Diagnostic du diabète
What to Do After a Diabetes Diagnosis FR
Publié: May 21, 2025
Mis à jour: Oct. 30, 2025
7 temps de lecture
Being newly diagnosed with diabetes can feel overwhelming. Learn more about your diabetes diagnosis and get tips to help you start your diabetes journey, including how to check blood sugar and where to find resources for support.
Takeaways:
- A diabetes diagnosis is never your fault. There are many interconnected factors that can contribute to diabetes.
- Learning more about diabetes can help you feel a little bit more confident about managing your diabetes diagnosis.
- Understanding some of the key diabetes terms can make it easier to talk to your diabetes care team.
- Treatments like insulin and medication, along with tools like continuous glucose monitoring (CGM) systems, can support your diabetes management.
- Reaching out for help and connecting with your community can help you cope with a diabetes diagnosis
Dealing with a Diagnosis of Diabetes
Facing a diabetes diagnosis takes a lot of courage. It’s completely normal to experience a range of emotions that might include anger, fear, anxiety, and sadness. If you’re a parent or a caregiver of a child who has just been diagnosed with diabetes, you may feel similar emotions while also managing your child’s reaction to the diagnosis. Being newly diagnosed with diabetes or receiving a diabetes diagnosis for your child can feel very overwhelming as you’re tasked with learning new medical terminology, building new habits, and figuring out how to check blood sugar and ways to manage it. These changes do affect your everyday life, and it’s also normal to experience feelings of grief or distress around how much you may need to change your lifestyle.
Because a diagnosis can bring up challenging feelings, it’s important to cultivate self-compassion. A diabetes diagnosis is never your fault. Diabetes is a complex condition that’s influenced by a variety of factors, many of which are not within your control. Know that there are plenty of resources and tools available to help support you as you learn how diabetes affects you and how to manage it.
One of the things you do have control over when you’re first diagnosed with diabetes is learning more about diabetes and increasing your diabetes self-management education. Improving your diabetes education has been clinically shown to lead to better health outcomes and it can empower you to feel more confident adapting to your diagnosis of diabetes.1
What Does a Diabetes Diagnosis Mean?
A diabetes diagnosis means that the body can’t regulate glucose effectively. Glucose is a type of sugar that comes from the foods we eat and the beverages we drink, usually in the form of carbohydrates. We can also get glucose from foods that aren’t considered “carbs”, such as dairy products, which contain a sugar called lactose that breaks down into glucose in the body. Glucose gets absorbed into the bloodstream and carried around the body to provide energy for all our cells and tissues. Without glucose, the body can’t function.
Diabetes happens because of issues with a hormone called insulin, which is made in an organ called the pancreas. Insulin is like a gatekeeper that tells your cells to open up and absorb the glucose that’s in your bloodstream. The different types of diabetes are distinguished by how insulin-related issues appear in the body. There are four main types of diabetes:
Type 1 Diabetes
Type 1 diabetes (T1D) happens when the body attacks the cells in the pancreas that make insulin in what’s known as an autoimmune event. When these cells are destroyed, the body can no longer make its own insulin. T1D is most commonly diagnosed in children. Doctors do not yet know what causes T1D, but some factors that may contribute to the development of the condition include genetics and environmental factors like viruses.
Type 1.5 Diabetes: Latent Autoimmune Diabetes in Adults
While T1D is associated with diagnosis in childhood, adults over the age of 30 can develop what’s known as type 1.5 diabetes or latent autoimmune diabetes in adults (LADA). Like T1D, LADA also happens because of an autoimmune event that destroys the cells that make insulin.
Type 2 Diabetes
Type 2 diabetes (T2D) develops over time and involves both the pancreas and the cells in the body. Prediabetes is the initial phase of T2D. In T2D, the pancreas may still make insulin, but the cells in the body have become less receptive to it, known as insulin resistance. This means that the pancreas has to produce more and more insulin, which can result in the cells in the pancreas burning out and eventually producing less than the body needs. Like T1D, there are many interconnected factors that influence the development of T2D. Just a handful of the risk factors for T2D include:
- Having a parent or sibling living with T2D.
- Having polycystic ovarian syndrome (PCOS).
- Experiencing low socioeconomic status.
- Having African, Arab, Asian, Hispanic, Indigenous, or South Asian heritage.
Gestational Diabetes
A gestational diabetes diagnosis happens only during pregnancy. Similar to T2D, gestational diabetes develops when the pancreas can’t make enough insulin to meet the body’s needs. Doctors think this may occur because of the hormonal changes during pregnancy. Typically, gestational diabetes goes away after you give birth.
Diabetes Definitions
A diabetes diagnosis can come with a steep learning curve. It’s a good idea to familiarize yourself with some of the key terms and medical concepts so that you can feel a little more confident talking about diabetes. Here are a few quick definitions you can refer to as you learn more about diabetes and glucose management.
Glucose and Blood Sugar
Glucose is a type of sugar molecule we get from the foods and drinks we consume. Through digestion, glucose is absorbed into the bloodstream and carried around the body, which is known as blood sugar. With the help of insulin, our cells absorb glucose and use it for energy.
Insulin
Insulin is a hormone made in the pancreas by cells called beta cells. Insulin is like a gatekeeper that tells the cells in the body to open up to the glucose passing by in the bloodstream. When insulin isn’t there to tell the cells to open up, the cells can’t let glucose in.
mmol/L
Millimoles per litre or mmol/L is the unit typically used to measure glucose in Canada. Millimoles refer to the amount of glucose molecules present in a litre of blood. You may also see mg/dL, which is milligrams of glucose per litre of blood, and is more commonly used in the US.8 Here’s a handy chart to help you convert between mmol/L and mg/dL .
A1C
Doctors use an A1C test to help confirm a diabetes diagnosis. Hemoglobin A1C, also known as HbA1C or simply A1C, is a blood test that tells doctors the average glucose level in the blood over the previous two or three months. Glucose in the bloodstream attaches to hemoglobin, a type of protein in red blood cells. An A1C test measures how many red blood cells are coated in glucose. Diabetes Canada recommends that individuals living with diabetes get their A1C tested every three months and work towards an A1C at or below 7.0%. 10
Target Glucose Range
Diabetes Canada generally recommends that individuals living with diabetes maintain glucose levels between 3.9 mmol/L and 10.0 mmol/L as often as possible to maintain their health and reduce the likelihood of complications.11 It’s a good idea to work with your doctor to define your personal target range.
Time in Range
Time in range (TIR) measures how frequently and how long you spend in your target range. Spending 70% of your time in range over the course of three months is associated with an A1C of 7.0%.12
Hypoglycemia
HYPOglycemia is also known as low blood sugar. It happens when there isn’t enough glucose in the blood for the body to function properly. Diabetes Canada defines hypoglycemia as glucose levels below 3.9 mmol/L. 13
Hyperglycemia
HYPERglycemia is also known as high blood sugar. It happens when the body can’t absorb the glucose in the bloodstream fast enough, leading to too much glucose in the blood. Diabetes Canada generally recommends that individuals living with diabetes aim to keep their glucose levels under 10.0 mmol/L.11
Treating and Managing Diabetes
Diabetes is a treatable condition. In addition to building and practicing healthy habits, there are many supportive medical technologies that can help you take care of yourself. Everyone experiences diabetes differently, so treatments must be personalized to each individual. In general, diabetes management requires you to look after your glucose levels, which is usually done by combining medical interventions, like insulin therapy and medication, with lifestyle management that can include eating well, exercising, and caring for your mental health.
Choose the Right Glucose Monitoring System
Individuals living with diabetes need to keep a close eye on their glucose levels. Many factors influence your glucose levels and glucose monitoring helps you understand what affects your glucose day-to-day and in the moment. It also allows you to determine when you’re going high or low so that you can prevent or treat hyperglycemia and hypoglycemia. There are two main options for monitoring your glucose:
Blood Glucose Meters (BGMs) require you to prick your finger with a lancing device and put a drop of blood on a test strip to read your glucose levels. It can be inconvenient to stop your day to check your glucose levels as often as you need to. Some BGMs are connected to apps and automatically log your glucose readings when you take them. However, some BGMs require you to write down your glucose readings in a logbook manually.
Continuous Glucose Monitoring (CGM) Systems do not require you to routinely prick your finger to check your glucose.* CGM systems like the Dexcom G7 CGM System consist of a wearable device that takes glucose readings using a sensor inserted just below the skin. The sensor continuously sends readings to an app on your compatible smart device or a handheld receiver.† Dexcom G7 can provide glucose readings up to every five minutes. The display device shows your glucose readings in an easy-to-understand graph alongside your current glucose number and trend arrows that can show you where your glucose is headed. Dexcom G7 also has customizable glucose alerts as well as a predictive alert that can let you know up to 20 minutes before a serious low below 3.1 mmol/L.
Diabetes Canada recommends that individuals living with T1D using insulin therapy should use a CGM system to help lower A1C, increase TIR, and reduce hypoglycemia.14-19 It’s important to talk to your doctor about your options for glucose monitoring. The system that is best for you is the one that’s comfortable, convenient, and helps you feel more confident about keeping your levels in range.
Getting Acquainted with Insulin Therapy
When the body is unable to make enough insulin to meet its energy needs, individuals living with diabetes can use insulin therapy to replace the insulin their pancreas produces. Insulin therapy is required for individuals living with T1D. Though individuals living with T2D often use only lifestyle management to treat diabetes (such as diet and exercise), they can also use insulin therapy or medication to support glucose management if their doctor prescribes it. There are two main types of insulin:20
Basal Insulin: Also known as background insulin, intermediate-acting, or long-acting insulin, basal insulin helps keep glucose levels stable between meals and overnight.
Bolus Insulin: Also known as short-acting or rapid-acting insulin, bolus insulin is taken immediately before eating to reduce the spike in glucose that happens after a meal.
There are several ways to take insulin, and determining which option suits you best may take some time. For those living with T1D, having an effective insulin routine is essential to maintain good health. You can take insulin using a syringe, an insulin pen, or an insulin pump.20 It’s important to talk to your doctor about the different insulin delivery options as they can guide you towards the one that will fit into your lifestyle and help you reach your glucose management goals.
Learn About Glucose Control Medication
Individuals living with T2D and those experiencing gestational diabetes can use glucose control medications to help support diabetes management. Your doctor will work closely with you to determine which medications are right for you and help you adjust your prescription as you fine-tune your diabetes management plan. Diabetes Canada has information sheets on all the main types of glucose management medications including:21
- Metformin
- Alpha-glucosidase inhibitors
- DPP-4 inhibitor
- GLP-1 receptor agonists
- Non-sulfonylurea insulin secretagogues
- SGLT2 Inhibitors
- Sulfonylurea insulin secretagogues
Understand Lifestyle Management
Prioritizing a healthy lifestyle and focusing on self-care are important parts of diabetes management. Many individuals living with T2D can manage their glucose levels by choosing healthy foods, getting enough physical activity, sleeping well, and managing stress. Building habits like these are also beneficial for individuals living with T1D as they can help support glucose regulation in the body.
5 Steps to Start Your Diabetes Journey
A diabetes diagnosis is the beginning of a lifelong commitment to looking after your health and well-being with greater care. It’s important to remember that you’re not alone on this journey. There are plenty of resources, tools, and community support systems to help you not only treat diabetes, but to live a full, vibrant life while managing the condition. Reaching out for guidance, connecting with others, and prioritizing your mental health can help you feel emotionally strong, increasing your confidence in your ability to manage your new diabetes diagnosis. Here are five things you can do when you receive a diabetes diagnosis to support yourself:
1. Connect with Your Diabetes Care Team
After a diabetes diagnosis, your family doctor should be your main point of contact when learning how to manage the condition. Doctors can direct you to specialists such as endocrinologists, certified diabetes educators, or registered diabetes dietitians. Endocrinologists can help provide greater insight into how insulin is working in your body. Diabetes educators can help you learn about various parts of your diabetes treatment, including how to manage your glucose and use diabetes technology. Registered dietitians are trained to help individuals living with diabetes create eating plans that support their glucose management and nutrition goals.
- What is my role in managing diabetes?
- What will my doctor’s role be in supporting me?
- Who are the other members of my diabetes care team? How often should I see them?
- Where do I get more reliable sources of diabetes education resources?
- What changes do I need to make to my lifestyle right away?
- How often should I monitor my glucose?
2. Take Care of Your Mental Health
It’s important to recognize the emotional and psychological toll that receiving news like a diabetes diagnosis can take. Be gentle with yourself. Remember to speak to yourself as you would to a close friend and try practicing self-compassion meditation or techniques such as mindfulness and grounding.
Prioritize reaching out for support from others, including your diabetes care team and your loved ones. Coping with challenging circumstances is a skill you can learn. Professional psychologists and counsellors can help you work through the emotions that are coming up around your diagnosis of diabetes. They can discuss techniques for feeling more optimistic, capable, and confident as you learn to manage diabetes.
3. Communicate with Your Loved Ones
Opening up about your feelings may not be easy, but doing so can help you feel connected and supported. You can decide when and how to bring up diabetes with your friends and family. It’s a good idea to take the time to figure out your boundaries around talking about the condition and be sure that you’re sharing your feelings with those who can give you an empathetic, caring response.
Your diabetes diagnosis might also bring up difficult feelings in other people, such as fear, concern, and worry. Those close to you might try to regain a sense of control by giving you unsolicited advice. It’s important to understand where they are coming from while establishing boundaries around how you’d like them to treat you going forward. A psychologist or counsellor can also help you set healthy boundaries and communicate with your loved ones effectively.
It’s a good idea to talk to your doctor about how others can support you if you have a health emergency, such as low or high blood sugar. People with whom you spend most of your time, such as your family and colleagues, likely need to know what to do to help you when you’re in trouble. You can use the Dexcom Follow app to keep your loved ones in the loop about your glucose so they can provide support if you need it.‡
4. Prioritize Diabetes Education
Diabetes education can equip you with the knowledge and tools you need to take care of yourself. When you’re newly diagnosed with diabetes, it can feel like you’re walking into a dark cave with no flashlight. Diabetes education is like a string of lights on the cave walls. As you walk forward on your diabetes journey, the bulbs turn on, illuminating the next right step and, eventually, lighting the whole place up as you become the expert on your own diabetes management.
A few resources you can explore to expand your knowledge and empower yourself after your diabetes diagnosis include:
- Diabetes Canada’s toll-free diabetes education line: 1-800-BANTING (226-8464)
- Diabetes Canada’s How 2 Type 1 series
- Diabetes Canada’s Virtual Diabetes Education Program
- Type 1 diabetes basics from the Juvenile Diabetes Research Foundation (JDRF)
- Articles from the Diabetes Care Community
- Bright Spots & Landmines by Adam Brown
- Articles from the diaTribe Foundation
- The Dexcom Canada CGM Blog
5. Find Community Connections
Beyond your diabetes care team and your loved ones, it’s a great idea to get involved with the diabetes community. Individuals who also live with the condition share some of your experiences and have likely felt the same way you do when they received their diabetes diagnosis. For children living with diabetes, socializing with other kids who live with the condition can give them a sense of belonging and acceptance. Having people around you who can relate to your experiences can inspire you to face diabetes with courage.
Your diabetes community can also give you, or your child, the opportunity to get active and participate in fun events. Some opportunities to connect with the diabetes communities across Canada include:
- Programs from the National Indigenous Diabetes Association.
- Diabetes Canada programs, events, and fundraisers.
- Breathrough T1D (formerly the JDRF) T1D peer-to-peer support and connection series.
- Connected in Motion adventures.
Kids and teens living with diabetes can get involved with programs like:
- Diabetes Canada D-Camps.
- Dskate Hockey Camps.
- I Challenge Diabetes camps, hiking adventures, and youth retreats.
You can also connect with the Dexcom Warrior community across Canada online. Dexcom Warriors are a diverse group of people who are thriving while managing diabetes. You can follow along with the Warriors on Instagram and Facebook @DexcomCanada and find Warrior stories on our YouTube channel.
Take Control of Your Diabetes Diagnosis with CGM
Continuous glucose monitoring (CGM) can support you as you adjust to the new lifestyle and self-care routines that your doctor recommends as part of your diabetes treatment plan. When you’re getting started with glucose management after a diabetes diagnosis, it can take time to figure out what affects your glucose levels. A CGM system like Dexcom G7 can provide a view into what’s going on with your glucose levels throughout the day and overnight. With this information, you and your doctor can pinpoint what’s making a difference to your glucose levels and overall sense of well-being.
Dexcom G7 can help you feel a greater sense of control around managing diabetes. With glucose readings in the palm of your hand, you can feel more confident making effective treatment decisions in the moment. Using Dexcom G7 can also give you extra peace of mind around monitoring your glucose so that you can focus on doing the things that matter to you.
* Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
† For a list of compatible devices, please visit dexcom.com/compatibility
‡ Separate Dexcom Follow app required. Internet connectivity required for data sharing. Followers should always confirm readings on the Dexcom G7 app or receiver before making treatment decisions.
† For a list of compatible devices, please visit dexcom.com/compatibility
‡ Separate Dexcom Follow app required. Internet connectivity required for data sharing. Followers should always confirm readings on the Dexcom G7 app or receiver before making treatment decisions.
1 Sherifali D, et. al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Self-Management Education and Support. Can J Diabetes. 2018;42 Suppl 1:S36-S41. doi:10.1016/j.jcjd.2017.10.006
2 Hantzidiamantis PJ, et. al. Physiology, Glucose. StatPearls Publishing. Updated September 19, 2022. Accessed March 14, 2024. https://www.ncbi.nlm.nih.gov/books/NBK545201/
3 Type 1 diabetes. Mayo Clinic. Updated September 15, 2023. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011
4 Punthakee Z, et al. Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42(Suppl 1):S10-S15. doi:10.1016/j.jcjd.2017.10.003
5 Type 2 diabetes. Mayo Clinic. Updated March 14, 2023. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
6 Ekoe JM, et. al. Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Screening for Diabetes in Adults. Can J Diabetes. 2018;42 Suppl 1:S16-S19. doi:10.1016/j.jcjd.2017.10.004
7 Gestational Diabetes. Mayo Clinic. Updated April 09, 2022. https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339
8 Blood Sugar Converter. Diabetes.co.uk. Updated November 10, 2023 https://www.diabetes.co.uk/blood-sugar-converter.html
9 All About Your A1C. Centers for Disease Control and Prevention. Reviewed September 30, 2022. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
10 Berard LD, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Monitoring Glycemic Control. Can J Diabetes. 2018;42 Suppl 1:S47-S53. doi:10.1016/j.jcjd.2017.10.007
11 Imran AS, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Targets for Glycemic Control. Can J Diabetes. 2018:42(S42–S46). doi: 10.1016/j.jcjd.2017.10.030
12 Cheng AYY, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Blood Glucose Monitoring in Adults and Children with Diabetes: Update 2021. Can J Diabetes. 2021;45(7):580-587. doi:10.1016/j.jcjd.2021.07.003
13 Lega IC, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Hypoglycemia in Adults. Can J Diabetes. 2023;47(7):548-559. doi:10.1016/j.jcjd.2023.08.003
14 Beck RW, et al. JAMA. 2017;317(4):371-378.
15 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374.
16 Martens T, et al. JAMA. 2021;325(22):2262-2272.
17 Laffel LM, et al. JAMA. 2020;323(23):2388-2396.
18 Welsh JB, et al. J Diabetes Sci Technol. 2024;18(1):143-7.
19 Heinemann L, et al. Lancet. 2018;391(10128):1367-1377.
20 4 Ways to Take Insulin. Centers for Disease Control and Prevention. Reviewed April 18, 2023. https://www.cdc.gov/diabetes/basics/type-1-4-ways-to-take-insulin.html
21 Lipscombe L, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update. Can J Diabetes. 2020;44(7):575-591. doi:10.1016/j.jcjd.2020.08.001
2 Hantzidiamantis PJ, et. al. Physiology, Glucose. StatPearls Publishing. Updated September 19, 2022. Accessed March 14, 2024. https://www.ncbi.nlm.nih.gov/books/NBK545201/
3 Type 1 diabetes. Mayo Clinic. Updated September 15, 2023. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011
4 Punthakee Z, et al. Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42(Suppl 1):S10-S15. doi:10.1016/j.jcjd.2017.10.003
5 Type 2 diabetes. Mayo Clinic. Updated March 14, 2023. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
6 Ekoe JM, et. al. Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Screening for Diabetes in Adults. Can J Diabetes. 2018;42 Suppl 1:S16-S19. doi:10.1016/j.jcjd.2017.10.004
7 Gestational Diabetes. Mayo Clinic. Updated April 09, 2022. https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339
8 Blood Sugar Converter. Diabetes.co.uk. Updated November 10, 2023 https://www.diabetes.co.uk/blood-sugar-converter.html
9 All About Your A1C. Centers for Disease Control and Prevention. Reviewed September 30, 2022. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
10 Berard LD, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Monitoring Glycemic Control. Can J Diabetes. 2018;42 Suppl 1:S47-S53. doi:10.1016/j.jcjd.2017.10.007
11 Imran AS, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Targets for Glycemic Control. Can J Diabetes. 2018:42(S42–S46). doi: 10.1016/j.jcjd.2017.10.030
12 Cheng AYY, et. al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Blood Glucose Monitoring in Adults and Children with Diabetes: Update 2021. Can J Diabetes. 2021;45(7):580-587. doi:10.1016/j.jcjd.2021.07.003
13 Lega IC, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Hypoglycemia in Adults. Can J Diabetes. 2023;47(7):548-559. doi:10.1016/j.jcjd.2023.08.003
14 Beck RW, et al. JAMA. 2017;317(4):371-378.
15 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374.
16 Martens T, et al. JAMA. 2021;325(22):2262-2272.
17 Laffel LM, et al. JAMA. 2020;323(23):2388-2396.
18 Welsh JB, et al. J Diabetes Sci Technol. 2024;18(1):143-7.
19 Heinemann L, et al. Lancet. 2018;391(10128):1367-1377.
20 4 Ways to Take Insulin. Centers for Disease Control and Prevention. Reviewed April 18, 2023. https://www.cdc.gov/diabetes/basics/type-1-4-ways-to-take-insulin.html
21 Lipscombe L, et al. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update. Can J Diabetes. 2020;44(7):575-591. doi:10.1016/j.jcjd.2020.08.001