By skipping the period of the exile, the Chronicler highlights that the exile was 70 years long.
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This raises the question: does this number hold significance? Could it possibly be related to why the people were in exile to begin with? Over the course of the time, from David up until the exile, the land the Lord gave as an inheritance to his people should have received a total of seventy Sabbath years you can read all about this in Leviticus Why seventy?
The Jewish calendar was set up in sequences of sevens. Every seven days, there was to be rest in the land. Every seven years, there was to be a year of release, where a mini-restoration took place. After seven of these seven-year cycles occurred, there was to be a year of Jubilee, the major release year when all sold land was restored to the original owners, when slaves were freed, and celebrations abounded! These cycles were symbolic festivals that retold the exodus story and commemorated how the Lord brought his people out of captivity as slaves and introduced joy back into their lives.
However, if you recall from reading Chronicles, the kings of Israel and Judah did not observe any of these Sabbath celebrations, rendering the land in dire need of rest, the way the Lord intended.
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If you can do the math, seventy times seven years of ignored Sabbath-Jubilees equals years! And if you go back and carefully track the chronology of Chronicles from the reign of David to the exile, guess what? It adds up to years! Keep reading in 2 Chronicles The expectation of this new cycle has to be connected with the main themes from the rest of the book, the hope for a promised king reigning over the new Jerusalem.
And, lo and behold, what do we read about in the final sentence of 2 Chronicles? No way. In Daniel 9, Daniel is sitting in Babylon reading the scroll of Jeremiah, which announced the seventy-year exile.
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From where Daniel sat, those seventy years were almost at their end, and he ponders when Israel will be restored. So just as the Israelites took years to break the covenant, there will be a corresponding seventy times seven years to restore the covenant. Now, back to 2 Chronicles The question remains as to why Chronicles—and the Hebrew canon—ends with the incomplete decree from Cyrus.
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Rather, there will be another seventy sevens, that is, another super-Jubilee cycle. Is your head spinning yet? Take a deep breath because the numbers game is about to get real. The fulfillment of the real Jubilee will come after the second installment of the exile. But why must there be another round of seventy times seven? This is the utmost the writer pretends to claim for them, and in this spirit he commends the book to his brethren of the press.
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We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. Learn about new offers and get more deals by joining our newsletter. Screening is not recommended for adults at low to moderate risk of diabetes risk determined with a validated risk calculator: FINDRISC 19 and CANRISK, 20 which factor in age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables.
For adults at high risk of diabetes, routine screening every three to five years with A1C. Preventive Services Task Force 8. Consider screening earlier in patients with higher risk i. Information from references 8 , and 16 through Based on expert consensus, current guidelines recommend annual screening in high-risk patients or those with results nearing diagnostic thresholds. For average-risk patients with normal screening results, testing can be repeated every three years.
Hyperglycemia increases the risk of congenital malformations and intrauterine fetal death. Women with gestational diabetes mellitus GDM who have fasting hyperglycemia have a three- to fourfold increased risk of infant malformations. The ADA advises screening pregnant women in their first trimester if they have risk factors for developing type 2 diabetes Table 1 8 , 16 — 20 or GDM, including obesity, advanced maternal age older than 35 years , history of GDM, family history of diabetes, and belonging to a high-risk ethnic group.
Screening for GDM should be performed using a two-step g nonfasting oral glucose challenge test; if the result is positive, this is followed by a diagnostic g fasting oral glucose tolerance test. The ADA recommends screening children and adolescents 18 years and younger who are overweight i. Although treatment goals may differ in older patients, diagnostic thresholds are the same. The diagnosis of diabetes can be made when classic signs and symptoms of hyperglycemia are associated with a single random plasma glucose measurement of mg per dL Alternatively, the diagnosis can be made with an A1C level of 6.
Risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at higher ends of the range. In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing. Adapted with permission from American Diabetes Association. Diabetes Care. A1C refers to the percentage of glycosylation of the hemoglobin A1C chain and approximates average blood glucose levels over the previous two to three months from the slow turnover of red blood cells in the body.
Despite efforts to standardize laboratory tests, there are some limitations to A1C testing, and an incomplete correlation between A1C level and average glucose level in certain individuals Table 3 41 — For example, hemolytic anemias and acute blood loss can falsely lower A1C levels, whereas prior splenectomy and aplastic anemias, which increase erythrocyte age, can falsely elevate A1C levels.
Hemoglobinopathies or hemoglobin variants can result in variable changes in A1C level and may be more prevalent among certain racial and ethnic groups. Information from references 41 through The National Health and Nutrition Examination Survey data indicate that fasting plasma glucose values may identify as many as one-third more undiagnosed cases of diabetes compared with A1C levels. Increasingly, diabetes is being recognized as a spectrum of disorders including type 1 diabetes, type 2 diabetes, GDM, prediabetes, neonatal diabetes, maturity-onset diabetes of youth, and latent autoimmune diabetes in the adult.
Overlap exists in the underlying etiology of these disorders. Patients with idiopathic type 1 diabetes have no autoantibodies, and some patients with latent autoimmune diabetes in the adult or type 2 diabetes may have certain autoantibodies present making these tests less specific. In the meantime, additional testing is not routinely recommended. Reflects endogenous insulin production; low or undetectable levels are predictive of type 1 diabetes or LADA.
Consider in patients clinically suspected to have LADA or type 1 diabetes but with negative autoimmune antibodies.
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Shown to correlate with autoimmune-mediated diabetes, even in otherwise autoantibody-negative patients. Singular positivity for glutamic acid decarboxylase 65 autoantibodies or islet cell autoantibodies may be more common in LADA. Required for the diagnosis of monogenic diabetes syndromes including mature-onset diabetes of the young and neonatal diabetes. Consider in children only if: diagnosed before six months of age, negative autoantibodies, or family history but without usual risk factors for type 2 diabetes e.
Information from references 17 , and 50 through Data Sources : A PubMed search was completed using the key terms diabetes mellitus, diabetes mellitus type 2, screening for diabetes mellitus, gestational diabetes, geriatrics, elderly, and pediatrics. The search included meta-analyses and reviews. Search dates: March 2, , and October 1, The authors thank Karen Gunning, PharmD, for her editing and mentorship.
Already a member or subscriber? Log in. Reprints are not available from the authors. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Projecting the future diabetes population size and related costs for the U. The top 20 in [Monitor]. Fam Pract Manag. Patel P, Macerollo A. Diabetes mellitus: diagnosis and screening. Am Fam Physician.
Screening for type 2 diabetes. Screening for type 2 diabetes mellitus: a systematic review for the U. Preventive Services Task Force. Ann Intern Med. Siu AL. Screening for abnormal blood glucose and type 2 diabetes mellitus: U. Preventive Services Task Force recommendation statement. Screening for abnormal glucose and type 2 diabetes mellitus: a systematic review to update the U.
Preventive Services Task Force recommendation. Rockville, Md. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis.
Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a year follow-up study. Lancet Diabetes Endocrinol. American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan— Endocr Pract.
Recommendations on screening for type 2 diabetes in adults [published correction appears in CMAJ.