to contact because I know nature has the power to heal anything.I was diagnosed with HIV for the past 7 year but Dr Akhigbe cured me with his herpes and I referred my aunt and her husband to him. Immediately because they where both suffering from herpes but to God be the glory, they were cured too. I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also good in curing diabetes,cancer,asthman,diarrhea,hiv/aids,impotence and other virus. Contact Dr Akhigbe on phone/WhatsApp no: +2348142454860 or email him on..drrealakhigbe@gmail.com
According to Centers for Disease Control and Prevention (CDC), 30.3 million people have diabetes, or some 9.4% of the US population. Type 1 diabetes sufferers’ pancreases make very little insulin or none at all. Without insulin—the hormone that enables blood sugar to enter the cells in your body where it can be used for energy—blood sugar can’t get into cells and dangerously builds up in the bloodstream.

The mice immune systems did not attack the new insulin-producing cells. Most important, according to the findings: The cells produced the right amount of insulin: not so much that they sent a mouse into a blood sugar free fall, not so little that blood sugar levels stayed high. The mice have shown no sign of diabetes for more than a year, according to the findings.
Cloves protect the heart, liver and lens of the eye of diabetic rats, according to studies. This spice contains 30% of the antioxidant phenol in dry weight, along with antioxidants anthocyanins and quercetin. As a result, cloves have antiseptic as well as germicidal properties. It also offers anti-inflammatory, analgesic and digestive health benefits for diabetics.
In 2016, the 2nd Diabetes Surgery Summit released its own guidelines, arguing that surgery should be widely recommended for moderately obese people with diabetes who haven’t responded well to other treatments. They also agreed it should be considered for mildly obese people. And because of how cost-effective surgery is, especially compared to standard treatment, insurance companies should be willing to foot the bill, it said.
Many people have heard about type 2 diabetes, but its common precursor, prediabetes, doesn’t get as much attention. Prediabetes is estimated by CDC to affect 86 million Americans (51% of whom are 65 years and older), and an estimated 90% of people with prediabetes don’t even know it. According to the CDC, 15-30% of these individuals will develop type 2 diabetes within five years. In other words, as many as 26 million people that currently have prediabetes could develop type 2 diabetes by 2020, effectively doubling the number of people with type 2 diabetes in the US.

The aptly named bitter melon is thought to help cells use glucose more effectively and block sugar absorption in the intestine. When Philippine researchers had men and women take bitter melon in capsule form for three months, they had slight, but consistently, lower blood sugar than those taking a placebo. Gastrointestinal problems are possible side effects. You can reverse diabetes with these science-backed strategies.
Alpha lipoic acid is an antioxidant that helps turn glucose into fuel for the body. It effectively improves insulin sensitivity and reduces symptoms of diabetic neuropathy, such as weakness, pain and numbness that’s caused by nerve damage. Although we make alpha lipoic acid and it can be found in some food sources, like broccoli, spinach and tomatoes, taking an ALA supplement will increase the amount that circulates in your body, which can be extremely beneficial when trying to reverse diabetes naturally. (17)
The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, defines complementary and alternative medicine as a "group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Complementary medicine is used with conventional treatments, whereas alternative medicine is used instead of conventional medicine.
The title is misleading to say the least. The first 71 pages are mostly about how the author has done such a wonderful job of coming up with the theories to write this book. What really got me was when she says in the beginning about trying combinations of diet, exercise, and/or medication but she has a better plan...which is her diet and exercises with other replacement herbs and such for medication. This is not a cure by even my imagination. It does have some good information and the format is decent. Although pretty much all the information is either online or common sense, it is all in one place which is pretty much the only reason I'm not returning it. It is very doubtful I will actually make any of the recipes but they are interesting to flip through. The easy to read format and writing is why I'm fining this 2 stars instead of 1 star. If you're looking for basic information and some common sense suggestions (example: cut down on sweets and sugar in your diet) then this is a worthwhile purchase. Otherwise this book has no magic bullet information that will cure diabetes.
Patients diagnosed with type 2 diabetes may discover that if they are overweight at diagnosis and then lose weight and begin regular physical activity, their blood glucose returns to normal. Does this mean diabetes has disappeared? No. The development of type 2 diabetes is a gradual process, too, in which the body becomes unable to produce enough insulin for its needs and/or the body's cells become resistant to insulin's effects. Gradually the patient goes from having "impaired glucose tolerance" — a decreased but still adequate ability to convert food into energy — to having "diabetes."

Chronic exposure of β-cells to triacylglycerol or fatty acids either in vitro or in vivo decreases β-cell capacity to respond to an acute increase in glucose levels (57,58). This concept is far from new (59,60), but the observations of what happens during reversal of diabetes provide a new perspective. β-Cells avidly import fatty acids through the CD36 transporter (24,61) and respond to increased fatty acid supply by storing the excess as triacylglycerol (62). The cellular process of insulin secretion in response to an increase in glucose supply depends on ATP generation by glucose oxidation. However, in the context of an oversupply of fatty acids, such chronic nutrient surfeit prevents further increases in ATP production. Increased fatty acid availability inhibits both pyruvate cycling, which is normally increased during an acute increase in glucose availability, and pyruvate dehydrogenase activity, the major rate-limiting enzyme of glucose oxidation (63). Fatty acids have been shown to inhibit β-cell proliferation in vitro by induction of the cell cycle inhibitors p16 and p18, and this effect is magnified by increased glucose concentration (64). This antiproliferative effect is specifically prevented by small interfering RNA knockdown of the inhibitors. In the Zucker diabetic fatty rat, a genetic model of spontaneous type 2 diabetes, the onset of hyperglycemia is preceded by a rapid increase in pancreatic fat (58). It is particularly noteworthy that the onset of diabetes in this genetic model is completely preventable by restriction of food intake (65), illustrating the interaction between genetic susceptibility and environmental factors.
Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.
The mice immune systems did not attack the new insulin-producing cells. Most important, according to the findings: The cells produced the right amount of insulin: not so much that they sent a mouse into a blood sugar free fall, not so little that blood sugar levels stayed high. The mice have shown no sign of diabetes for more than a year, according to the findings.
Acupuncture is a procedure where a practitioner inserts very thin needles into specific points on your skin. Some scientists say that acupuncture triggers the release of the body's natural painkillers. Acupuncture has been shown to offer relief from chronic pain and is sometimes used by people with neuropathy, the painful nerve damage that can happen with diabetes.
Meanwhile, other scientists are studying fenugreek seeds, a folk remedy for diabetes. Several studies, including one published in 1990 in the European Journal of Clinical Nutrition suggest that this herb can lower blood sugar. Researchers found that type 1 diabetics who took 50 grams of fenugreek seed powder twice daily had significantly lower blood sugar levels than those who took a placebo.

Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

But does Darkes' story really mean type 1 diabetes can be cured? Darkes declined to provide his medical records, and the experts Live Science spoke to said there were several missing or confusing pieces of information in his story. Usually, incredible medical stories like this one are reported as case reports in the medical literature, the experts said. And even if the details of his story can ultimately be confirmed, the experts emphasized that it's extremely unlikely that Darkes' case would lead to a widespread cure for type 1 diabetes, as reports in the media have wrongly suggested.


Joseph, you should talk with your doctor or diabetes educator about this. In general, you can take metformin with most herbs, but your case might be different, and you might not need to. You might have to experiment. The same with insulin, although you have to be more careful there — in all cases you should work with your doctor or diabetes educator.

The core problem is insulin. Most people naturally secrete that substance when they eat something with carbohydrates, such as bread, potatoes and candy bars. Insulin acts like a concierge that escorts the sugar from the bloodstream into the cells, providing the cells with the energy to function. In most people, the body is continually monitoring blood sugar and producing insulin as needed.
Many people have heard about type 2 diabetes, but its common precursor, prediabetes, doesn’t get as much attention. Prediabetes is estimated by CDC to affect 86 million Americans (51% of whom are 65 years and older), and an estimated 90% of people with prediabetes don’t even know it. According to the CDC, 15-30% of these individuals will develop type 2 diabetes within five years. In other words, as many as 26 million people that currently have prediabetes could develop type 2 diabetes by 2020, effectively doubling the number of people with type 2 diabetes in the US.
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The results of his medical tests are still being analyzed, Darkes said, but he hasn't needed insulin injections for a year and a half. "It took a long time to sink in," he noted. But Darkes is confident he no longer has type 1 diabetes. He said that doctors told him that he has a "rare" gene that somehow facilitated his cure. "I'm the only one who carries [the gene], at the moment," and there's no further explanation so far, he said.
With that in mind, let’s take a look at some of the best herbs that lower blood sugar, along with a few spices thrown in, to give you a more comprehensive list. Please note that while we normally do not use animal studies to support any dietary supplement, several herbs like garlic and ginger are considered ‘food’ and so, are used traditionally by cultures across the world in their daily diet for their additional medical benefits. So human lab research studies on these are not always available. You can check all available studies under ‘References’ at the end of the article.
Aside from the financial costs of diabetes, the more frightening findings are the complications and co-existing conditions. In 2014, 7.2 million hospital discharges were reported with diabetes as a listed diagnosis. Patients with diabetes were treated for major cardiovascular diseases, ischemic heart disease, stroke, lower-extremity amputation and diabetic ketoacidosis.
Together with evidence of normalization of insulin secretion after bariatric surgery (84), insights into the behavior of the liver and pancreas during hypocaloric dieting lead to a hypothesis of the etiology and pathogenesis of type 2 diabetes (Fig. 6): The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol (85), which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function. However, of note, observations of the reversal of type 2 diabetes confirm that if the primary influence of positive calorie balance is removed, then the processes are reversible (21).
Known for its immune-boosting and disease-fighting benefits, this Chinese herb has several positive diabetes studies behind it. Re­searchers have found that ginseng slows carbohydrate absorption; increases cells’ ability to use glucose; and increases insulin secretion from the pancreas. A team from the University of Toronto has repeatedly demonstrated that ginseng capsules lower blood glucose 15 to 20 percent compared to placebo pills. These are the best superfoods for people with diabetes.
"Traditionally, we transplant islets in the liver of the animal and never do it under the skin, in large part because the skin doesn't have the blood flow that the liver has for transporting insulin released by islets. And there are a lot of immune cells in the skin, so chances of rejection are high," said Raghu Mirmira, professor of pediatrics and medicine and director of the Diabetes Research Center at the Indiana University School of Medicine.
It was the same endorsement the first Diabetes Surgery Summit, also organized by Cummings in 2007, had made, but the landscape had changed since then. In addition to more accumulated research, this time, their stance was backed by over 50 international professional organizations, including the American Diabetes Association. And while other medical societies and organizations had long backed surgery as an option for diabetes, the DSS-II guidelines are the first meant to guide clinical practice.
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