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n
s
a
r
e
a
m
o
n
g
t
h
e
m
a
j
o
r
i
n
f
e
c
t
i
o
n
s
a
s
s
o
c
i
a
t
e
d
w
i
t
h
d
i
a
b
e
t
e
s
[
5]
.
C
o
m
m
u
ni
t
y
-
a
c
qu
i
r
e
d
p
n
e
u
m
o
ni
a
(
C
A
P
)
i
s
o
ne
o
f
t
h
e
m
o
s
t
c
o
m
m
o
n
i
n
f
e
c
t
i
o
us
d
i
s
e
a
s
e
s
r
e
qu
i
r
i
ng
h
o
s
p
i
t
a
li
z
a
t
i
o
n
i
n
de
v
e
l
o
pe
d
c
o
un
t
r
i
e
s
.
On
As
s
o
c
i
a
t
i
o
n
o
f
D
M
w
it
h
C
A
P
,
h
o
s
p
i
t
a
l
i
z
a
t
i
o
ns
h
a
ve
b
e
e
n
s
ugg
e
s
t
e
d
pr
e
vi
o
u
s
ly
.
Ho
we
v
e
r
,
i
nf
o
r
m
a
t
i
o
n
r
e
ga
r
d
i
n
g
t
hi
s
c
o
m
bi
ne
d
b
u
r
de
n
a
n
d
o
u
t
c
o
m
e
s
o
f
C
A
P
i
n
pa
t
i
e
n
t
s
w
i
t
h
D
M
,
s
pe
c
ia
l
ly
i
t
s
r
e
l
a
t
i
o
n
s
hi
p
w
i
t
h
h
o
s
p
i
t
a
l
i
z
a
t
i
o
n
a
n
d
m
o
r
t
a
l
i
t
y
e
x
pe
c
t
a
t
i
o
n
,
i
s
s
t
i
l
l
li
mi
t
e
d
[
6]
.
M
u
l
t
i
p
l
e
s
c
o
r
i
n
g
s
y
s
t
e
m
s
a
r
e
a
v
a
il
a
bl
e
t
o
a
s
s
e
s
s
t
he
s
e
v
e
r
i
t
y
o
f
C
A
P
a
n
d
t
o
h
e
l
p
i
n
de
c
i
d
i
ng
w
h
e
t
h
e
r
a
pa
t
i
e
n
t
i
s
i
n
n
e
e
d
f
o
r
h
o
s
p
i
t
a
l
i
z
a
t
i
o
n
o
r
a
dm
i
s
s
i
o
n
t
o
t
h
e
i
n
t
e
n
s
i
ve
c
a
r
e
uni
t
(
I
C
U)
.
T
h
e
C
UR
B
-
65
s
c
o
r
e
i
s
o
n
e
o
f
t
h
e
s
c
o
r
e
s
r
e
c
o
m
m
e
n
de
d
by
t
h
e
2007
I
nf
e
c
t
i
o
us
D
i
s
e
a
s
e
s
S
o
c
i
e
t
y
o
f
Am
e
r
i
c
a
/
Am
e
r
i
c
a
n
T
h
o
r
a
c
i
c
S
o
c
i
e
t
y
C
o
ns
e
n
s
u
s
Gu
i
de
li
ne
s
[
7]
.
T
hi
s
wo
r
k
a
i
m
e
d
a
t
e
s
t
i
m
a
t
i
n
g
t
he
pr
e
va
l
e
n
c
e
o
f
D
i
a
b
e
t
e
s
M
e
ll
i
t
u
s
a
m
o
n
g
C
A
P
pa
t
i
e
n
t
s
a
d
m
i
t
t
e
d
to
A
b
a
s
s
i
a
c
he
s
t
h
o
s
p
i
t
a
l
,
C
a
i
r
o
,
E
gy
pt
,
a
n
d
e
v
a
l
ua
t
i
o
n
o
f
i
t
s
i
m
p
a
c
t
o
n
C
A
P
o
ut
c
o
m
e
.
G
l
y
c
a
t
e
d
H
b
(
HbA
1
c
)
l
e
v
e
l
r
e
pr
e
s
e
n
t
s
t
h
e
m
e
a
n
g
l
u
c
o
s
e
c
o
n
c
e
n
t
r
a
t
i
o
n
o
v
e
r
t
h
e
pr
e
vi
o
us
8
-
12
w
e
e
ks
a
n
d
pr
o
vi
de
s
b
e
t
t
e
r
s
ugge
s
t
i
o
n
o
f
l
o
n
g
-
t
e
r
m
g
l
y
c
e
mi
c
c
o
n
t
r
o
l
t
h
a
n
bl
o
o
d
a
n
d
ur
i
n
a
r
y
g
l
u
c
o
s
e
[
8]
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
T
hi
s
pr
o
s
pe
c
t
i
ve
o
bs
e
r
v
a
t
i
o
n
a
l
s
t
ud
y
wa
s
c
a
r
r
i
e
d
o
ut
i
n
Ab
a
s
s
i
a
C
he
s
t
Ho
s
p
i
t
a
l
w
i
th
i
n
t
h
e
pe
r
i
o
d
f
r
o
m
J
a
n
ua
r
y
2016
to
De
c
e
m
b
e
r
2016
a
f
t
e
r
t
a
ki
n
g
a
pe
r
mi
s
s
i
o
n
f
r
o
m
c
o
m
m
i
t
t
e
e
o
f
m
e
d
i
c
a
l
e
t
hi
c
s
a
n
d
s
c
i
e
n
t
i
f
i
c
r
e
s
e
a
r
c
h
,
f
a
c
u
l
t
y
o
f
M
e
d
i
c
i
ne
,
M
e
n
o
u
f
i
a
U
ni
ve
r
s
i
t
y
a
n
d
t
a
k
i
n
g
a
wr
i
t
t
e
n
c
o
n
s
e
n
t
f
r
o
m
e
a
c
h
pa
t
i
e
n
t
.
All
pa
t
i
e
n
t
s
d
i
a
g
n
o
s
e
d
a
s
C
A
P
m
e
e
t
i
n
g
i
nc
l
u
s
i
o
n
a
n
d
e
x
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
o
f
t
hi
s
s
t
ud
y
we
r
e
e
n
r
o
l
l
e
d
.
P
a
ti
e
n
ts
a
g
e
d
>
1
8
a
n
d
<
8
0
y
e
a
r
s
,
th
o
s
e
p
r
e
s
e
n
t
e
d
w
i
th
a
n
e
w
r
a
d
i
o
g
r
a
p
h
i
c
i
n
f
i
l
t
r
a
t
e
.
S
h
o
w
e
d
a
t
l
e
a
s
t
t
w
o
c
om
p
a
ti
b
l
e
c
l
i
n
i
c
a
l
s
y
m
p
t
om
s
(
e
g
,
b
o
dy
t
e
m
p
e
r
a
t
u
r
e
<
38
o
c
,
p
r
o
d
u
c
ti
v
e
c
o
u
g
h
,
c
h
e
s
t
p
a
i
n
,
s
h
o
r
tn
e
s
s
of
b
r
e
a
th
,
c
r
a
c
kl
e
s
on
a
u
s
c
ul
ta
ti
on
w
e
r
e
i
n
c
l
u
d
e
d
.
W
h
i
l
e
h
e
p
a
ti
e
n
ts
p
r
e
s
e
n
te
d
b
y
c
on
d
i
ti
on
s
m
i
m
i
c
p
n
e
u
m
on
i
a
,
H
e
a
r
t
f
a
i
l
u
r
e
,
L
i
v
e
r
c
e
l
l
f
a
i
l
u
r
e
,
R
e
n
a
l
f
a
i
l
u
r
e
,
C
a
n
c
e
r
p
a
ti
e
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ts
,
H
u
m
a
n
i
m
m
u
n
e
-
d
e
f
i
c
i
e
n
c
y
v
i
r
u
s
i
n
f
e
c
ti
on
,
P
a
ti
e
n
ts
on
h
e
m
od
i
a
l
y
s
i
s
,
C
h
r
on
i
c
s
u
p
p
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r
a
ti
v
e
l
u
n
g
d
i
s
e
a
s
e
s
,
B
e
e
n
h
os
pi
ta
l
i
z
e
d
i
n
th
e
l
a
s
t
9
0
d
a
y
s
b
e
f
o
r
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th
e
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t
a
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t
of
t
h
e
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t
u
dy
,
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B
p
a
ti
e
n
ts
,
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os
pi
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l
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c
q
ui
r
e
d
p
n
e
um
on
i
a
,
V
e
n
t
i
l
a
t
o
r
a
s
s
o
c
i
a
t
e
d
p
n
e
um
on
i
a
,
C
O
P
D
w
i
th
a
c
u
t
e
e
x
a
c
e
r
b
a
ti
on
w
e
r
e
e
x
c
l
u
d
e
d
f
r
om
th
i
s
s
t
u
d
y
.
T
h
e
tot
a
l
c
o
l
l
e
c
t
e
d
n
u
m
b
e
r
i
n
t
h
e
s
t
ud
y
dur
a
t
i
o
n
wa
s
1
08
pa
t
i
e
n
t
s
.
I
nf
o
r
m
e
d
c
o
ns
e
n
t
wa
s
t
a
ke
n
f
r
o
m
e
a
c
h
pa
t
i
e
n
t
pr
i
o
r
to
t
h
e
i
r
e
n
r
o
l
lm
e
n
t
i
n
t
h
e
s
t
ud
y
.
C
A
P
pa
t
i
e
n
t
wa
s
de
f
i
ne
d
by
t
h
e
pr
e
s
e
n
c
e
o
f
a
n
a
c
ut
e
i
ll
ne
s
s
w
i
t
h
t
w
o
o
r
m
o
r
e
o
f
t
h
e
s
y
m
pt
o
m
s
a
n
d
s
i
g
n
s
o
f
l
o
we
r
r
e
s
p
i
r
a
t
o
r
y
t
r
a
c
t
i
nf
e
c
t
i
o
n
:
f
e
v
e
r
,
n
e
w
o
r
i
n
c
r
e
a
s
in
g
c
o
ugh
o
r
s
put
um
p
r
o
duc
t
i
o
n
,
d
y
s
p
n
o
e
a
,
c
h
e
s
t
pa
i
n
a
n
d
n
e
w
f
o
c
a
l
s
i
g
n
o
n
c
h
e
s
t
e
x
a
m
i
na
t
i
o
n
a
n
d
pr
e
s
e
nc
e
o
f
i
nf
il
t
r
a
t
i
o
n
i
n
t
h
e
c
h
e
s
t
r
a
di
o
gr
a
ph
o
n
or
w
i
t
hi
n
48
h
o
ur
s
o
f
a
d
mi
s
s
i
o
n
)
t
h
a
t
wa
s
c
o
n
s
i
s
t
e
n
t
w
i
t
h
a
c
ut
e
i
nf
e
c
t
i
o
n
[
9]
.
C
UR
B
-
65
s
c
o
r
i
n
g
wa
s
do
n
e
by
c
a
l
c
u
l
a
t
i
n
g
s
c
o
r
e
s
o
n
c
o
n
f
u
s
i
o
n
o
f
n
e
w
o
ns
e
t
(
M
i
ni
m
e
n
t
a
l
s
t
a
t
e
s
c
o
r
e
≤
8
)
,
r
e
s
pi
r
a
t
o
r
y
r
a
t
e
(
≥
30/m
i
n)
,
pr
e
s
e
n
c
e
o
f
hy
po
t
e
n
s
i
o
n
(
s
y
s
t
o
l
i
c
bl
o
o
d
pr
e
s
s
ur
e
<
90
mm
o
f
Hg
a
n
d
d
i
a
s
to
l
i
c
bl
o
o
d
pr
e
s
s
ur
e
≤
60
mm
o
f
Hg)
o
n
a
d
m
i
s
s
i
o
n
,
bl
o
o
d
ur
e
a
ni
t
r
o
ge
n
(
B
UN
)
l
e
v
e
l
(
≥
7
m
m
o
l
/L
)
a
n
d
a
ge
(
≥
65
y
e
a
r
s
)
[1
0
]
.
A
d
i
a
g
n
o
s
i
s
o
f
d
i
a
b
e
t
e
s
m
e
ll
i
t
us
w
a
s
ba
s
e
d
o
n
hi
s
to
r
y
o
f
t
r
e
a
t
m
e
n
t
w
i
t
h
o
r
a
l
a
n
t
i
-
d
i
a
b
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t
i
c
a
ge
n
t
s
o
r
i
ns
u
li
n.
Al
t
e
r
n
a
t
i
v
e
ly
,
d
i
a
g
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o
s
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s
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o
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l
d
be
e
s
t
a
bli
s
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d
dur
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ng
t
hi
s
e
p
i
s
o
de
o
f
p
n
e
u
m
o
ni
a
w
he
n
t
he
f
a
s
t
i
n
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p
l
a
s
m
a
g
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o
s
e
c
o
n
c
e
n
t
r
a
t
i
o
n
wa
s
≥
126
m
g/dL
a
n
d/o
r
2h
o
ur
s
p
o
s
t
l
o
a
d
bl
o
o
d
s
uga
r
wa
s
≥
200
m
g/dL
o
n
t
w
o
or
m
o
r
e
s
e
pa
r
a
t
e
o
c
c
a
s
i
o
ns
o
r
m
a
y
b
e
ba
s
e
d
o
n
H
bA
1c
l
e
ve
l
(
>
6.
4)
[1
1
]
.
I
m
m
e
d
i
a
t
e
a
n
d
s
h
o
r
t
o
u
t
c
o
m
e
wa
s
a
s
s
e
s
s
e
d
;
im
m
e
d
i
a
t
e
o
ut
c
o
m
e
w
a
s
de
f
i
ne
d
a
s
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19 (
27.8)
21 (
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r
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s
p
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c
ti
v
e
l
y
(
T
a
b
l
e
2)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
S
S
N:
2252
-
8806
Diabe
tes
M
e
ll
it
us
P
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v
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4.
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[1
]
Ch
e
s
t
n
u
t
M
.
S.
,
et
a
l
.
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“
Pu
l
m
o
n
ar
y
d
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s
o
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d
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,”
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n
M
c
P
h
ee
S
.
J
.
a
n
d
Pap
ad
a
k
i
s
M
.
A.
,
“
Cu
rr
e
n
t
M
ed
i
c
al
D
i
ag
n
o
s
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s
an
d
T
r
e
at
men
t
,”
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8
t
h
e
d
,
N
ew
Y
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:
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c
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raw
H
i
l
l
,
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.
2
3
,
2
0
0
9
.
[2
]
J
ai
n
S
.,
et
a
l
.
,
“
Co
m
mu
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t
y
-
A
c
q
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amo
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U
.
S.
A
d
u
l
t
s
,”
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E
n
g
l
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M
ed
,
v
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l
/
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u
e:
373
(
5
),
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p
.
4
1
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-
4
2
7
,
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0
1
5
.
[3
]
K
en
n
y
C
.
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“
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h
e
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y
p
o
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l
y
cemi
a
i
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b
v
i
o
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s
:
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p
o
g
l
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cemi
a
,”
P
r
i
m
a
r
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ca
r
e
d
i
a
b
e
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es
,
vol
/
i
s
s
u
e:
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(
1
),
p
p
.
3
–
11
,
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0
1
4
.
[4
]
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o
rb
el
L
.
an
d
Sp
en
ce
r
J
.
D
.
,
“
D
i
ab
e
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e
s
mel
l
i
t
u
s
an
d
i
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f
ec
t
i
o
n
:
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n
ev
al
u
at
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f
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p
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c
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U
n
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d
St
at
e
s
,”
J
D
i
a
b
et
es
C
o
m
p
l
i
ca
t
i
o
n
s
,
v
o
l
.
29
,
pp.
1
9
2
–
1
9
5
,
2
0
1
5
.
[5
]
Smi
t
h
S
.
A
.
an
d
P
o
l
a
n
d
G
.
A
.,
“
A
me
ri
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a
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A
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at
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n
.
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n
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en
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p
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i
mm
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ab
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,
”
D
i
a
b
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Ca
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,
vol
/
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s
s
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:
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7
(
1
),
p
p
.
S1
1
1
–
13
,
2
0
0
4
.
[6
]
T
o
rre
s
A
.,
et
a
l
.
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“
W
h
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v
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a
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m
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co
cc
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Im
p
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o
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,
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l
.
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0
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p
p
.
9
8
4
–
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8
9
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0
1
5
.
[7
]
Man
d
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l
l
L
.
A
.,
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a
l
.
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“
In
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c
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p
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eu
m
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n
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t
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,”
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n
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f
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s
.
,
vol
/
i
s
s
u
e
:
44
(
l
),
p
p
.
S2
7
-
72
,
2
0
0
7
.
[8
]
L
i
u
J
.
L
.,
et
a
l
.
,
“
E
x
p
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C
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-
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p
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ffi
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cy
,”
S
ci
R
ep
,
v
o
l
.
6
,
p
p
.
2
2
9
1
1
,
2
0
1
6
.
[9
]
A
n
d
r
ew
s
J
.,
et
a
l
.
,
“
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mm
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a
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r
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P
u
l
m
M
ed
,
v
o
l
.
9
,
pp.
175
–
80
,
2
0
0
3
.
[1
0
]
A
m
e
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c
an
D
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t
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s
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s
s
o
ci
at
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,
“
D
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s
Car
e
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v
o
l
/
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a
au
e:
38
(1
)
,
pp.
S8
-
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.
[1
1
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Pel
eg
A
.
Y
.,
et
a
l
.
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“
Co
mmo
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o
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emi
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c
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ro
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es
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ev
.
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v
o
l
.
2
3
,
p
p
.
3
–
13
,
2
0
0
7
.
[1
2
]
K
h
al
i
l
M
.
M
.,
et
a
l
.
,
“P
at
t
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rn
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t
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n
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mi
l
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ar
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o
s
p
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s
,”
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g
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n
Jo
u
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Ch
e
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t
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l
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s
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s
,
vol
/
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s
s
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e
:
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(
1
),
p
p
.
9
–
16
,
2
0
1
3
.
[1
3
]
I
n
t
e
rn
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o
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l
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e
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s
F
e
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rat
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n
,
“
I
D
F
D
i
ab
e
t
e
s
A
t
l
as
(7
t
h
e
d
.
)
,”
2016
.
A
v
ai
l
ab
l
e
at
h
t
t
p
:
/
/
w
w
w
.
d
i
ab
e
t
e
s
at
l
as
.
o
rg
.
[1
4
]
A
k
b
ar
D.
H
.,
“
Bac
t
e
r
i
al
p
n
e
u
mo
n
i
a:
co
m
p
ari
s
o
n
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n
d
i
ab
e
t
i
c
s
an
d
n
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n
d
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ab
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t
i
c
s
,”
A
ct
a
D
i
a
b
e
t
o
l
.
,
vol
/
i
s
s
u
e:
38
(
2
),
p
p
.
7
7
-
82
,
2
0
0
1
.
[1
5
]
Mart
i
n
s
M
.,
et
a
l
.
,
“
Pre
v
al
en
ce
an
d
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m
p
a
c
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o
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D
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me
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s
(D
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p
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mo
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a
(C
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p
at
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s
,”
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u
r
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a
n
R
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p
i
r
a
t
o
r
y
J
o
u
r
n
a
l,
vol.
46
,
p
p
.
PA
1
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4
,
2
0
1
5
.
[1
6
]
de
-
A
n
d
rés
A
.
L
.,
et
a
l
.
,
“
H
o
s
p
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al
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s
at
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o
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i
t
h
co
mm
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n
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t
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-
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c
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u
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p
n
eu
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o
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i
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a
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o
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p
at
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2
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a
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ai
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m
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o
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,”
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,
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l
/
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s
s
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:
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p
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e
0
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7
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7
.
[1
7
]
K
o
rn
u
m
J
.
B
.,
et
a
l
.
,
“
T
y
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i
ab
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e
s
an
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p
n
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o
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t
c
o
me
,”
D
i
a
b
et
es
Ca
r
e
,
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l
.
3
0
,
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p
.
2
2
5
1
-
2
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7
,
2
0
0
7
.
[1
8
]
Sai
b
al
M
.
A
.,
et
a
l
.
,
“
Co
mm
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al
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p
at
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s
:
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re
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p
at
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o
me
,”
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a
n
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l
a
d
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h
M
ed
R
es
Co
u
n
c
B
u
l
l
.
,
vol
/
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s
s
u
e
:
3
(
3
),
p
p
.
9
8
-
1
0
3
,
2
0
1
2
.
[1
9
]
Fal
g
u
e
ra
M.
,
et
a
l
.
,
“
E
t
i
o
l
o
g
y
a
n
d
o
u
t
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o
me
o
f
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o
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n
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-
ac
q
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p
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eu
m
o
n
i
a
i
n
p
at
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e
n
t
s
w
i
t
h
d
i
ab
e
t
e
s
mel
l
i
t
u
s
,”
Ch
es
t
,
vol.
128
,
p
p
.
3
2
3
3
–
3
2
3
9
,
2
0
0
9
.
[2
0
]
Sat
o
K
.
K
.,
et
a
l
.
,
“
Co
m
b
i
n
ed
me
as
u
r
eme
n
t
o
f
fas
t
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n
g
p
l
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m
a
g
l
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e
a
n
d
A
1
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i
s
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ff
ec
t
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v
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fo
r
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p
r
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d
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c
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f
t
y
p
e
2
d
i
ab
e
t
e
s
:
t
h
e
K
a
n
s
ai
H
e
al
t
h
c
ar
e
St
u
d
y
,”
D
i
a
b
et
es
Ca
r
e
,
vol.
32
,
p
p
.
6
4
4
–
6
4
6
,
2
0
0
9
.
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