INS and diabetes mellitus: This framework emphasized four major interventions to reduce average glycosylated hemoglobin (HgbA1c or A1c) in patients with HgbA1c greater than 9%—improved healthy eating and physical activity (L—lifestyle), increased use of insulin to control blood sugars (I—insulin), increased visit frequency (to a goal of every 1–3 months) (V—visit frequency), and attention to comorbid emotional and mood disorders that can worsen diabetes control (E—emotional care).