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    The UK Prospective Diabetes Study, a large clinical trial performed in 1980-90s, provided evidence that metformin reduced the rate of adverse cardiovascular outcomes in overweight patients with type 2 diabetes relative to other antihyperglycemic agents. Treatment guidelines for major professional associations including the European Association for the Study of Diabetes, the European Society for Cardiology and the American Diabetes Association, now describe evidence for the cardiovascular benefits of metformin as equivocal. In 2017, the American College of Physicians's guidelines were updated to recognize metformin as the first-line treatment for type-2 diabetes. For example, a 2014 review found tentative evidence that people treated with sulfonylureas had a higher risk of severe low blood sugar events (RR 5.64), though their risk of non-fatal cardiovascular events was lower than the risk of those treated with metformin (RR 0.67). There was not enough data available at that time to determine the relative risk of death or of death from heart disease. study known as the Diabetes Prevention Program, participants were divided into groups and given either placebo, metformin, or lifestyle intervention and followed for an average of three years. Metformin treatment of people at a prediabetes stage of risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose. The intensive program of lifestyle modifications included a 16-lesson training on dieting and exercise followed by monthly individualized sessions with the goals of decreasing weight by 7% and engaging in physical activity for at least 150 minutes per week. The incidence of diabetes was 58% lower in the lifestyle group and 31% lower in individuals given metformin. Among younger people with a higher body mass index, lifestyle modification was no more effective than metformin, and for older individuals with a lower body mass index, metformin was no better than placebo in preventing diabetes. This guide isn’t intended to be a source of “cut and paste” bullets for you to simply “check the block” on an evaluation. Instead, these examples are intended to get you, the Rater, to break your writer’s block and create unique bullets for your NCO. Bullets/Comments for Bullet comments for “FAIL” entries may include the reason(s) for failure and/or note any progress toward meeting physical fitness standards of AR 350–1. Rated NCO fails to meet or maintain the required Army standards and organizational goals of leader competencies and attributes; does not enforce or meet the standard for the unit or those in his/her charge; exhibits/displays minimal or no effort; actions often have a negative effect on the mission, their Soldiers, the unit, and the Army. Rated NCO successfully achieves and maintains the required Army standards and organizational goals of leader competencies and attributes; effectively meets and enforces the standard for the unit and those in his/her charge; succeeds by taking appropriate initiative in applying the leader competencies and attributes; results have a positive impact on the mission, their Soldiers, the unit, and the Army; this level of performance is considered normal and typically demonstrated by a majority of NCOs of the same grade.• served as Howitzer/Launcher/Fire Direction Center/Fire Support Section Chief during an operational deployment; performance led to notable improvements in the effectiveness, efficiency, and morale of the unit• relieved of duty for not following Standard Operating Procedures while performing duties as a Watch Commander at the United States Disciplinary Barracks (USDB)• information dissemination was inconsistent and often untimely; resulted in a lack of trust among subordinates and supervisors• lacked the communication skills and tact required of an effective and credible NCO; did not properly clear Battalion Headquarters nor stress the danger of existing UXO in the building placing personnel in danger Rated NCO performs above the required Army standards and organizational goals of leader competencies and attributes; this NCO and his/her Soldiers often take disciplined initiative in applying leader competencies and attributes; results have an immediate impact on the mission, their Soldiers, the unit, and the Army; this level of performance is not common, typically demonstrated by the upper third of NCOs of the same grade.• lead platoon during a complex attack in _____ directing fires on enemy positions while maintaining command and control of dismounted elements; multiple valorous awards wear earned after the engagement• trained 284 deploying Soldiers of the 4/25 IN on current IED threats and enemy TTPs, enhancing their knowledge on explosive safety and IED awareness; increased Soldiers survivability on the battle field Rated NCO performs extraordinarily above the required Army standards and organizational goals of leader competencies and attributes; leadership enables Soldiers and unit to far surpass required organizational and Army standards; demonstrated performance epitomizes excellence in all aspects; this NCO and his/her Soldiers consistently take disciplined initiative in applying leader competencies and attributes; results have an immediate impact and enduring effect on the mission, their Soldiers, the unit, and the Army; often demonstrated by the best of the upper third of the NCOs of the same grade.

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