Pub Date : 2026-01-01DOI: 10.1016/j.deman.2026.100301
Haider Ayad Alidrisi, Khulood Abed Reman, Emad Sakran Alhubaish, Ibrahim Hani Hussein, Hussein Ali Nwayyir, Ibrahim Abbood Zaboon, Musaab Ali Ashkar, Ali Hussain Alhamza, Abbas Ali Mansour
Aims
Chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is underdiagnosed. We aimed to evaluate the prevalence of undiagnosed CKD in patients with T2DM and identify factors associated with increased prevalence of CKD.
Methods
This cross-sectional study included patients with T2DM presenting for their visit to two centers in Basrah, Southern Iraq. CKD was diagnosed based on the measurement of estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). The association of the patients’ demographic and biochemical characteristics with CKD was analyzed using logistic regression analysis.
Results
Among 1779 patients (mean age 55.0 ± 11.5 years, 39.0% male, mean T2DM duration 8.9 ± 6.9years), CKD was diagnosed in 887 (49.9%) patients. Specifically, 13.4% had eGFR <60 mL/min/1.73 m²and 45.4% had UACR ≥30 mg/g. Independent predictors of CKD included increasing age (OR 1.03,95% CI 1.02–1.04), longer T2DM duration (OR 1.03, 95% CI 1.01–1.04), elevated HbA1c (OR 1.1, 95% CI1.09–1.19), higher total cholesterol (OR 1.008, 95% CI 1.003–1.01), uncontrolled hypertension (OR 1.4,95% CI 1.03–2.10), and lower HDL cholesterol (OR 0.9, 95% CI 0.9–0.99).
Conclusions
CKD was highly prevalent, affecting almost half of the patients with T2DM. Our findings highlighted the multiple risk factors associated with CKD and emphasized the importance of active CKD screening and comprehensive management strategies.
2型糖尿病（T2DM）患者的慢性肾病（CKD）未得到充分诊断。我们的目的是评估T2DM患者中未确诊CKD的患病率，并确定与CKD患病率增加相关的因素。方法本横断面研究纳入了到伊拉克南部巴士拉两个中心就诊的2型糖尿病患者。CKD的诊断基于肾小球滤过率（eGFR）和尿白蛋白肌酐比（UACR）的测量。采用logistic回归分析患者人口学和生化特征与CKD的关系。结果1779例患者（平均年龄55.0±11.5岁，男性39.0%，平均T2DM病程8.9±6.9年）中，有887例（49.9%）患者诊断为CKD。具体来说，13.4%的eGFR为60 mL/min/1.73 m²，45.4%的UACR≥30 mg/g。CKD的独立预测因子包括年龄增加（OR 1.03,95% CI 1.02-1.04）、T2DM病程延长（OR 1.03,95% CI 1.01-1.04）、HbA1c升高（OR 1.1, 95% CI1.09 - 1.19）、总胆固醇升高（OR 1.008, 95% CI 1.003-1.01）、高血压未控制（OR 1.4,95% CI 1.03 - 2.10）和高密度脂蛋白胆固醇降低（OR 0.9, 95% CI 0.9 - 0.99）。结论sckd发生率高，约占T2DM患者的一半。我们的研究结果强调了与CKD相关的多种危险因素，并强调了积极的CKD筛查和综合管理策略的重要性。
{"title":"Prevalence of chronic kidney disease and associated risk factors in patients with Type 2 Diabetes Mellitus in Basrah, Iraq: A cross-sectional study","authors":"Haider Ayad Alidrisi, Khulood Abed Reman, Emad Sakran Alhubaish, Ibrahim Hani Hussein, Hussein Ali Nwayyir, Ibrahim Abbood Zaboon, Musaab Ali Ashkar, Ali Hussain Alhamza, Abbas Ali Mansour","doi":"10.1016/j.deman.2026.100301","DOIUrl":"10.1016/j.deman.2026.100301","url":null,"abstract":"<div><h3>Aims</h3><div>Chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is underdiagnosed. We aimed to evaluate the prevalence of undiagnosed CKD in patients with T2DM and identify factors associated with increased prevalence of CKD.</div></div><div><h3>Methods</h3><div>This cross-sectional study included patients with T2DM presenting for their visit to two centers in Basrah, Southern Iraq. CKD was diagnosed based on the measurement of estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). The association of the patients’ demographic and biochemical characteristics with CKD was analyzed using logistic regression analysis.</div></div><div><h3>Results</h3><div>Among 1779 patients (mean age 55.0 ± 11.5 years, 39.0% male, mean T2DM duration 8.9 ± 6.9years), CKD was diagnosed in 887 (49.9%) patients. Specifically, 13.4% had eGFR <60 mL/min/1.73 m²and 45.4% had UACR ≥30 mg/g. Independent predictors of CKD included increasing age (OR 1.03,95% CI 1.02–1.04), longer T2DM duration (OR 1.03, 95% CI 1.01–1.04), elevated HbA1c (OR 1.1, 95% CI1.09–1.19), higher total cholesterol (OR 1.008, 95% CI 1.003–1.01), uncontrolled hypertension (OR 1.4,95% CI 1.03–2.10), and lower HDL cholesterol (OR 0.9, 95% CI 0.9–0.99).</div></div><div><h3>Conclusions</h3><div>CKD was highly prevalent, affecting almost half of the patients with T2DM. Our findings highlighted the multiple risk factors associated with CKD and emphasized the importance of active CKD screening and comprehensive management strategies.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"21 ","pages":"Article 100301"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.deman.2025.100299
Minghao Zhou , Hairui Yu , Renee Underwood , Hongning Cai , Tung-Sung Tseng , Susu Luo
Background
Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status.
Methods
Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates better dietary quality. HEI-2020 scores were calculated per person using a standard scoring algorithm. Survey-weighted descriptive analyses and regression models were applied.
Results
The prevalence of diagnosed T2DM in the US adults (≥20 years) was 9.9%, with an average HEI-2020 score of 53.9. In unadjusted analyses, males with diagnosed T2DM had a significantly higher HEI score than those without (53.3 vs. 51.8, respectively) . Across both sexes, individuals with diagnosed T2DM reported higher HEI component scores for added sugar, indicating lower sugar intake, but lower scores for sodium and refined grains, indicating higher intake of these components, compared to those without diagnoses. Age- and sex-specific patterns were evident in adjusted models: adults aged ≥60 years with T2DM consumed less added sugar but more sodium than their non-diagnosed counterparts, while younger women (20–40 years) with T2DM reported higher added sugar intake.
Conclusions
Diet quality among adults with diagnosed T2DM was heterogeneous rather than uniformly improved. Although lower added sugar intake represents a favorable dietary change, persistently high sodium and refined grain consumption remains a concern, particularly among older adults, and poorer sugar intake was observed among younger women. These findings highlight important gaps in dietary management following diabetes diagnosis and underscore the need for targeted, subgroup-specific nutritional guidance in T2DM care.
{"title":"Diet quality as assessed by the healthy eating Index-2020 among individuals diagnosed with and without type 2 diabetes","authors":"Minghao Zhou , Hairui Yu , Renee Underwood , Hongning Cai , Tung-Sung Tseng , Susu Luo","doi":"10.1016/j.deman.2025.100299","DOIUrl":"10.1016/j.deman.2025.100299","url":null,"abstract":"<div><h3>Background</h3><div>Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status.</div></div><div><h3>Methods</h3><div>Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates better dietary quality. HEI-2020 scores were calculated per person using a standard scoring algorithm. Survey-weighted descriptive analyses and regression models were applied.</div></div><div><h3>Results</h3><div>The prevalence of diagnosed T2DM in the US adults (≥20 years) was 9.9%, with an average HEI-2020 score of 53.9. In unadjusted analyses, males with diagnosed T2DM had a significantly higher HEI score than those without (53.3 vs. 51.8, respectively) . Across both sexes, individuals with diagnosed T2DM reported higher HEI component scores for added sugar, indicating lower sugar intake, but lower scores for sodium and refined grains, indicating higher intake of these components, compared to those without diagnoses. Age- and sex-specific patterns were evident in adjusted models: adults aged ≥60 years with T2DM consumed less added sugar but more sodium than their non-diagnosed counterparts, while younger women (20–40 years) with T2DM reported higher added sugar intake.</div></div><div><h3>Conclusions</h3><div>Diet quality among adults with diagnosed T2DM was heterogeneous rather than uniformly improved. Although lower added sugar intake represents a favorable dietary change, persistently high sodium and refined grain consumption remains a concern, particularly among older adults, and poorer sugar intake was observed among younger women. These findings highlight important gaps in dietary management following diabetes diagnosis and underscore the need for targeted, subgroup-specific nutritional guidance in T2DM care.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"21 ","pages":"Article 100299"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-07DOI: 10.1016/j.deman.2025.100296
Rie Kudoh, Taiga Shibayama
Background
Despite the bidirectional relationship between diabetes and periodontal disease, dental hygienists' (DHs') engagement in diabetes screening remains underexplored in Japan. This study examined associations between attitudes and diabetes screening practices among Japanese DHs.
Methods
A cross-sectional survey was conducted among 234 DHs in the Kanto region between December 2023 and February 2024. After excluding invalid responses, 75 (response rate: 32.1 %) were analyzed. Attitudes and practices were assessed using a self-administered questionnaire. Exploratory factor analysis identified underlying constructs, and multiple regression analyses examined associations between attitudes and screening practices.
Results
Only 36 % had received diabetes management training. Factor analysis identified two attitude factors—willingness to manage diabetes and lack of knowledge and confidence—and two practice factors—checking diabetes management status and checking diabetes therapeutic management status. Willingness to manage diabetes was positively associated with all screening practices: checking diabetes management status (β = 0.34, 95 % CI 0.28–1.41), checking diabetes therapeutic management status (β = 0.39, 95 % CI 0.22–0.84), and symptom checking (β = 0.30, 95 % CI 0.12–0.72), indicating substantial effects. Lack of knowledge and confidence was negatively associated with checking diabetes management status (β = -0.33, 95 % CI -0.94 to -0.17), reflecting a moderate effect. Clinical experience and diabetes education experience also predicted symptom checking, highlighting the importance of structured training.
Conclusions
Educational interventions targeting knowledge, confidence, and willingness are essential to promote diabetes screening practices among DHs. These findings provide evidence for developing targeted training programs to enhance medical-dental collaboration in diabetes care.
尽管糖尿病和牙周病之间存在双向关系，但在日本，牙科保健师（DHs）参与糖尿病筛查的程度仍未得到充分探讨。本研究调查了日本卫生保健人员的态度与糖尿病筛查之间的关系。方法于2023年12月至2024年2月对关东地区234名卫生保健员进行横断面调查。排除无效应答后，对75例（应答率32.1%）进行分析。态度和做法采用自我管理的问卷进行评估。探索性因素分析确定了潜在的构念，多元回归分析检查了态度和筛查做法之间的联系。结果仅有36%的患者接受过糖尿病管理培训。因子分析确定了两个态度因素-管理糖尿病的意愿和缺乏知识和信心，以及两个实践因素-检查糖尿病管理状况和检查糖尿病治疗管理状况。管理糖尿病的意愿与所有筛查实践呈正相关：检查糖尿病管理状态（β = 0.34, 95% CI 0.28-1.41），检查糖尿病治疗管理状态（β = 0.39, 95% CI 0.22-0.84）和症状检查（β = 0.30, 95% CI 0.12-0.72），表明效果显著。缺乏知识和信心与检查糖尿病管理状态呈负相关（β = -0.33, 95% CI -0.94至-0.17），反映了中等效果。临床经验和糖尿病教育经验也预测了症状检查，突出了结构化培训的重要性。结论以知识、信心和意愿为目标的诱导性干预措施对促进卫生保健人员的糖尿病筛查实践至关重要。这些发现为制定有针对性的培训计划提供了证据，以加强医疗和牙科在糖尿病护理方面的合作。
{"title":"Diabetes screening practices of japanese dental hygienists: The role of attitudes and training","authors":"Rie Kudoh, Taiga Shibayama","doi":"10.1016/j.deman.2025.100296","DOIUrl":"10.1016/j.deman.2025.100296","url":null,"abstract":"<div><h3>Background</h3><div>Despite the bidirectional relationship between diabetes and periodontal disease, dental hygienists' (DHs') engagement in diabetes screening remains underexplored in Japan. This study examined associations between attitudes and diabetes screening practices among Japanese DHs.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted among 234 DHs in the Kanto region between December 2023 and February 2024. After excluding invalid responses, 75 (response rate: 32.1 %) were analyzed. Attitudes and practices were assessed using a self-administered questionnaire. Exploratory factor analysis identified underlying constructs, and multiple regression analyses examined associations between attitudes and screening practices.</div></div><div><h3>Results</h3><div>Only 36 % had received diabetes management training. Factor analysis identified two attitude factors—willingness to manage diabetes and lack of knowledge and confidence—and two practice factors—checking diabetes management status and checking diabetes therapeutic management status. Willingness to manage diabetes was positively associated with all screening practices: checking diabetes management status (β = 0.34, 95 % CI 0.28–1.41), checking diabetes therapeutic management status (β = 0.39, 95 % CI 0.22–0.84), and symptom checking (β = 0.30, 95 % CI 0.12–0.72), indicating substantial effects. Lack of knowledge and confidence was negatively associated with checking diabetes management status (β = -0.33, 95 % CI -0.94 to -0.17), reflecting a moderate effect. Clinical experience and diabetes education experience also predicted symptom checking, highlighting the importance of structured training.</div></div><div><h3>Conclusions</h3><div>Educational interventions targeting knowledge, confidence, and willingness are essential to promote diabetes screening practices among DHs. These findings provide evidence for developing targeted training programs to enhance medical-dental collaboration in diabetes care.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"21 ","pages":"Article 100296"},"PeriodicalIF":1.4,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the rising prevalence of diabetes mellitus type 1 (DM type 1), continuous glucose monitoring (CGM) has emerged as a key management tool. While studies suggest CGM improves glycemic control, its broader impact on healthcare utilization and costs remains limited. This study evaluates demographic and clinical variations between DM type 1 patients using CGM and non-CGM users; assessing healthcare utilization, glycemic outcomes, costs and impact on Durable Medical Equipment (DME).
Methods
A retrospective cohort analysis was conducted using health insurance claims and electronic medical records from Allegheny Health Network (AHN) from 2019 to 2021. Patient eligibility required 36 months of continuous medical and drug coverage; insulin use and AHN affiliation. The cohort included 3007 patients, divided into CGM users and non-users. Additionally, patient data was stratified by demographics, social vulnerability index (SVI), healthcare use by per member per month (PMPM) and 1000 person-months.
Results
CGM users had higher PMPM and utilization/1000 for all service types, except for DME, when compared to non-CGM users. There was a progressive increase in the cost of prescriptions among CGM users (prescription PMPM, 2019: $621.33, 2020: $723.97, 2021: $851.39). Non-CGM users had greater prescription-related expenses, comprising 43 % of total costs but a higher likelihood of achieving an HbA1c <9.0. Number of hospitalizations was significantly higher among CGM users compared to non-CGM users (18.4 % vs. 10.55 %, p < 0.001). CGM use was more common among non-Caucasian, non-English-speaking, and tobacco-using groups but declined with increasing SVI. CGM users had higher rates of frailty, depression, congestive heart failure and seizures.
Conclusion
This study highlights the complexity of CGM uptake and its impact on healthcare costs in DM type 1 patients. Increased healthcare spending associated with CGM use raises concerns about cost-effectiveness and accessibility. Further studies are needed to assess disparities in CGM utilization and diabetes management including diabetes-related complications and associated costs across varying demographics and socioeconomic groups.
{"title":"Continuous Glucose Monitoring (CGM) use in patients with diabetes mellitus type 1 is associated with higher healthcare costs, increased hospitalizations, and social disparities in a real-world setting: Analysis of adoption pattern, impact on health services utilization and cost of care in a large integrated health system","authors":"Ameer Khowaja , Lina Adil , Teigan Dwyer , Tyson Barrett , Jamil Alkhaddo","doi":"10.1016/j.deman.2025.100274","DOIUrl":"10.1016/j.deman.2025.100274","url":null,"abstract":"<div><h3>Background</h3><div>With the rising prevalence of diabetes mellitus type 1 (DM type 1), continuous glucose monitoring (CGM) has emerged as a key management tool. While studies suggest CGM improves glycemic control, its broader impact on healthcare utilization and costs remains limited. This study evaluates demographic and clinical variations between DM type 1 patients using CGM and non-CGM users; assessing healthcare utilization, glycemic outcomes, costs and impact on Durable Medical Equipment (DME).</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using health insurance claims and electronic medical records from Allegheny Health Network (AHN) from 2019 to 2021. Patient eligibility required 36 months of continuous medical and drug coverage; insulin use and AHN affiliation. The cohort included 3007 patients, divided into CGM users and non-users. Additionally, patient data was stratified by demographics, social vulnerability index (SVI), healthcare use by per member per month (PMPM) and 1000 person-months.</div></div><div><h3>Results</h3><div>CGM users had higher PMPM and utilization/1000 for all service types, except for DME, when compared to non-CGM users. There was a progressive increase in the cost of prescriptions among CGM users (prescription PMPM, 2019: $621.33, 2020: $723.97, 2021: $851.39). Non-CGM users had greater prescription-related expenses, comprising 43 % of total costs but a higher likelihood of achieving an HbA1c <9.0. Number of hospitalizations was significantly higher among CGM users compared to non-CGM users (18.4 % vs. 10.55 %, <em>p</em> < 0.001). CGM use was more common among non-Caucasian, non-English-speaking, and tobacco-using groups but declined with increasing SVI. CGM users had higher rates of frailty, depression, congestive heart failure and seizures.</div></div><div><h3>Conclusion</h3><div>This study highlights the complexity of CGM uptake and its impact on healthcare costs in DM type 1 patients. Increased healthcare spending associated with CGM use raises concerns about cost-effectiveness and accessibility. Further studies are needed to assess disparities in CGM utilization and diabetes management including diabetes-related complications and associated costs across varying demographics and socioeconomic groups.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100274"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100288
Gabrielle R. Nemeh , Aubrey L. Doede , Raphael E. Cuomo
<div><h3>Background</h3><div>Type 2 diabetes (T2D) elevates dementia risk through vascular injury, neuroinflammation, and perturbed insulin signaling. Antidiabetic classes differ in extra-glycemic actions that could modify neurodegeneration, yet head-to-head comparative data remain limited.</div></div><div><h3>Objective</h3><div>To compare time to incident dementia among older adults with T2D exposed to SGLT2 inhibitors, GLP-1 receptor agonists (GLP-1 RAs), metformin, or two-way combinations, and to quantify the contribution of comorbidities and neuroactive co-medications.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study in the UCHDW (2012–2024). Adults aged 55–80 were assigned to the earliest qualifying exposure group and followed from index to first coded Alzheimer’s disease or unspecified dementia; vascular/multi-infarct dementias were excluded by design to reduce etiologic heterogeneity. Events recorded within 84 days of index were not considered incident outcomes (individuals were retained and censored at 84 days). Covariates included age, sex, cardiovascular disease, hypertension, chronic kidney disease, obesity, smoking, anticholinergic/overactive bladder agents, tricyclic antidepressants, proton-pump inhibitors, opioids, benzodiazepines, and ever-exposure to insulin, DPP-4 inhibitors, sulfonylureas, and thiazolidinediones. Analyses comprised Kaplan–Meier (KM) curves with log-rank testing, a pooled multivariable Cox model with a six-level exposure factor, and one-versus-rest Cox models complemented by stabilized, truncated inverse probability of treatment weighting (IPTW).</div></div><div><h3>Results</h3><div>The cohort included 22,677 SGLT2-only (150 events; 0.66 %), 219,523 metformin-only (2,174; 0.99 %), 35,012 GLP-1-only (149; 0.43 %), 37,317 SGLT2+metformin (453; 1.21 %), 7,210 SGLT2+GLP-1 (62; 0.86 %), and 41,595 metformin+GLP-1 (421; 1.01 %). KM curves differed significantly (log-rank χ²=38.5, p<0.001). In the pooled Cox model (reference SGLT2-only), metformin-only (HR=1.24, 95 % CI 1.05–1.47; p=0.011) and SGLT2+metformin (HR=1.21, 95 % CI 1.00–1.46; p=0.045) had higher hazards; GLP-1-only (HR=0.94, 95 % CI 0.74–1.20; p=0.614) and SGLT2+GLP-1 (HR=0.85, 95 % CI 0.64–1.15; p=0.299) did not differ significantly; metformin+GLP-1 trended higher (HR=1.18, 95 % CI 0.97–1.42; p=0.092). Absolute risk differences were small (0.23–0.78 percentage points vs GLP-1-only). One-versus-rest models yielded directionally consistent estimates; IPTW with 1st–99th percentile truncation improved covariate balance and produced stable weighted estimates. Median follow-up (years) was 1.96 (SGLT2-only), 5.34 (metformin-only), 1.81 (GLP-1-only), 4.13 (SGLT2+metformin), 3.44 (SGLT2+GLP-1), and 4.84 (metformin+GLP-1).</div></div><div><h3>Conclusions</h3><div>In routine care of older adults with T2D, GLP-1 RA monotherapy demonstrates the most favorable dementia profile, whereas metformin monotherapy and SGLT2+metformin identify gr
背景2型糖尿病（T2D）通过血管损伤、神经炎症和胰岛素信号紊乱增加痴呆风险。抗糖尿病患者的不同类别在额外的血糖作用上可能改变神经退行性变，但头对头的比较数据仍然有限。目的比较暴露于SGLT2抑制剂、GLP-1受体激动剂（GLP-1 RAs）、二甲双胍或双向联合用药的老年T2D患者发生痴呆的时间，并量化合并症和神经活性联合用药的贡献。方法在UCHDW（2012-2024）进行回顾性队列研究。年龄在55-80岁之间的成年人被分配到最早符合条件的暴露组，并从索引到第一个编码阿尔茨海默病或未指定的痴呆症；为减少病因异质性，设计排除血管性/多发性梗死性痴呆。在84天内记录的事件不被视为事件结果（个体在84天内被保留和审查）。协变量包括年龄、性别、心血管疾病、高血压、慢性肾脏疾病、肥胖、吸烟、抗胆碱能/膀胱过度活跃药物、三环抗抑郁药、质子泵抑制剂、阿片类药物、苯二氮卓类药物，以及长期暴露于胰岛素、DPP-4抑制剂、磺脲类药物和噻唑烷二酮类药物。分析包括Kaplan-Meier （KM）曲线和log-rank检验，包含六水平暴露因子的合并多变量Cox模型，以及由稳定的截断处理权重逆概率（IPTW）补充的单对余Cox模型。结果该队列包括22,677例仅SGLT2（150例；0.66%）、219,523例仅二甲双胍（2174例；0.99%）、35,012例仅GLP-1（149例；0.43%）、37,317例SGLT2+二甲双胍（453例；1.21%）、7,210例SGLT2+GLP-1（62例；0.86%）和41,595例二甲双胍+GLP-1（421例；1.01%）。KM曲线差异显著（log-rank χ²=38.5,p<0.001）。在合并Cox模型（参考SGLT2-only）中，单用二甲双胍（HR=1.24, 95% CI 1.05-1.47, p=0.011）和SGLT2+二甲双胍（HR=1.21, 95% CI 1.00-1.46, p=0.045）的危险性更高；仅GLP-1 （HR=0.94, 95% CI 0.74-1.20, p=0.614）和SGLT2+GLP-1 （HR=0.85, 95% CI 0.64-1.15, p=0.299）无显著差异；二甲双胍+GLP-1呈较高趋势（HR=1.18, 95% CI 0.97-1.42; p=0.092）。绝对风险差异很小（0.23-0.78个百分点与仅glp -1）。One-versus-rest模型产生方向一致的估计；采用第1 - 99百分位截断的IPTW改善了协变量平衡，并产生了稳定的加权估计。中位随访（年）为1.96（仅SGLT2）、5.34（仅二甲双胍）、1.81（仅GLP-1）、4.13 （SGLT2+二甲双胍）、3.44 （SGLT2+GLP-1）和4.84（二甲双胍+GLP-1）。结论在老年T2D患者的常规护理中，GLP-1 RA单药治疗表现出最有利的痴呆特征，而二甲双胍单药治疗和SGLT2+二甲双胍组的痴呆风险相对较高。鉴于低绝对差异和缺乏额外的混杂协变量，谨慎的解释是必要的。需要前瞻性研究纳入血糖控制和暴露时间，以确定因果分类效应和指导神经保护性糖尿病管理。
{"title":"Diabetes medications and dementia risk: Comparisons of SGLT2 inhibitors, GLP-1 RAs, metformin, and their combinations","authors":"Gabrielle R. Nemeh , Aubrey L. Doede , Raphael E. Cuomo","doi":"10.1016/j.deman.2025.100288","DOIUrl":"10.1016/j.deman.2025.100288","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes (T2D) elevates dementia risk through vascular injury, neuroinflammation, and perturbed insulin signaling. Antidiabetic classes differ in extra-glycemic actions that could modify neurodegeneration, yet head-to-head comparative data remain limited.</div></div><div><h3>Objective</h3><div>To compare time to incident dementia among older adults with T2D exposed to SGLT2 inhibitors, GLP-1 receptor agonists (GLP-1 RAs), metformin, or two-way combinations, and to quantify the contribution of comorbidities and neuroactive co-medications.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study in the UCHDW (2012–2024). Adults aged 55–80 were assigned to the earliest qualifying exposure group and followed from index to first coded Alzheimer’s disease or unspecified dementia; vascular/multi-infarct dementias were excluded by design to reduce etiologic heterogeneity. Events recorded within 84 days of index were not considered incident outcomes (individuals were retained and censored at 84 days). Covariates included age, sex, cardiovascular disease, hypertension, chronic kidney disease, obesity, smoking, anticholinergic/overactive bladder agents, tricyclic antidepressants, proton-pump inhibitors, opioids, benzodiazepines, and ever-exposure to insulin, DPP-4 inhibitors, sulfonylureas, and thiazolidinediones. Analyses comprised Kaplan–Meier (KM) curves with log-rank testing, a pooled multivariable Cox model with a six-level exposure factor, and one-versus-rest Cox models complemented by stabilized, truncated inverse probability of treatment weighting (IPTW).</div></div><div><h3>Results</h3><div>The cohort included 22,677 SGLT2-only (150 events; 0.66 %), 219,523 metformin-only (2,174; 0.99 %), 35,012 GLP-1-only (149; 0.43 %), 37,317 SGLT2+metformin (453; 1.21 %), 7,210 SGLT2+GLP-1 (62; 0.86 %), and 41,595 metformin+GLP-1 (421; 1.01 %). KM curves differed significantly (log-rank χ²=38.5, p<0.001). In the pooled Cox model (reference SGLT2-only), metformin-only (HR=1.24, 95 % CI 1.05–1.47; p=0.011) and SGLT2+metformin (HR=1.21, 95 % CI 1.00–1.46; p=0.045) had higher hazards; GLP-1-only (HR=0.94, 95 % CI 0.74–1.20; p=0.614) and SGLT2+GLP-1 (HR=0.85, 95 % CI 0.64–1.15; p=0.299) did not differ significantly; metformin+GLP-1 trended higher (HR=1.18, 95 % CI 0.97–1.42; p=0.092). Absolute risk differences were small (0.23–0.78 percentage points vs GLP-1-only). One-versus-rest models yielded directionally consistent estimates; IPTW with 1st–99th percentile truncation improved covariate balance and produced stable weighted estimates. Median follow-up (years) was 1.96 (SGLT2-only), 5.34 (metformin-only), 1.81 (GLP-1-only), 4.13 (SGLT2+metformin), 3.44 (SGLT2+GLP-1), and 4.84 (metformin+GLP-1).</div></div><div><h3>Conclusions</h3><div>In routine care of older adults with T2D, GLP-1 RA monotherapy demonstrates the most favorable dementia profile, whereas metformin monotherapy and SGLT2+metformin identify gr","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100288"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100287
Sufyan Shahid , Aya Abdulrahman Ajeel , Ali Dheyaa Marsool , Muneeb Saifullah , Hiba Mukhtar , Muhammad Umer Sattar , Anum Waseem , Zareen Shafqat , Zunaira Rehman , Raheel Ahmed , Dr. Muzammil Farhan
Background
Diabetes mellitus (DM) has emerged as a major contributor to the non-communicable disease burden in Asia. Understanding temporal, regional, and demographic patterns is essential for guiding prevention and control efforts.
Methods
We analyzed age-standardized prevalence, incidence, and mortality for DM from the Global Burden of Disease 1990–2021 dataset, encompassing both type 1 and type 2 diabetes across Asian countries and subregions. Joinpoint regression analysis (permutation tests; NCI Joinpoint v5.2.0) was applied to detect significant inflection points as well as to estimate annual percentage changes (APCs) and Average Annual Percent Changes (AAPCs) in trends.
Results
By 2021, an estimated 314 million individuals in Asia were living with DM, with an age-standardized prevalence rate (ASPR) of 6,098.31 per 100,000, incidence rate (ASIR) of 277.23, and death rate (ASDR) of 18.78. From 1990 to 2021, ASPR, ASIR, and ASDR increased with average annual percent changes (AAPCs) of 1.92%, 1.60%, and 0.35%, respectively. Central Asia demonstrated the highest increases in prevalence (AAPC: 2.73%) and mortality (1.73%), while East Asia showed slower growth and declining mortality (–0.31%). High-income Asia Pacific experienced rising prevalence but a marked decline in mortality (–2.86%). Southeast Asia recorded a sharp recent surge in prevalence (APC: 5.61% during 2019–2021). Male patients consistently had higher prevalence and mortality than females. At the national level, Brunei, Mongolia, and Malaysia had the highest prevalence, while Pakistan and the Philippines reported disproportionately high mortality.
Conclusion
The diabetes burden in Asia has risen substantially, with pronounced regional, temporal, and sex-based disparities. These findings highlight the urgent need for tailored, region-specific public health strategies to mitigate the growing impact of DM.
{"title":"Trends and regional disparities in the diabetes burden across Asia, 1990–2021: Insights from the global burden of disease study","authors":"Sufyan Shahid , Aya Abdulrahman Ajeel , Ali Dheyaa Marsool , Muneeb Saifullah , Hiba Mukhtar , Muhammad Umer Sattar , Anum Waseem , Zareen Shafqat , Zunaira Rehman , Raheel Ahmed , Dr. Muzammil Farhan","doi":"10.1016/j.deman.2025.100287","DOIUrl":"10.1016/j.deman.2025.100287","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes mellitus (DM) has emerged as a major contributor to the non-communicable disease burden in Asia. Understanding temporal, regional, and demographic patterns is essential for guiding prevention and control efforts.</div></div><div><h3>Methods</h3><div>We analyzed age-standardized prevalence, incidence, and mortality for DM from the Global Burden of Disease 1990–2021 dataset, encompassing both type 1 and type 2 diabetes across Asian countries and subregions. Joinpoint regression analysis (permutation tests; NCI Joinpoint v5.2.0) was applied to detect significant inflection points as well as to estimate annual percentage changes (APCs) and Average Annual Percent Changes (AAPCs) in trends.</div></div><div><h3>Results</h3><div>By 2021, an estimated 314 million individuals in Asia were living with DM, with an age-standardized prevalence rate (ASPR) of 6,098.31 per 100,000, incidence rate (ASIR) of 277.23, and death rate (ASDR) of 18.78. From 1990 to 2021, ASPR, ASIR, and ASDR increased with average annual percent changes (AAPCs) of 1.92%, 1.60%, and 0.35%, respectively. Central Asia demonstrated the highest increases in prevalence (AAPC: 2.73%) and mortality (1.73%), while East Asia showed slower growth and declining mortality (–0.31%). High-income Asia Pacific experienced rising prevalence but a marked decline in mortality (–2.86%). Southeast Asia recorded a sharp recent surge in prevalence (APC: 5.61% during 2019–2021). Male patients consistently had higher prevalence and mortality than females. At the national level, Brunei, Mongolia, and Malaysia had the highest prevalence, while Pakistan and the Philippines reported disproportionately high mortality.</div></div><div><h3>Conclusion</h3><div>The diabetes burden in Asia has risen substantially, with pronounced regional, temporal, and sex-based disparities. These findings highlight the urgent need for tailored, region-specific public health strategies to mitigate the growing impact of DM.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100287"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100286
Rasmus Rørth , Thomas A. Gerds , Vanja Kosjerina , Bendix Carstensen , Frederik Persson , Peter Rossing
Objective
Kidney- and cardiovascular complications are the main challenges in modern diabetes care. Several drugs to prevent these have emerged in recent years. A key problem is therapy implementation to ensure benefits demonstrated in trials and recommended in guidelines. We investigated time-trends in use of cardiorenal protective medication in persons with type-2 diabetes(T2D) with or without chronic kidney disease (CKD).
Research design and Methods
By use of data from Danish health registers we were able to identify individuals with diabetes and stratify them by CKD status. We assessed the medication use in individuals with T2D with and without CKD on a national level between 2011-2022.
Results
By 2022, 312,990 persons had T2D and 102,216 (33 %) of these had CKD. Use of SGLT2i and GLP-1RA increased over time and was more abundant among persons with T2D without CKD, whereas the use of ACE-inhibitors, ARBs, MRA, antiplatelet - and lipid lowering drugs was more frequent among people with diabetes and CKD. The use of cardiorenal protective medication across age and sex was similar for persons with T2D with or without CKD with men having marginally higher degree of exposure than women for most medication classes except GLP-1RA and ARB.
Conclusion
Exposure to SGLT2i and GLP-1RA increased over time but was, in contrast to current guideline recommendations, more pronounced among individuals with diabetes without CKD and contrary to the other cardiorenal protective medications. The cardiorenal protective benefits of these agents can only be achieved with continued focus on implementation of guideline recommendations for high-risk individuals with complications.
{"title":"Trends in use of cardiorenal protective medication among people with type 2 diabetes and chronic kidney disease in Denmark","authors":"Rasmus Rørth , Thomas A. Gerds , Vanja Kosjerina , Bendix Carstensen , Frederik Persson , Peter Rossing","doi":"10.1016/j.deman.2025.100286","DOIUrl":"10.1016/j.deman.2025.100286","url":null,"abstract":"<div><h3>Objective</h3><div>Kidney- and cardiovascular complications are the main challenges in modern diabetes care. Several drugs to prevent these have emerged in recent years. A key problem is therapy implementation to ensure benefits demonstrated in trials and recommended in guidelines. We investigated time-trends in use of cardiorenal protective medication in persons with type-2 diabetes(T2D) with or without chronic kidney disease (CKD).</div></div><div><h3>Research design and Methods</h3><div>By use of data from Danish health registers we were able to identify individuals with diabetes and stratify them by CKD status. We assessed the medication use in individuals with T2D with and without CKD on a national level between 2011-2022.</div></div><div><h3>Results</h3><div>By 2022, 312,990 persons had T2D and 102,216 (33 %) of these had CKD. Use of SGLT2i and GLP-1RA increased over time and was more abundant among persons with T2D without CKD, whereas the use of ACE-inhibitors, ARBs, MRA, antiplatelet - and lipid lowering drugs was more frequent among people with diabetes and CKD. The use of cardiorenal protective medication across age and sex was similar for persons with T2D with or without CKD with men having marginally higher degree of exposure than women for most medication classes except GLP-1RA and ARB.</div></div><div><h3>Conclusion</h3><div>Exposure to SGLT2i and GLP-1RA increased over time but was, in contrast to current guideline recommendations, more pronounced among individuals with diabetes without CKD and contrary to the other cardiorenal protective medications. The cardiorenal protective benefits of these agents can only be achieved with continued focus on implementation of guideline recommendations for high-risk individuals with complications.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100286"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100275
Tra Thu Doan , Cuong Duy Do
{"title":"Longitudinal analysis of diabetes risk factors in HIV-positive patients in a 15-year cohort study","authors":"Tra Thu Doan , Cuong Duy Do","doi":"10.1016/j.deman.2025.100275","DOIUrl":"10.1016/j.deman.2025.100275","url":null,"abstract":"","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100275"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.deman.2025.100285
Fereshteh Baygi , Carl J. Brandt , Kathrine Kjær-Hansen , Anders Grøntved , Jan C. Brønd , Sia K. Nicolaisen , Jacob V. Stidsen , Reimar W. Thomsen , Jens Søndergaard , Jens S. Nielsen
Background
Behavioural lifestyle interventions can support type 2 diabetes (T2D) self-management; however, participation and adherence rates are often low. This feasibility study examined characteristics of individuals with T2D who were willing or unwilling to participate in, complete, and adhere to a personalised e-health behavioural lifestyle intervention in a general practitioner (GP) setting.
Method
Nurses at two Danish GP setting invited patients with T2D to participate in a one-year smartphone-based intervention. Patient characteristics were obtained from Danish health registers, GP records, and previously collected data. The personalized intervention included three face-to-face consultations (at baseline, 2 months, and 12 months) to set personal goals and measure weight, height, waist, and hip circumferences. Physical and mental health were assessed using the SF-12v1 survey. All other support and interactions occurred via app. Adherence to the app usage was evaluated by tracking logins, messages sent, and response times during the first and final three months of the intervention.
Results
Of the 63 eligible individuals with T2D, 20 (31.7 %) agreed to participate. Those who were willing to participate were predominantly men (75 %), younger (median age 57 years [IQR 52; 66] vs. 65 years [IQR: 57; 73]), had a longer duration of diabetes (6.6 years [2.9; 8.2] vs. 5.5 years [3.7; 7.0], higher fasting glucose levels (8.5 mmol/L [6.8; 10.4] vs. 7.9 mmol/L [7.1; 9.3]), and lower mental component scores (48.8 [38.5; 52.0] vs. 54.7 [47.3; 58.7]) compared to those unwilling. Of 20 individuals who were willing to participate, 13 (65 %) completed the intervention. After 2 months their mental component scores were 47.4 (40.6; 50.5), compared to 31.5 (31.5; 45.8) among those who dropped out. Additionally, completers demonstrated more consistent app usage, whereas app engagement among dropouts declined significantly over the first two months.
Conclusion
Willingness to participate in the behavioural intervention among individual with T2D was modest. Those willing to participate and completed the intervention were more often men, had better mental health, and showed higher app engagement than dropouts. These findings underscore the need for personalized strategies to improve participation and adherence in e-health lifestyle interventions.
{"title":"Participation of individuals with type 2 diabetes in a behavioural e-health lifestyle intervention in Denmark: A feasibility study","authors":"Fereshteh Baygi , Carl J. Brandt , Kathrine Kjær-Hansen , Anders Grøntved , Jan C. Brønd , Sia K. Nicolaisen , Jacob V. Stidsen , Reimar W. Thomsen , Jens Søndergaard , Jens S. Nielsen","doi":"10.1016/j.deman.2025.100285","DOIUrl":"10.1016/j.deman.2025.100285","url":null,"abstract":"<div><h3>Background</h3><div>Behavioural lifestyle interventions can support type 2 diabetes (T2D) self-management; however, participation and adherence rates are often low. This feasibility study examined characteristics of individuals with T2D who were willing or unwilling to participate in, complete, and adhere to a personalised e-health behavioural lifestyle intervention in a general practitioner (GP) setting.</div></div><div><h3>Method</h3><div>Nurses at two Danish GP setting invited patients with T2D to participate in a one-year smartphone-based intervention. Patient characteristics were obtained from Danish health registers, GP records, and previously collected data. The personalized intervention included three face-to-face consultations (at baseline, 2 months, and 12 months) to set personal goals and measure weight, height, waist, and hip circumferences. Physical and mental health were assessed using the SF-12v1 survey. All other support and interactions occurred via app. Adherence to the app usage was evaluated by tracking logins, messages sent, and response times during the first and final three months of the intervention.</div></div><div><h3>Results</h3><div>Of the 63 eligible individuals with T2D, 20 (31.7 %) agreed to participate. Those who were willing to participate were predominantly men (75 %), younger (median age 57 years [IQR 52; 66] vs. 65 years [IQR: 57; 73]), had a longer duration of diabetes (6.6 years [2.9; 8.2] vs. 5.5 years [3.7; 7.0], higher fasting glucose levels (8.5 mmol/L [6.8; 10.4] vs. 7.9 mmol/L [7.1; 9.3]), and lower mental component scores (48.8 [38.5; 52.0] vs. 54.7 [47.3; 58.7]) compared to those unwilling. Of 20 individuals who were willing to participate, 13 (65 %) completed the intervention. After 2 months their mental component scores were 47.4 (40.6; 50.5), compared to 31.5 (31.5; 45.8) among those who dropped out. Additionally, completers demonstrated more consistent app usage, whereas app engagement among dropouts declined significantly over the first two months.</div></div><div><h3>Conclusion</h3><div>Willingness to participate in the behavioural intervention among individual with T2D was modest. Those willing to participate and completed the intervention were more often men, had better mental health, and showed higher app engagement than dropouts. These findings underscore the need for personalized strategies to improve participation and adherence in e-health lifestyle interventions.</div></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"19 ","pages":"Article 100285"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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