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d
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m
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ll
it
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s p
a
ti
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ts
.
K
ey
w
o
r
d
s
:
Diab
etes
m
el
lit
u
s
Diab
etics
E
d
u
ca
tio
n
P
h
y
sic
a
l
e
x
e
rc
is
e
Self
-
m
an
a
g
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m
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n
t
T
h
is
is
a
n
o
p
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n
a
c
c
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ss
a
rticle
u
n
d
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e
CC B
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-
SA
li
c
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n
se
.
C
o
r
r
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s
p
o
nd
ing
A
uth
o
r
:
R
ap
ito
s
Sid
iq
Hea
lth
P
r
o
m
o
tio
n
St
u
d
y
P
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r
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m
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lth
P
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y
tec
h
n
ic
P
ad
an
g
J
l.
Si
m
p
an
g
P
o
n
d
o
k
Ko
p
i,
Sit
eb
a,
P
a
d
an
g
,
W
est Su
m
ater
a,
I
n
d
o
n
esia
E
m
ail:
r
ap
ito
s
@
p
o
ltek
k
esp
ad
an
g
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Diab
etes
m
el
lit
u
s
is
a
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
e
t
h
at
h
as
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ec
o
m
e
a
p
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b
le
m
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f
g
lo
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al
h
e
alth
to
d
a
y
,
b
ec
au
s
e
o
f
th
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co
m
p
licatio
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s
.
T
h
e
p
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ce
o
f
g
lo
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al
d
iab
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is
m
o
r
e
th
a
n
d
o
u
b
led
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v
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p
ast
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r
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w
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r
ates
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ar
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p
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n
2
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,
th
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p
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ce
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tag
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o
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lts
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f
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g
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m
d
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ch
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f
1
1
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lts
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u
f
f
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f
r
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m
d
iab
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m
ell
itu
s
)
i
n
t
h
e
w
o
r
ld
[
1
,
2
]
.
I
n
2
0
1
9
it is
esti
m
ated
th
at
t
h
e
g
lo
b
al
p
r
ev
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n
ce
o
f
Diab
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elli
tu
s
is
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.
3
(
4
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illi
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p
eo
p
le)
,
in
cr
ea
s
in
g
to
1
0
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il
lio
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in
2
0
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d
1
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.
9
%
(
7
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n
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in
2
0
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5
[
3
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T
h
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d
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th
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t
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lead
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s
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th
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2
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4
[
4
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.
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n
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d
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ca
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s
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t
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,
h
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p
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u
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to
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tin
u
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to
i
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cr
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u
t
th
e
w
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ld
w
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h
s
o
cial
an
d
f
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n
an
c
ial
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m
p
licatio
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s
[
5
]
.
I
n
d
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s
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r
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ev
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t
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w
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iab
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th
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w
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alo
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g
w
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th
C
h
i
n
a,
I
n
d
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t
h
e
U
n
ited
States
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B
r
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R
u
s
s
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an
d
Me
x
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1
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ill
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s
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f
er
er
s
in
2
0
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5
[
6
]
.
B
ase
d
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th
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latest
d
ata
f
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t
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B
asic
H
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2
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in
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th
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p
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len
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f
d
iab
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h
a
s
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cr
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s
ed
s
ig
n
i
f
ica
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tl
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v
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th
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p
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f
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v
e
y
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la
s
tl
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.
I
n
2
0
1
3
,
th
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p
r
ev
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f
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in
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lt
s
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ch
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6
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9
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,
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2
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th
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f
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r
e
co
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ti
n
u
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to
s
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to
8
.
5
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[
7
]
.
T
h
e
p
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c
en
t
ag
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o
f
d
ea
th
s
d
u
e
to
d
iab
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in
I
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d
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i
s
th
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s
ec
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n
d
-
h
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g
h
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s
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a
f
ter
Sri
L
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I
n
ad
d
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to
d
iab
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m
ellit
u
s
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in
cl
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d
i
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f
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v
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d
is
ea
s
es
w
it
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h
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g
h
e
s
t
Evaluation Warning : The document was created with Spire.PDF for Python.
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b
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ag
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R
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k
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in
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w
h
ile
i
n
2
0
1
8
u
p
to
Ma
y
it
r
ea
ch
ed
2
,
5
3
2
ca
s
es,
f
r
o
m
t
h
e
s
e
d
ata
th
e
d
is
tr
ict
s
o
f
P
ad
an
g
Utar
a
an
d
Nan
g
g
alo
w
er
e
t
h
e
h
ig
h
e
s
t
ar
ea
s
o
f
d
iab
etics
(
P
ad
an
g
C
it
y
e
-
p
u
s
k
es
m
a
s
d
ata,
ac
ce
s
s
ed
o
n
J
u
l
y
3
1
,
2
0
1
9
)
[
9
]
.
Diab
etes
Me
llit
u
s
ca
n
n
o
t
b
e
c
u
r
ed
,
b
u
t
ef
f
o
r
ts
ar
e
n
ee
d
ed
to
i
m
p
r
o
v
e
t
h
e
q
u
al
it
y
o
f
li
f
e
o
f
s
u
f
f
er
er
s
.
T
o
im
p
r
o
v
e
t
h
e
q
u
a
lit
y
o
f
li
f
e
o
f
d
iab
etics
it
i
s
n
ec
e
s
s
ar
y
to
co
n
tr
o
l
ef
f
o
r
ts
w
it
h
f
o
u
r
m
ain
p
illar
s
,
n
a
m
e
l
y
ed
u
ca
tio
n
,
ea
ti
n
g
,
e
x
er
cise,
m
ed
icatio
n
ad
h
er
e
n
ce
[
1
0
]
.
E
x
p
er
ts
r
ef
er
to
t
h
e
ter
m
s
el
f
-
m
an
ag
e
m
e
n
t
o
r
Se
lf
-
m
an
a
g
e
m
e
n
t o
f
d
iab
etics
w
i
th
d
iab
etes
m
ellit
u
s
,
w
h
i
c
h
i
s
a
n
e
f
f
o
r
t
t
h
a
t
d
i
a
b
e
t
i
c
s
c
a
n
d
o
t
o
f
o
r
m
a
b
i
l
i
t
y
i
n
m
a
n
a
g
i
n
g
h
i
m
s
e
l
f
,
c
u
l
t
i
v
a
t
i
n
g
l
i
f
e
s
t
y
l
e
s
f
o
l
l
o
w
i
n
g
t
h
e
d
e
m
a
n
d
s
o
f
h
i
s
i
l
l
n
e
s
s
,
s
o
s
e
l
f
-
m
a
n
a
g
e
m
e
n
t
i
s
v
e
r
y
i
m
p
o
r
t
a
n
t
,
w
i
t
h
t
h
e
e
x
i
s
t
e
n
c
e
o
f
s
e
l
f
-
m
a
n
a
g
e
m
e
n
t
i
s
e
x
p
e
c
t
e
d
t
o
h
a
v
e
a
n
i
m
p
a
c
t
o
n
c
o
n
t
r
o
l
l
i
n
g
b
l
o
o
d
s
u
g
a
r
[
1
1
-
1
3
]
.
Self
-
m
an
a
g
e
m
e
n
t
o
f
d
iab
etics
r
ef
er
s
to
s
ev
er
al
ac
tiv
itie
s
n
a
m
el
y
m
o
n
ito
r
in
g
th
e
s
i
g
n
s
an
d
s
y
m
p
to
m
s
,
m
ai
n
tai
n
an
d
i
m
p
r
o
v
e
h
ea
lt
h
b
eh
av
io
r
,
an
d
o
v
er
co
m
e
th
e
n
e
g
ativ
e
i
m
p
ac
t
o
f
t
h
e
d
is
ea
s
e
o
n
th
e
p
h
y
s
ica
l
f
u
n
c
ti
o
n
in
g
o
f
s
u
f
f
er
er
s
,
e
m
o
tio
n
al
f
ee
l
in
g
s
,
a
n
d
i
n
ter
p
er
s
o
n
al
r
elatio
n
s
h
ip
s
[
1
4
]
,
b
ec
au
s
e
t
h
e
k
e
y
to
co
n
tr
o
lli
n
g
t
y
p
e
2
d
iab
etes
is
to
ch
an
g
e
t
h
e
s
u
f
f
er
er
's
li
f
est
y
l
e
in
th
e
f
o
r
m
o
f
s
el
f
-
m
an
a
g
e
m
en
t
[
1
5
]
.
On
e
v
er
y
i
m
p
o
r
tan
t
asp
ec
t
o
f
s
el
f
-
m
an
a
g
e
m
e
n
t
is
ed
u
ca
tio
n
.
E
d
u
ca
tio
n
ai
m
s
to
r
ed
u
ce
o
r
m
ai
n
tai
n
b
lo
o
d
s
u
g
ar
s
tab
ili
t
y
,
r
eg
u
late
d
ie
t
a
n
d
m
an
a
g
e
th
e
d
i
s
ea
s
e
[
1
6
,
1
7
]
.
Hea
lth
ed
u
ca
tio
n
th
a
t
is
f
o
llo
w
ed
b
y
d
iab
etics
i
s
v
er
y
i
m
p
o
r
tan
t
to
co
n
tr
o
l
t
h
e
d
is
ea
s
e,
w
it
h
ed
u
ca
tio
n
i
t
ca
n
in
cr
ea
s
e
t
h
e
k
n
o
w
led
g
e
o
f
d
ia
b
etics
an
d
i
n
cr
ea
s
e
th
eir
a
w
ar
en
es
s
[
1
8
,
1
9
]
.
B
u
t
to
d
o
Su
ch
ed
u
c
atio
n
is
n
o
t
as
ea
s
y
as
o
n
e
m
i
g
h
t
i
m
ag
i
n
e,
it
n
ee
d
s
s
y
s
te
m
atic
e
f
f
o
r
ts
,
alt
h
o
u
g
h
h
ea
lt
h
ed
u
ca
tio
n
is
s
u
itab
le
f
o
r
v
ar
i
o
u
s
lev
e
ls
o
f
a
g
e,
g
e
n
d
er
an
d
ed
u
ca
tio
n
(
1
7
)
.
T
h
e
g
o
v
er
n
m
e
n
t
h
as
i
n
itia
ted
v
ar
io
u
s
p
r
o
g
r
a
m
s
to
i
m
p
r
o
v
e
th
e
q
u
alit
y
o
f
li
f
e
o
f
p
eo
p
le
w
it
h
d
iab
etes,
o
n
e
o
f
w
h
ich
i
s
a
ch
r
o
n
ic
d
is
ea
s
e
s
er
v
ice
p
r
o
g
r
a
m
(
P
R
OL
ANI
S
)
,
w
h
ic
h
in
cl
u
d
es
d
iab
etes
an
d
h
y
p
er
ten
s
io
n
.
T
h
e
aim
is
t
o
ac
h
iev
e
o
p
ti
m
al
q
u
alit
y
o
f
li
f
e
w
it
h
th
e
co
s
t o
f
ef
f
ec
tiv
e
a
n
d
ef
f
icie
n
t
h
ea
lt
h
s
er
v
ices [
2
0
]
.
T
h
e
r
esu
lts
o
f
Sid
iq
's
et
al,
r
es
ea
r
ch
in
2
0
1
8
at
th
e
Me
u
r
asi
L
a
m
b
ar
o
A
ce
h
B
esar
cli
n
ic
b
a
s
ic
s
er
v
ice
f
ac
ilit
y
i
n
A
ce
h
P
r
o
v
in
ce
,
f
o
u
n
d
th
at
o
f
5
2
d
iab
etics
w
h
o
p
ar
ticip
ated
in
th
e
P
R
O
L
A
NI
S
p
r
o
g
r
am
,
2
7
p
eo
p
le
o
r
5
2
%
h
ad
p
o
o
r
s
elf
-
m
a
n
a
g
e
m
en
t,
th
is
h
ad
an
i
m
p
ac
t
o
n
s
u
g
ar
i
n
s
tab
ilit
y
b
lo
o
d
,
a
ls
o
f
o
u
n
d
s
o
m
e
d
iab
etics
w
h
o
h
a
v
e
h
y
p
o
g
l
y
ce
m
ia
d
u
e
to
a
s
tr
ict
d
iet
b
y
n
o
t
ea
tin
g
s
o
th
at
t
h
eir
p
h
y
s
ical
co
n
d
itio
n
is
w
ea
k
[
2
1
]
.
T
h
e
in
itial
s
u
r
v
e
y
co
n
d
u
cted
b
y
r
esear
ch
er
s
i
n
J
u
l
y
2
0
1
9
,
at
s
ev
e
r
al
co
m
m
u
n
it
y
Hea
lt
h
ce
n
ter
s
P
ad
an
g
C
it
y
,
f
o
u
n
d
th
at
n
o
t
all
D
M
s
u
f
f
er
er
s
w
er
e
r
eg
is
ter
ed
I
n
P
R
O
L
ANI
S
a
ctiv
el
y
p
ar
ticip
atin
g
i
n
cti
v
it
i
es,
w
it
h
a
v
ar
iet
y
o
f
r
ea
s
o
n
s
,
s
u
ch
as
n
o
t
h
av
in
g
t
i
m
e
b
ec
au
s
e
t
h
e
y
h
a
v
e
to
w
o
r
k
,
n
o
o
n
e
tak
es
t
h
e
m
o
r
n
i
n
g
s
u
f
f
er
er
s
w
h
o
ar
e
eld
er
ly
an
d
d
u
e
to
w
ea
k
p
h
y
s
ical
co
n
d
itio
n
.
R
e
s
ea
r
ch
er
s
al
s
o
f
o
u
n
d
s
o
m
e
DM
s
u
f
f
e
r
er
s
w
h
o
w
er
e
n
o
t
ac
tiv
el
y
p
ar
ticip
ati
n
g
in
th
i
s
p
r
o
g
r
am
,
ca
m
e
to
th
e
P
u
s
k
es
m
as
in
a
w
ea
k
p
h
y
s
ica
l
co
n
d
i
tio
n
a
n
d
h
i
g
h
b
lo
o
d
s
u
g
ar
.
T
h
is
r
esear
ch
is
a
p
r
eli
m
i
n
ar
y
s
t
u
d
y
to
f
i
n
d
o
u
t
th
e
q
u
alit
y
o
f
s
el
f
-
m
a
n
ag
e
m
e
n
t
in
p
eo
p
le
w
it
h
d
iab
etes
m
ellit
u
s
at
th
e
P
u
s
k
e
s
m
a
s
in
P
ad
an
g
C
it
y
i
n
2
0
1
9
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
d
escr
ip
tiv
e
-
a
n
al
y
tic
s
t
u
d
y
w
a
s
co
n
d
u
cted
f
r
o
m
J
u
l
y
t
o
No
v
e
m
b
er
2
0
1
9
o
n
s
ev
en
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
in
P
ad
an
g
C
it
y
,
n
a
m
el
y
L
ap
ai,
Am
b
ac
an
g
,
Nan
g
g
alo
,
A
lai,
An
d
alas,
Ku
r
an
j
i,
an
d
P
a
uh
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
.
T
h
e
n
u
m
b
er
o
f
s
a
m
p
les
ar
e
1
0
5
p
eo
p
le
w
it
h
Diab
etes
Me
llit
u
s
w
h
o
s
ee
k
tr
ea
t
m
e
n
t
at
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
b
et
w
ee
n
J
u
l
y
to
N
o
v
e
m
b
er
2
0
1
9
.
Data
w
er
e
co
l
lecte
d
b
y
in
ter
v
ie
w
u
s
i
n
g
a
q
u
e
s
tio
n
n
air
e
t
h
at
ad
ap
ted
f
r
o
m
t
h
e
d
iab
etes
s
el
f
-
m
a
n
ag
e
m
e
n
t q
u
esti
o
n
n
air
e,
t
h
e
s
u
m
m
ar
y
o
f
d
iab
etes
s
elf
-
ca
r
e
ac
ti
v
it
ies
(
S
DSC
A
)
[
2
2
]
.
W
h
ich
h
a
s
b
ee
n
m
o
d
if
i
ed
,
th
at
i
n
cl
u
d
es
ite
m
s
as
s
es
s
in
g
t
h
e
f
o
llo
w
i
n
g
asp
ec
ts
o
f
th
e
d
iab
ete
s
r
eg
i
m
en
:
Dietar
y
R
eg
u
latio
n
,
e
x
er
cise,
b
lo
o
d
-
g
l
u
co
s
e
te
s
ti
n
g
,
h
e
alth
ed
u
ca
tio
n
,
a
n
d
in
f
o
r
m
atio
n
n
ee
d
s
.
Data
w
a
s
p
r
o
ce
s
s
ed
b
y
co
d
in
g
,
ed
iti
n
g
,
tab
u
lati
n
g
an
d
tr
an
s
f
er
r
i
n
g
s
tag
e
s
.
Data
w
as
p
r
o
ce
s
s
ed
b
y
u
s
i
n
g
a
co
m
p
u
t
er
ized
s
y
s
te
m
.
Data
w
as
an
al
y
ze
d
b
y
u
s
in
g
u
n
i
v
ar
iate
a
n
d
b
iv
ar
iate
w
it
h
c
h
i
-
s
q
u
ar
e
an
d
m
u
lti
v
ar
iate
w
i
th
l
o
g
is
tic
r
e
g
r
es
s
io
n
w
i
th
a
s
ig
n
i
f
ica
n
t
le
v
el
o
f
0
.
0
5
(
5
%).
Un
i
v
ar
iate
a
n
al
y
s
is
w
as
u
s
ed
to
ex
p
lai
n
t
h
e
ch
ar
ac
t
er
is
tics
o
f
th
e
r
esp
o
n
d
en
t
s
,
u
n
i
v
ar
iate
a
n
al
y
s
i
s
w
a
s
u
s
ed
to
ex
p
lai
n
t
h
e
ch
ar
ac
ter
is
tic
s
o
f
r
esp
o
n
d
en
t
s
,
w
h
ile
b
i
v
ar
iate
a
n
al
y
s
is
is
u
s
ed
to
d
escr
ib
e
t
h
e
r
el
atio
n
s
h
ip
b
et
w
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P
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NI
S
v
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q
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d
th
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en
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
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SS
N:
2
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5
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Qu
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35
3.
RE
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Fro
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t
P
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as
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itio
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f
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iab
etics
.
[
2
3
,
2
4
]
.
T
h
is
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esear
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as
also
id
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ti
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ied
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e
w
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o
p
ar
tici
p
ate
in
P
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ac
tiv
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s
an
d
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[
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.
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.
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h
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h
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f
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it
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to
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ail
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f
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[
2
5
]
.
T
h
is
is
b
ec
au
s
e
w
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m
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n
h
a
v
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e
n
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u
g
h
ti
m
e
to
p
ar
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in
P
R
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ac
ti
v
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s
s
u
c
h
as
p
h
y
s
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ac
tiv
ities
s
u
c
h
as
g
y
m
n
a
s
tics
,
h
ea
lt
h
ed
u
ca
tio
n
an
d
b
lo
o
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s
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g
ar
ch
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k
in
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a
ctiv
itie
s
.
T
h
r
o
u
g
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N:
2
2
5
2
-
8
8
0
6
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
Vo
l.
1
0
,
No
.
1
,
Ma
r
ch
20
21
:
3
3
–
4
0
36
p
r
o
g
r
am
s
li
k
e
t
h
is
,
d
iab
etics
c
an
also
s
o
cialize
w
it
h
f
e
llo
w
s
u
f
f
er
er
s
,
s
o
th
e
y
ca
n
r
ed
u
ce
th
e
b
u
r
d
en
o
f
t
h
eir
m
en
tal
ill
n
es
s
es
b
ec
au
s
e
t
h
e
y
ca
n
s
h
ar
e
in
f
o
r
m
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n
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n
o
v
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co
m
i
n
g
n
e
g
ati
v
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e
f
f
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ts
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illn
e
s
s
,
d
ail
y
s
el
f
-
m
an
a
g
e
m
e
n
t,
e
m
o
tio
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al
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ee
l
in
g
s
,
an
d
i
n
ter
p
er
s
o
n
al
r
elatio
n
s
h
ip
s
[
1
4
,
1
5
,
2
6
,
2
7
]
.
I
n
th
i
s
s
tu
d
y
f
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u
n
d
t
w
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th
i
n
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s
th
at
ar
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also
v
er
y
i
n
ter
esti
n
g
,
th
e
f
ir
s
t
is
t
h
at
n
o
t
all
d
iab
etics
w
h
o
h
av
e
p
ar
ticip
ated
in
P
R
O
L
ANI
S
ac
tiv
it
ies
h
a
v
e
a
g
o
o
d
s
e
lf
-
m
a
n
a
g
e
m
en
t
q
u
alit
y
w
h
ich
is
3
1
.
5
1
%,
I
t
m
ea
n
th
at
s
o
m
e
d
iab
etics
h
av
e
p
ar
ti
cip
ated
in
th
i
s
ac
ti
v
it
y
b
u
t
h
av
e
n
o
t
b
ee
n
ab
le
to
ch
a
n
g
e
t
h
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r
lif
est
y
le
w
h
ic
h
i
s
f
o
llo
w
in
g
t
h
e
d
e
m
a
n
d
s
o
f
d
ia
b
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s
el
f
-
m
a
n
a
g
e
m
e
n
t.
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r
t
h
is
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n
d
itio
n
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it
i
s
n
ec
ess
ar
y
to
s
tu
d
y
d
ee
p
l
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h
e
f
ac
to
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t
h
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o
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u
r
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ev
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al
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s
t
h
at
ca
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e
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ak
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to
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n
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id
er
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s
u
c
h
as;
p
er
ce
p
tio
n
s
o
f
r
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n
d
en
ts
ab
o
u
t
t
h
e
p
u
r
p
o
s
e
o
f
b
lo
o
d
s
u
g
ar
test
i
n
g
a
ctiv
itie
s
,
e
m
o
tio
n
al
co
n
d
itio
n
s
,
p
ain
,
co
s
t
a
n
d
m
o
tiv
a
tio
n
o
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t
h
e
f
a
m
i
l
y
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i
n
c
l
u
d
in
g
t
h
e
p
atie
n
t
'
s
at
titu
d
e
to
w
ar
d
s
t
h
e
q
u
a
lit
y
o
f
i
n
f
o
r
m
ati
o
n
[
2
8
,
2
9
]
.
G
r
ea
tl
y
af
f
ec
t
th
e
r
es
u
lts
o
f
P
R
OL
A
NI
S
ac
ti
v
it
ies,
esp
ec
iall
y
e
d
u
ca
tio
n
al
ac
ti
v
itie
s
,
s
o
it
n
ee
d
s
a
s
tr
ateg
y
to
o
v
er
co
m
e
t
h
e
m
[
3
0
]
.
I
n
ter
m
s
o
f
t
h
e
p
ar
ticip
an
t,
f
ee
s
d
o
n
o
t
h
av
e
to
p
a
y
b
ec
au
s
e
t
h
is
ac
ti
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it
y
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f
u
ll
y
f
u
n
d
ed
b
y
I
n
d
o
n
esia
n
h
ea
l
th
i
n
s
u
r
an
c
e
ag
en
c
y
(
B
P
J
S
)
,
esp
ec
iall
y
f
o
r
lab
o
r
ato
r
y
ex
a
m
i
n
atio
n
s
.
T
h
e
f
ac
to
r
o
f
f
a
m
i
l
y
s
u
p
p
o
r
t
is
also
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er
y
d
ec
i
s
iv
e
.
Fa
m
il
y
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d
s
o
cial
s
u
p
p
o
r
t
ar
e
i
m
p
o
r
tan
t
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ts
o
f
ad
h
er
en
ce
to
d
iab
etes
m
an
a
g
e
m
e
n
t.
N
u
m
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o
u
s
s
tu
d
i
es
h
a
v
e
s
h
o
w
n
a
p
o
s
iti
v
e
an
d
s
ig
n
i
f
ica
n
t
r
elatio
n
s
h
ip
b
et
wee
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s
o
cial
s
u
p
p
o
r
t
an
d
ad
h
er
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ce
to
d
iab
etes
tr
ea
t
m
e
n
t.
I
n
clu
d
i
n
g
s
o
cial
s
u
p
p
o
r
t
d
ir
ec
tly
a
f
f
ec
t
s
h
ea
lt
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o
u
tco
m
es,
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l
th
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er
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u
tili
za
t
io
n
,
an
d
b
eh
a
v
io
r
ch
a
n
g
e
[
3
1
-
3
3
]
.
I
d
e
ally
,
f
a
m
il
ies
w
it
h
m
e
m
b
er
s
w
h
o
h
av
e
d
ia
b
etes
s
h
o
u
ld
h
a
v
e
a
r
o
le
to
p
lay
in
h
elp
i
n
g
d
iab
eti
cs
[
3
4
]
.
T
h
is
s
tu
d
y
f
o
u
n
d
th
at
m
o
s
t
d
iab
etics
co
m
e
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th
e
f
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h
ea
lt
h
i
s
n
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t
ac
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m
p
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ied
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f
a
m
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s
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ex
ce
p
t
d
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etics
w
i
th
w
ea
k
p
h
y
s
ical
co
n
d
itio
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s
w
ith
h
i
g
h
b
lo
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d
s
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ar
le
v
el
s
.
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t
is
w
h
at
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o
u
t
d
iab
etics
w
it
h
d
iab
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s
elf
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m
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g
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m
en
t
w
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f
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O
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S
.
T
h
is
s
t
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d
y
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d
5
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.
3
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%
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f
d
iab
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w
h
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d
id
n
o
t
f
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llo
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P
R
O
L
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NI
S
w
i
th
p
o
o
r
s
elf
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m
a
n
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g
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m
en
t
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n
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itio
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s
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I
n
t
h
i
s
ca
s
e,
ad
v
o
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c
y
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ee
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o
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h
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n
d
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t
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e
P
R
OL
A
NI
S.
3
.
3
.
Asp
ec
t
a
nd
qu
a
lity
o
f
s
elf
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m
a
na
g
e
m
ent
Asp
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o
f
s
el
f
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m
a
n
a
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t
ca
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m
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s
p
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Me
d
icatio
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h
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alth
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tio
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s
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t
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m
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l
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ticip
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s
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ical
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h
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eg
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1
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h
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m
p
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is
o
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o
f
t
h
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alu
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n
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th
eir
r
elatio
n
s
h
ip
w
ith
t
h
e
q
u
al
it
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o
f
s
el
f
-
m
a
n
a
g
e
m
en
t c
a
n
b
e
s
ee
n
in
T
ab
le
3.
T
ab
le
3
.
A
s
p
ec
ts
an
d
q
u
ali
t
y
o
f
s
el
f
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m
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m
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t
S
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man
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n
t
a
sp
e
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t
s
Q
u
a
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i
t
y
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l
f
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man
a
g
e
me
n
t
T
o
t
a
l
p
G
o
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d
N
o
t
g
ood
Ex
a
mi
n
a
t
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o
n
o
f
b
l
o
o
d
s
u
g
a
r
R
u
t
i
n
e
4
0
(
7
0
.
1
8
)
1
7
(
2
9
.
8
2
)
57
0
.
0
2
0
N
o
t
r
u
t
i
n
e
2
3
(
4
7
.
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2
)
2
5
(
5
2
.
8
)
48
p
h
y
si
c
a
l
e
x
e
r
c
i
se
(
sp
o
r
t
s)
R
u
t
i
n
e
4
4
(
7
3
.
3
3
)
1
6
(
2
6
.
6
7
)
60
0
.
0
1
N
o
t
r
u
t
i
n
e
1
9
(
4
2
.
2
2
)
2
6
(
5
7
.
7
8
)
45
T
h
e
r
e
g
u
l
a
r
i
t
y
o
f
t
a
k
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n
g
me
d
i
c
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t
i
o
n
R
e
g
u
l
a
r
6
0
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6
6
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)
3
0
(
3
3
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90
0
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0
0
1
N
o
t
r
e
g
u
l
e
r
3
(
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0
)
1
2
(
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0
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15
D
i
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t
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r
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r
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g
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l
a
t
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o
n
G
o
o
d
5
0
(
6
3
.
2
9
)
2
9
(
3
6
.
7
1
)
79
0
.
2
3
N
o
t
g
o
o
d
1
3
(
5
0
)
1
3
(
5
0
)
26
H
e
a
l
t
h
e
d
u
c
a
t
i
o
n
Y
e
s
4
6
(
7
0
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7
7
)
1
9
(
2
9
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3
2
)
65
0
.
0
0
4
No
1
7
(
4
2
.
5
0
)
2
3
(
5
7
.
5
0
)
40
I
n
f
o
r
mat
i
o
n
n
e
e
d
H
i
g
h
3
0
(
5
4
.
5
)
2
5
(
4
5
.
5
)
55
0
.
2
3
1
L
o
w
3
3
(
6
0
.
1
)
1
7
(
3
9
.
9
)
50
B
ased
o
n
T
ab
le
2
ab
o
v
e,
it
is
f
o
u
n
d
th
at
t
h
er
e
ar
e
5
a
s
p
ec
t
s
o
f
s
el
f
-
m
an
a
g
e
m
e
n
t
t
h
at
ar
e
r
elate
d
to
th
e
q
u
al
it
y
o
f
s
el
f
-
m
a
n
ag
e
m
e
n
t
o
f
d
iab
etics,
n
a
m
el
y
p
ar
tici
p
atio
n
in
P
R
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L
A
NI
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(
p
=
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0
0
7
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tio
n
o
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ar
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0
2
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er
cise
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,
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eg
u
lar
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i
n
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m
ed
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n
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d
Hea
lth
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u
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tio
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,
w
h
ile
t
h
e
a
s
p
ec
ts
o
f
F
o
o
d
R
eg
u
latio
n
an
d
I
n
f
o
r
m
ati
o
n
Nee
d
s
d
o
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o
t
h
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v
e
a
s
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g
n
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f
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ca
n
t r
elatio
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s
h
ip
t
o
th
e
q
u
alit
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o
f
s
elf
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m
a
n
ag
e
m
en
t
o
f
d
iab
etics.
F
u
r
th
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m
o
r
e,
f
o
r
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t
s
o
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e
lf
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m
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en
t
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m
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n
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g
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m
en
t to
m
u
lti
v
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an
al
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is
.
3
.
4
.
F
a
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det
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m
i
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na
ly
s
is
Mu
lti
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an
al
y
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is
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eter
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in
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h
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ip
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et
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r
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p
r
esen
ted
in
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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.
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b
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Hea
lth
Sci.
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SS
N:
2
2
5
2
-
8806
Qu
a
lity o
f
s
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-
ma
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ia
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ellitu
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p
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tien
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R
a
p
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id
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37
th
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f
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llo
w
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T
ab
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4,
w
h
ic
h
ex
p
lai
n
s
t
h
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te
n
t
to
w
h
i
ch
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e
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tr
e
n
g
th
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f
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asp
ec
t
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v
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h
as
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ip
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s
elf
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m
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e
m
e
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t o
f
p
eo
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le
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it
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el
litu
s
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ased
o
n
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e
T
ab
le
5
ab
o
v
e,
it
is
f
o
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t
h
at
r
es
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lt
s
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ag
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th
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ts
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tio
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y
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t th
e
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t o
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ellit
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atie
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asicall
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h
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ee
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h
a
v
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v
al
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e
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5
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it
m
ea
n
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h
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s
e
asp
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ts
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as
a
s
ig
n
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f
ica
n
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ar
tial
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f
ec
t
o
n
t
h
e
s
elf
-
m
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g
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m
en
t
o
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iab
etics.
T
ab
le
4
.
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h
e
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is
tic
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eg
r
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io
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test
r
es
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S
e
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man
a
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me
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p
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s
1
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D
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Su
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eq
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t
s
t
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d
ies
o
n
t
h
e
c
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n
tr
ib
u
tio
n
o
f
a
s
p
ec
ts
o
f
s
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lf
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m
a
n
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t
to
t
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q
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y
o
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s
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f
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m
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d
th
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s
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eg
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d
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eq
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id
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m
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t
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m
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to
b
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asp
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t
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ed
u
ca
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a
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r
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g
u
lar
it
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f
ta
k
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g
m
ed
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h
av
e
a
s
i
g
n
if
ican
t
p
ar
tial
ef
f
ec
t
o
n
th
e
s
elf
-
m
a
n
ag
e
m
e
n
t
o
f
d
iab
etics.
P
h
y
s
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ex
er
ci
s
e/ex
er
cise
r
o
u
ti
n
el
y
af
f
ec
ts
t
h
e
q
u
alit
y
o
f
s
el
f
-
m
an
ag
e
m
e
n
t
o
f
d
iab
etics,
th
i
s
w
ill
ce
r
tain
l
y
h
av
e
a
p
o
s
iti
v
e
i
m
p
ac
t
o
n
b
lo
o
d
s
u
g
ar
co
n
tr
o
l
[
3
5
]
.
R
esear
ch
s
h
o
w
s
th
at
th
er
e
is
a
r
elatio
n
s
h
ip
b
etw
ee
n
s
p
o
r
ts
b
eh
av
io
r
w
i
th
b
l
o
o
d
s
u
g
ar
lev
els
o
f
p
eo
p
le
w
it
h
d
iab
etes
m
el
lit
u
s
,
s
o
p
h
y
s
ica
l
ac
ti
v
it
y
a
n
d
e
x
er
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ar
e
r
ec
o
m
m
e
n
d
ed
as
p
ar
t
o
f
g
l
y
ce
m
ic
co
n
tr
o
l
m
an
a
g
e
m
e
n
t
an
d
o
v
er
all
h
ea
lt
h
[
3
6
,
3
7
]
.
T
h
e
ef
f
ec
ts
o
f
p
h
y
s
ical
ac
tiv
i
t
y
o
n
co
n
tr
o
lli
n
g
g
l
u
co
s
e
in
th
e
b
lo
o
d
w
il
l
v
ar
y
d
ep
en
d
in
g
o
n
h
o
w
l
o
n
g
t
h
e
ac
ti
v
it
y
tak
e
s
,
b
ec
au
s
e
at
th
e
ti
m
e
o
f
p
h
y
s
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ac
ti
v
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r
ex
er
cise
t
h
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o
d
y
ce
ll
s
w
il
l
i
n
cr
ea
s
e
t
h
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s
en
s
iti
v
it
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to
t
h
e
h
o
r
m
o
n
e
i
n
s
u
li
n
,
t
h
e
ca
r
d
io
v
asc
u
lar
s
y
s
te
m
a
n
d
b
r
ea
t
h
i
n
g
co
n
s
ta
n
tl
y
ad
j
u
s
ts
to
th
e
w
o
r
k
lo
ad
o
f
th
e
e
x
er
cise
to
en
s
u
r
e
th
at
b
lo
o
d
r
ich
in
g
l
u
co
s
e
an
d
o
x
y
g
en
(
O2
)
r
ea
ch
es t
h
e
m
u
s
cles t
h
at
ar
e
wo
r
k
in
g
at
t
h
e
r
eq
u
ir
ed
s
p
ee
d
.
I
n
cr
ea
s
ed
b
r
ain
m
o
to
r
ac
ti
v
it
y
ce
n
ter
s
a
n
d
s
k
eleta
l
m
u
s
cle
a
f
f
er
en
t
s
(
te
n
s
io
n
)
a
n
d
m
e
ta
b
o
lic
m
u
s
cles
(
f
o
r
e
x
a
m
p
le,
H+
,
K
+,
a
n
d
lo
ca
l
is
ch
e
m
ia)
s
ti
m
u
late
s
y
m
p
ath
e
tic
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er
v
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u
s
s
y
s
te
m
a
ctiv
it
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a
n
d
ca
u
s
e
i
n
cr
ea
s
ed
ca
tech
o
la
m
in
e
cir
cu
la
tio
n
ac
tin
g
o
n
ad
r
en
o
ce
p
to
r
s
in
s
k
eleta
l
m
u
s
cle
ce
ll
s
an
d
ce
lls
an
d
co
n
s
eq
u
en
tl
y
v
aso
d
ilat
io
n
in
h
ea
lt
h
y
i
n
d
iv
id
u
al
s
[
3
6
]
.
T
h
is
s
t
u
d
y
also
f
o
u
n
d
th
e
i
m
p
ac
t
o
f
ed
u
ca
tio
n
a
l
f
ac
to
r
s
o
n
t
h
e
q
u
a
lit
y
o
f
d
iab
etes
m
a
n
a
g
e
m
en
t
s
elf
-
m
an
a
g
e
m
e
n
t.
Ma
n
y
o
th
er
s
tu
d
ies
h
a
v
e
f
o
u
n
d
a
p
o
s
iti
v
e
i
m
p
ac
t
o
f
ed
u
ca
t
io
n
o
n
t
h
e
s
elf
-
m
a
n
a
g
e
m
en
t
o
f
d
iab
etics
w
h
ic
h
i
n
tu
r
n
h
a
s
a
n
i
m
p
ac
t
o
n
m
ai
n
tai
n
i
n
g
b
lo
o
d
s
u
g
ar
s
tab
ili
t
y
,
r
eg
u
lati
n
g
d
iet
an
d
m
a
n
ag
i
n
g
d
is
ea
s
e
[
1
6
,
1
7
,
1
9
]
.
I
n
f
er
til
it
y
in
d
r
in
k
in
g
i
s
al
s
o
a
f
a
cto
r
th
at
g
r
ea
tl
y
co
n
tr
ib
u
tes
to
th
e
q
u
ali
t
y
o
f
m
an
a
g
e
m
e
n
t
d
iab
etics
th
e
m
s
e
lv
es.
A
n
u
m
b
er
o
f
f
ac
to
r
s
ca
n
in
f
lu
e
n
ce
t
h
e
r
eg
u
lar
it
y
o
f
ta
k
i
n
g
t
h
is
m
ed
icatio
n
s
u
c
h
as
ed
u
ca
tio
n
le
v
el,
d
u
r
atio
n
o
f
d
iab
etes,
an
d
k
n
o
w
led
g
e
ab
o
u
t
DM
an
d
i
ts
tr
e
at
m
e
n
t
a
n
d
h
ea
l
t
h
ed
u
ca
tio
n
i
n
clu
d
i
n
g
ad
h
er
en
ce
co
u
n
s
el
in
g
to
cr
ea
te
a
w
ar
e
n
es
s
o
f
DM
an
d
it
s
tr
ea
t
m
e
n
t [
3
8
-
4
0
]
.
3
.
5
.
Dif
f
icultie
s
in s
e
lf
-
m
a
na
g
e
m
ent
T
o
g
et
an
o
v
er
v
ie
w
o
f
th
e
d
if
f
icu
l
ties
in
s
el
f
-
m
an
a
g
e
m
en
t
ex
p
er
ien
ce
d
b
y
r
esp
o
n
d
e
n
ts
s
o
f
ar
,
t
h
e
f
r
eq
u
en
c
y
d
is
tr
ib
u
tio
n
d
ata
i
s
o
b
tain
ed
b
ased
o
n
th
e
ca
teg
o
r
ie
s
o
f
an
s
w
er
ch
o
ices
a
n
d
s
co
r
es:
Stro
n
g
l
y
Dis
ag
r
ee
=
5
,
Dis
a
g
r
ee
=
4
,
Neu
tr
al=
3
,
Ag
r
ee
=
2
,
Stro
n
g
l
y
Ag
r
ee
=
1,
th
e
r
esu
l
ts
ca
n
b
e
s
e
en
f
r
o
m
T
ab
le
5.
B
ased
o
n
T
ab
le
6,
it
ca
n
b
e
s
ee
n
t
h
at
t
h
e
m
aj
o
r
ity
o
f
r
esp
o
n
d
en
t
s
d
id
n
o
t
e
x
p
er
ien
ce
d
i
f
f
icu
ltie
s
i
n
th
e
asp
ec
ts
o
f
s
el
f
-
m
a
n
a
g
e
m
e
n
t
(
tak
i
n
g
m
ed
icatio
n
,
ea
tin
g
p
atter
n
s
,
ch
ec
k
in
g
b
lo
o
d
s
u
g
a
r
,
p
h
y
s
ical
ex
er
cise
o
r
s
p
o
r
ts
,
m
a
n
ag
in
g
e
m
o
tio
n
s
an
d
ac
ce
s
s
in
g
in
f
o
r
m
at
io
n
)
,
t
h
is
i
s
b
ec
au
s
e
o
f
m
o
s
t
o
f
th
e
r
esp
o
n
d
en
ts
j
o
in
ed
i
n
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0
,
No
.
1
,
Ma
r
ch
20
21
:
3
3
–
4
0
38
th
e
p
r
o
tein
s
(
6
9
.
5
%).
I
n
P
R
OL
A
NI
S
ac
t
iv
i
ties
i
n
ad
d
itio
n
to
p
h
y
s
ica
l
ac
tiv
ities
s
u
c
h
as
g
y
m
n
ast
ics,
h
ea
lt
h
co
u
n
s
e
lin
g
t
h
er
e
i
s
also
b
lo
o
d
s
u
g
ar
c
h
ec
k
i
n
g
ac
ti
v
itie
s
e
v
e
r
y
m
o
n
t
h
.
B
u
t
f
o
r
r
esp
o
n
d
en
t
s
w
h
o
d
id
n
o
t
j
o
in
th
e
P
R
O
L
A
NI
S
h
ad
p
r
o
b
lem
s
o
r
d
if
f
ic
u
ltie
s
.
Of
al
l
th
e
a
s
p
ec
ts
o
f
s
e
lf
-
m
an
a
g
e
m
e
n
t
o
f
d
iab
etes
m
e
llit
u
s
p
atien
ts
,
e
m
o
tio
n
al/
s
tr
e
s
s
m
a
n
ag
e
m
e
n
t
i
s
a
v
er
y
i
n
ter
est
i
n
g
asp
ec
t.
As
a
p
er
ce
n
tag
e
o
f
t
h
e
n
u
m
b
er
o
f
r
esp
o
n
d
en
ts
w
h
o
d
is
a
g
r
ee
h
a
v
e
d
if
f
ic
u
lt
y
in
m
an
a
g
i
n
g
e
m
o
tio
n
s
/s
tr
e
s
s
h
ig
h
er
th
a
n
t
h
o
s
e
w
h
o
ag
r
ee
th
at
i
s
m
o
r
e
th
a
n
5
0
%
(
2
6
.
7
%
s
tr
o
n
g
l
y
d
is
a
g
r
ee
a
n
d
2
4
.
8
%
ag
r
ee
)
,
b
u
t
t
h
er
e
ar
e
1
8
.
1
%
w
h
o
d
ec
lar
e
n
e
u
tr
al,
m
o
r
e
th
an
3
0
% a
d
m
it th
e
d
i
f
f
icu
l
t
y
in
m
a
n
a
g
i
n
g
e
m
o
tio
n
s
/s
tr
e
s
s
s
o
th
at
th
eir
b
lo
o
d
s
u
g
ar
le
v
els
r
is
e.
T
ab
le
6
.
Ov
er
v
ie
w
o
f
asp
ec
ts
o
f
s
el
f
m
a
n
a
g
e
m
e
n
t
A
sp
e
c
t
s o
f
se
l
f
-
man
a
g
e
me
n
t
S
t
r
o
n
g
l
y
d
i
s
a
g
r
e
e
D
i
sag
r
e
e
N
e
u
t
r
a
l
A
g
r
e
e
S
t
r
o
n
g
l
y
a
g
r
e
e
T
o
t
a
l
D
i
f
f
i
c
u
l
t
y
o
f
t
a
k
i
n
g
me
d
i
c
a
t
i
o
n
3
4
(
3
.
4)
3
2
(
3
0
.
5
)
1
0
(
9
.
5
)
2
4
(
2
2
.
9
)
5
(
4
.
8
)
1
0
5
D
i
f
f
i
c
u
l
t
y
o
f
r
e
g
u
l
a
t
i
n
g
d
i
e
t
2
6
(
2
4
.
8
)
3
1
(
2
9
.
5
)
2
3
(
2
1
.
9
)
1
9
(
1
8
.
1
)
6
(
5
.
7
)
1
0
5
D
i
f
f
i
c
u
l
t
y
o
f
c
h
e
c
k
i
n
g
b
l
o
o
d
su
g
a
r
r
e
g
u
l
a
r
l
y
5
0
(
4
7
.
6
)
2
5
(
2
3
.
8
)
1
5
(
1
4
.
3
)
1
0
(
9
.
3
)
5
(
4
.
8
)
1
0
5
D
i
f
f
i
c
u
l
t
y
i
n
c
a
r
r
y
i
n
g
o
u
t
r
e
g
u
l
a
r
p
h
y
si
c
a
l
e
x
e
r
c
i
se
o
r
sp
o
r
t
s
2
6
(
2
4
.
8
)
3
5
(
3
3
.
3
)
1
8
(
1
7
.
1
)
1
6
(
1
5
.
2
)
1
0
(
9
.
5
)
1
0
5
D
i
f
f
i
c
u
l
t
y
o
f
man
a
g
i
n
g
e
mo
t
i
o
n
s
/
st
r
e
ss
2
8
(
2
6
.
7
)
2
6
(
2
4
.
8
)
1
9
(
1
8
.
1
)
2
2
(
2
1
)
1
0
(
9
.
5
)
1
0
5
D
i
f
f
i
c
u
l
t
y
i
n
g
e
t
t
i
n
g
i
n
f
o
r
mat
i
o
n
3
6
(
3
4
.
3
)
2
4
(
2
2
.
9
)
1
9
(
1
8
.
1
)
1
4
(
1
3
.
3
)
1
2
(
1
1
.
4
)
1
0
5
T
h
is
r
esear
ch
id
en
tifie
s
t
h
e
d
i
f
f
ic
u
lties
in
th
i
s
asp
ec
t
o
f
s
el
f
-
m
an
a
g
e
m
e
n
t
,
an
d
m
o
s
t
r
e
s
p
o
n
d
en
t
s
d
id
n
o
t
ex
p
er
ien
ce
d
i
f
f
icu
l
ties
,
b
u
t
f
r
o
m
all
asp
ec
ts
o
f
s
el
f
-
m
an
ag
e
m
e
n
t,
it
is
v
er
y
i
n
ter
est
in
g
to
s
tu
d
y
m
o
r
e
d
ee
p
ly
,
n
a
m
el
y
t
h
e
m
a
n
a
g
e
m
e
n
t
o
f
e
m
o
tio
n
s
an
d
s
tr
ess
,
as
d
escr
ib
ed
p
r
ev
io
u
s
l
y
in
p
er
ce
n
t
ag
e
o
f
th
e
n
u
m
b
er
o
f
r
esp
o
n
d
en
ts
w
h
o
h
a
v
e
d
if
f
icu
lt
y
o
f
m
an
a
g
i
n
g
e
m
o
tio
n
s
/
s
tr
ess
m
o
r
e
th
a
n
3
0
%
,
th
is
h
a
s
an
i
m
p
ac
t
o
n
th
e
s
tab
ilit
y
o
f
b
lo
o
d
s
u
g
ar
lev
els.
I
n
an
u
n
s
tab
le
e
m
o
tio
n
al
s
tate
o
r
s
tr
ess
th
e
b
lo
o
d
s
u
g
ar
w
i
ll
in
cr
ea
s
e
d
u
e
to
th
e
in
f
lu
e
n
ce
o
f
h
o
r
m
o
n
es
[
4
1
]
.
No
t
o
n
l
y
ca
lo
r
ie
in
tak
e,
b
o
d
y
m
a
s
s
in
d
e
x
,
b
u
t
s
tr
ess
a
n
d
f
a
m
il
y
i
n
co
m
e
ar
e
ass
o
ciate
d
w
i
th
i
n
cr
ea
s
ed
lev
els
o
f
Hb
A
1
c.
s
o
d
iab
etics
m
u
s
t
p
a
y
atte
n
tio
n
to
th
ese
b
io
p
s
y
ch
o
s
o
cial
f
ac
to
r
s
an
d
ca
lo
r
ie
in
ta
k
e
to
co
n
tr
o
l
b
lo
o
d
s
u
g
ar
[
4
2
,
4
3
]
.
T
h
is
s
t
u
d
y
id
en
tifie
s
t
h
at
i
t
t
u
r
n
s
o
u
t
a
n
u
m
b
er
o
f
p
r
o
b
le
m
s
th
at
ca
u
s
e
th
ese
d
iab
etics
to
ex
p
er
ien
ce
e
m
o
tio
n
al
d
is
tr
ess
/
s
tr
ess
ar
e
ec
o
n
o
m
ic
an
d
f
a
m
il
y
p
r
o
b
le
m
s
.
T
h
is
i
s
p
r
ec
is
el
y
e
x
p
er
ien
ce
d
b
y
p
eo
p
le
w
it
h
d
iab
elts
m
el
l
it
u
s
w
h
o
ar
e
n
o
t
i
n
v
o
l
v
ed
i
n
P
R
O
L
A
NI
S
ac
ti
v
itie
s
,
d
o
n
o
t
h
av
e
f
i
x
ed
i
n
co
m
e
a
n
d
ea
r
l
y
e
ld
er
ly
.
Stre
s
s
an
d
d
iab
etes
ar
e
lik
e
v
icio
u
s
cir
cle
s
[
4
4
]
.
A
lt
h
o
u
g
h
t
h
er
e
ar
e
also
s
tu
d
ie
s
th
at
f
i
n
d
n
o
d
ir
ec
t
co
r
r
elatio
n
b
et
w
ee
n
s
tr
ess
a
n
d
an
in
cr
ea
s
e
i
n
b
lo
o
d
s
u
g
a
r
[
4
5
]
.
So
,
a
s
tr
ess
m
an
a
g
e
m
e
n
t in
ter
v
e
n
tio
n
i
s
n
ee
d
ed
to
h
elp
r
ed
u
ce
s
tr
ess
an
d
in
cr
ea
s
e
s
el
f
-
e
f
f
icac
y
,
s
o
cial
s
u
p
p
o
r
t [
4
6
]
.
4.
CO
NCLU
SI
O
N
T
h
e
q
u
alit
y
o
f
s
elf
-
m
a
n
ag
e
m
e
n
t
o
f
d
iab
etes
p
atien
ts
at
th
e
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
i
n
P
a
d
an
g
is
i
n
a
g
o
o
d
ca
teg
o
r
y
.
A
n
u
m
b
er
o
f
f
ac
to
r
s
t
h
at
r
elate
d
to
t
h
e
q
u
alit
y
o
f
s
el
f
-
m
an
a
g
e
m
e
n
t
ar
e
p
h
y
s
ical/sp
o
r
ts
tr
ain
i
n
g
,
ed
u
ca
tio
n
,
an
d
r
eg
u
l
ar
m
ed
icatio
n
.
T
h
er
e
is
a
d
if
f
er
en
ce
in
th
e
q
u
alit
y
o
f
s
el
f
-
m
an
ag
e
m
e
n
t
b
et
w
ee
n
p
eo
p
le
w
it
h
d
iab
etes
m
ellit
u
s
w
h
o
p
ar
ticip
ate
in
P
R
OL
ANI
S
ac
ti
v
it
ies
an
d
t
h
o
s
e
w
h
o
d
o
n
o
t.
Ma
n
a
g
e
m
e
n
t
o
f
s
tr
ess
o
r
e
m
o
tio
n
s
is
a
n
i
n
ter
e
s
tin
g
f
ac
to
r
to
b
e
f
o
llo
w
ed
u
p
esp
ec
iall
y
i
n
d
iab
etics
w
h
o
d
o
n
o
t
p
ar
ticip
ate
in
P
R
OL
A
NI
S
ac
tiv
i
ties
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
W
e
w
o
u
ld
li
k
e
to
t
h
an
k
all
th
e
h
ea
d
s
an
d
s
t
af
f
o
f
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
i
n
P
ad
an
g
C
it
y
,
esp
ec
iall
y
p
atie
n
ts
w
i
th
d
iab
et
es
m
ell
itu
s
,
th
e
n
also
t
h
e
d
ir
ec
to
r
o
f
th
e
P
ad
an
g
Hea
lt
h
P
o
ly
tech
n
ic,
esp
ec
ial
l
y
th
e
ap
p
lied
h
ea
lt
h
p
r
o
m
o
tio
n
u
n
d
er
g
r
ad
u
ate
p
r
o
g
r
a
m
w
h
o
h
av
e
f
u
ll
y
s
u
p
p
o
r
ted
th
e
i
m
p
l
e
m
en
tatio
n
o
f
t
h
is
f
ir
s
t
s
tag
e
o
f
r
esear
ch
RE
F
E
R
E
NC
E
S
[1
]
S
.
Ba
su
,
P
.
Yo
f
f
e
,
N.
Hill
s,
a
n
d
R.
H.
L
u
stig
,
“
T
h
e
Re
latio
n
sh
ip
o
f
S
u
g
a
r
to
P
o
p
u
latio
n
-
L
e
v
e
l
Dia
b
e
tes
P
re
v
a
len
c
e
:
A
n
Eco
n
o
m
e
tri
c
A
n
a
l
y
sis o
f
Re
p
e
a
ted
Cro
ss
-
S
e
c
ti
o
n
a
l
Da
ta,”
PL
o
S
O
n
e
,
v
o
l.
8
,
n
o
.
2
,
2
0
1
3
.
[2
]
M
.
Ba
x
ter
e
t
a
l.
,
“
Est
im
a
ti
n
g
th
e
i
m
p
a
c
t
o
f
b
e
tt
e
r
m
a
n
a
g
e
m
e
n
t
o
f
g
ly
c
a
e
m
ic
c
o
n
tro
l
i
n
a
d
u
lt
s
w
it
h
T
y
p
e
1
a
n
d
T
y
p
e
2
d
ia
b
e
tes
o
n
t
h
e
n
u
m
b
e
r
o
f
c
li
n
ica
l
c
o
m
p
li
c
a
ti
o
n
s
a
n
d
th
e
a
ss
o
c
iate
d
f
in
a
n
c
ial
b
e
n
e
f
it
,
”
Dia
b
e
ti
c
M
e
d
icin
e
:
A
J
o
u
rn
a
l
o
f
th
e
Brit
ish
Di
a
b
e
ti
c
Asso
c
ia
ti
o
n
,
v
o
l.
3
3
,
n
o
.
1
1
,
p
p
.
1
5
7
5
-
1
5
8
1
,
2
0
1
6
.
[3
]
P
.
S
a
e
e
d
i
,
e
t
a
l.
,
“
G
lo
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In
tern
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A
tl
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it
io
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,
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b
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Res
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d
Cli
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ica
l
Pra
c
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l.
1
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7
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1
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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J
.
P
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Hea
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2
2
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-
8806
Qu
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elf
-
ma
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a
mo
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ia
b
etes m
ellitu
s
p
a
tien
t
(
R
a
p
ito
s
S
id
iq
)
39
[4
]
Ce
n
ter
f
o
r
P
u
b
li
c
Co
m
m
u
n
ica
ti
o
n
S
e
c
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taria
t
G
e
n
e
ra
l
o
f
th
e
M
in
istry
o
f
He
a
lt
h
o
f
th
e
Re
p
u
b
li
c
o
f
In
d
o
n
e
sia
,
“
Dia
b
e
tes
m
e
ll
it
u
s
is
th
e
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u
m
b
e
r
six
c
a
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d
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th
in
th
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w
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;
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h
e
M
in
istry
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lt
h
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f
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e
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s
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rt
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lu
ti
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th
ro
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id
a
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p
o
sts,”
M
i
n
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str
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f
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lt
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o
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Re
p
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l
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In
d
o
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,
2
0
1
6
.
[
O
n
li
n
e
]
.
A
v
a
il
a
b
le:
ww
w
.
d
e
p
k
e
s.g
o
.
id
.
[5
]
K.
Og
u
rtso
v
a
,
J.
D.
Ro
c
h
a
,
Y.
H
u
a
n
g
,
U.
L
in
n
e
n
k
a
m
p
,
a
n
d
L
.
G
u
a
rig
u
a
ta,
“
IDF
Dia
b
e
tes
A
tl
a
s :
Glo
b
a
l
e
stim
a
tes
f
o
r
th
e
p
re
v
a
len
c
e
o
f
d
iab
e
tes
f
o
r
2
0
1
5
a
n
d
2
0
4
0
,
”
Di
a
b
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tes
Res
e
a
rc
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n
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Cli
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Pra
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l.
1
2
8
,
p
p
.
4
0
-
5
0
,
2
0
1
7
.
[6
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
“
Dia
b
e
tes
f
a
c
ts
a
n
d
f
i
g
u
re
s/
Dia
b
e
tes
fa
k
ta
d
a
n
a
n
g
k
a
,
”
W
o
rld
jo
u
r
n
a
l
o
f
d
ia
b
e
tes
,
2
0
1
6
.
[
O
n
li
n
e
]
.
A
v
a
il
a
b
le:
h
tt
p
:/
/w
ww
.
se
a
ro
.
w
h
o
.
in
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n
d
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si
a
/t
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ics
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-
w
h
d
2
0
1
6
-
d
iab
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f
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-
n
u
m
b
e
rs
-
in
d
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sia
n
.
p
d
f
.
[7
]
Ke
m
e
n
teria
n
Ke
se
h
a
tan
RI,
“
Risk
e
sd
a
s/Ba
sic
h
e
a
lt
h
re
se
a
rc
h
,
”
Ja
k
a
rta,
2
0
1
8
.
[8
]
BP
S
DM
Ke
s.,
“
Op
p
o
rtu
n
it
ies
a
n
d
Ch
a
ll
e
n
g
e
s
o
f
IA
KMI
in
th
e
He
a
lt
h
y
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i
v
in
g
Co
m
m
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n
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y
M
o
v
e
m
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n
t
/
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n
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Da
n
T
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n
t
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g
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n
IAKM
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P
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d
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Ge
ra
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sy
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k
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t
Hi
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t
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d
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n
Pen
g
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n
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RI,
Ja
k
a
rta
,
p
p
.
4
-
1
0
,
2
0
1
7
.
[9
]
Din
a
s
Ke
se
h
a
tan
Ko
ta
P
a
d
a
n
g
,
“
2
0
1
8
An
n
u
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l
Re
p
o
rt
2
0
1
9
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d
it
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n
/
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2
0
1
8
Ed
isi
2
0
1
9
,
”
P
a
d
a
n
g
,
2
0
1
9
.
[1
0
]
K.
P
.
N.
Ha
id
a
a
n
d
I.
M
.
A
to
il
la
h
,
“
T
h
e
re
latio
n
s
h
ip
b
e
tw
e
e
n
th
e
f
o
u
r
p
il
lars
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f
ty
p
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2
DM
c
o
n
tr
o
l
w
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h
b
lo
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su
g
a
r
lev
e
ls/
Hu
b
u
n
g
a
n
e
mp
a
t
p
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r
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n
d
a
li
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n
DM
ti
p
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2
d
e
n
g
a
n
re
ra
ta
k
a
d
a
r
g
u
la
d
a
ra
h
,
”
J
u
rn
a
l
Ber
k
a
l
a
Ep
id
e
mi
o
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g
i
,
v
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l.
1
,
n
o
.
2
,
p
p
.
2
3
4
-
2
4
3
,
2
0
1
1
.
[1
1
]
D.
H.
Iu
n
e
s,
C.
B.
J.
Ro
c
h
a
,
N
.
C.
S
.
B
o
rg
e
s,
C.
O.
M
a
rc
o
n
,
V
.
M
.
P
e
re
ira,
a
n
d
L
.
C.
Ca
rv
a
lh
o
,
“
S
e
lf
-
c
a
re
a
ss
o
c
iate
d
w
it
h
h
o
m
e
e
x
e
rc
ise
s in
p
a
ti
e
n
t
s w
it
h
ty
p
e
2
d
iab
e
tes
m
e
l
li
tu
s
,
”
PL
o
S
On
e
,
v
o
l
.
9
,
n
o
.
1
2
,
2
0
1
4
.
[1
2
]
H.
Ho
lm
a
n
a
n
d
K.
L
o
rig
,
“
P
a
ti
e
n
t
S
e
lf
-
M
a
n
a
g
e
m
e
n
t :
A
Ke
y
to
Eff
e
c
ti
v
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n
e
ss
a
n
d
Eff
icie
n
c
y
in
Ca
re
o
f
Ch
ro
n
ic
Dise
a
se
,
”
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b
li
c
He
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lt
h
Rep
o
rts,
v
o
l.
1
1
9
,
n
o
.
3
,
p
p
.
2
3
9
-
2
4
3
,
2
0
0
4
.
[1
3
]
C.
H.
Yu
,
e
t
a
l.
,
“
A
w
e
b
-
b
a
se
d
i
n
terv
e
n
ti
o
n
t
o
su
p
p
o
r
t
se
lf
-
m
a
n
a
g
e
m
e
n
t
o
f
p
a
ti
e
n
ts
w
it
h
t
y
p
e
2
d
iab
e
tes
m
e
ll
it
u
s:
e
ffe
c
t
o
n
se
l
f
-
e
ff
ic
a
c
y
,
se
l
f
-
c
a
r
e
a
n
d
d
iab
e
tes
d
istres
s,”
BM
C
M
e
d
ica
l
In
f
o
rm
a
ti
c
s
a
n
d
De
c
isio
n
M
a
k
in
g
,
v
o
l.
1
4
,
n
o
.
1
,
p
.
1
1
7
,
2
0
1
4
.
[1
4
]
M
.
Hu
a
n
g
,
R.
Z
h
a
o
,
S
.
L
i,
a
n
d
X
.
Jia
n
g
,
“
S
e
lf
-
m
a
n
a
g
e
m
e
n
t
b
e
h
a
v
io
r
in
p
a
ti
e
n
ts
w
it
h
ty
p
e
2
d
iab
e
tes
:
a
c
ro
ss
-
se
c
ti
o
n
a
l
su
rv
e
y
in
we
ste
rn
u
rb
a
n
Ch
in
a
,
”
P
L
o
S
On
e
,
v
o
l
.
9
,
n
o
.
4
,
2
0
1
4
.
[1
5
]
J.
T
u
o
m
il
e
h
to
,
“
Ty
p
e
2
d
iab
e
tes
i
s
a
p
re
v
e
n
tab
le
d
ise
a
se
-
li
f
e
sty
l
e
is
th
e
k
e
y
,
”
J
o
u
rn
a
l
o
f
M
e
d
ica
l
S
c
i
e
n
c
e
s
,
v
o
l.
3
,
n
o
.
2
,
p
p
.
8
2
-
8
6
,
2
0
1
0
.
[1
6
]
Ra
h
m
a
wa
ti
,
T
.
Tah
li
l,
a
n
d
S
y
a
h
ru
l,
“
T
h
e
e
ff
e
c
t
o
f
d
iab
e
tes
se
l
f
-
m
a
n
a
g
e
m
e
n
t
e
d
u
c
a
ti
o
n
p
r
o
g
ra
m
o
n
se
l
f
-
m
a
n
a
g
e
m
e
n
t
in
p
a
ti
e
n
ts
w
it
h
ty
p
e
2
d
ia
b
e
tes
m
e
ll
it
u
s
/
Pen
g
a
ru
h
p
ro
g
r
a
m
d
i
a
b
e
tes
se
lf
-
ma
n
a
g
e
me
n
t
e
d
u
c
a
ti
o
n
ter
h
a
d
a
p
ma
n
a
jem
e
n
d
iri
p
a
d
a
p
e
n
d
e
rita
d
i
a
b
e
tes
me
ll
it
u
s
ti
p
e
2
,”
J
u
rn
a
l
Ilmu
Ke
p
e
ra
wa
t
a
n
,
v
o
l.
4
,
n
o
.
1
,
p
p
.
4
6
-
5
8
,
2
0
1
6
.
[1
7
]
S
.
No
rris,
M
.
M
.
E
n
g
e
lg
a
u
,
a
n
d
V
.
Na
ra
y
a
n
,
“
E
ff
e
c
ti
v
e
n
e
ss
o
f
se
lf
-
m
a
n
a
g
e
m
e
n
t
train
in
g
in
ty
p
e
2
d
iab
e
tes
a
s
y
ste
m
a
ti
c
re
v
ie
w
o
f
ra
n
d
o
m
ize
d
c
o
n
tro
ll
e
d
tr
ials
,
”
Dia
b
e
tes
Ca
re
,
v
o
l.
2
4
,
n
o
.
3
,
p
p
.
5
6
1
-
5
6
7
,
20
01
.
[1
8
]
M
.
A
.
F
.
Os
m
a
n
,
E.
T
.
A
h
m
e
d
,
a
n
d
H.
A
.
-
T
.
S
.
A
h
m
e
d
,
“
Eff
e
c
ts
o
f
h
e
a
lt
h
e
d
u
c
a
ti
o
n
o
f
d
i
a
b
e
ti
c
p
a
ti
e
n
t’s
k
n
o
w
led
g
e
a
t
Dia
b
e
ti
c
He
a
lt
h
Ce
n
ters
,
Kh
a
rt
o
u
m
S
tate
,
S
u
d
a
n
:
2
0
0
7
-
2
0
1
0
,
”
Gl
o
b
a
l
J
o
u
rn
a
l
o
f
He
a
l
th
S
c
i
e
n
c
e
,
v
o
l.
6
,
n
o
.
2
,
p
p
.
2
2
1
-
2
2
6
,
2
0
1
4
.
[1
9
]
J.
J.
G
a
g
li
a
rd
in
o
,
J.
Ch
a
n
telo
t,
C
.
Do
m
e
n
g
e
r,
G
.
Ka
d
d
a
h
a
,
J.
C.
M
b
a
n
y
a
,
a
n
d
M
.
S
h
e
sta
k
o
v
a
,
“
I
m
p
a
c
t
o
f
d
iab
e
tes
e
d
u
c
a
ti
o
n
a
n
d
se
lf
-
m
a
n
a
g
e
m
e
n
t
o
n
th
e
q
u
a
li
ty
o
f
c
a
re
f
o
r
p
e
o
p
le
w
it
h
t
y
p
e
1
d
iab
e
tes
m
e
ll
it
u
s
in
th
e
M
id
d
le
Eas
t
(T
h
e
In
tern
a
ti
o
n
a
l
Dia
b
e
t
e
s
M
e
ll
i
tu
s P
ra
c
ti
c
e
s
S
tu
d
y
,
IDMP
S
),
”
Di
a
b
e
tes
Res
e
a
rc
h
a
n
d
Cl
in
ica
l
Pra
c
t
ice
,
v
o
l.
1
4
7
,
p
p
.
2
9
-
3
6
,
2
0
1
8
.
[2
0
]
BP
JS
,
“
P
ROL
AN
IS
p
ra
c
ti
c
a
l
g
u
id
e
(Ch
ro
n
ic
d
ise
a
se
m
a
n
a
g
e
m
e
n
t
p
ro
g
ra
m
),
”
J
a
k
a
rta
:
He
a
lt
h
BP
J
S
,
2
0
1
4
.
[2
1
]
R.
S
i
d
iq
,
J.
A
m
o
s,
a
n
d
F
.
Ha
n
u
m
,
“
S
e
lf
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[22]
D.
J.
T
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rt
,
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.
E.
Ha
m
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n
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.
[2
3
]
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y
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tri
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n
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.
,
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u
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Re
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4
]
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h
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rta,
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.
[2
5
]
M
.
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.
D.
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o
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a
,
R.
V
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.
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6
]
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.
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n
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o
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.
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rrick
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d
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.
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7
]
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.
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tri
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ica
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[2
8
]
W
.
M
.
On
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sie
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g
Ch
u
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n
d
C.
Je
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,
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sin
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q
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tativ
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ti
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Pre
fer
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2
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.
[2
9
]
X
.
L
u
,
Be
n
g
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a
n
d
R.
Z
h
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n
g
,
“
Im
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M
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0
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1
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[3
2
]
A
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it
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.
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.
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[3
3
]
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.
O.
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Aw
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.
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.
El
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.
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.
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4
]
Z.
A
h
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.
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n
,
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tes
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5
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p
.
1
0
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.
[3
5
]
M
.
Co
y
le,
K.
F
ra
n
c
is,
a
n
d
Y.
Ch
a
p
m
a
n
,
“
S
e
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f
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m
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g
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t
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c
ti
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it
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re
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m
a
ti
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lf
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m
a
n
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e
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t
a
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ti
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a
re
:
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s
y
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st
ra
li
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He
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Rev
iew
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l.
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4
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p
.
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3
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.
[3
6
]
S
.
R.
C
o
lb
e
rg
,
e
t
a
l.
,
“
P
h
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/ex
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tes
:
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p
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rica
n
d
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e
tes
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ss
o
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n
,
”
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b
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Ca
re
,
v
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l.
3
9
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.
11
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p
p
.
2
0
6
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9
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6
.
[3
7
]
S
.
Ch
ian
g
,
M
.
M
.
He
it
k
e
m
p
e
r,
Y.
Hu
n
g
,
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.
T
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.
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e
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a
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L
in
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ts
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a
1
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e
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l.
9
8
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o
.
36,
2
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.
[3
8
]
M
.
A
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e
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a
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.
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.
Ha
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,
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f
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r
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sp
it
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l
,
No
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Et
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Ad
v
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n
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s i
n
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rs
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n
g
,
v
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l.
2
0
1
6
,
2
0
1
6
.
[3
9
]
J.
Ba
g
o
n
z
a
,
E.
Ru
teb
e
m
b
e
r
w
a
,
a
n
d
W
.
Ba
z
e
y
o
,
“
A
d
h
e
re
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e
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ti
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iab
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ti
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m
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d
ica
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ti
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ts
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it
h
d
iab
e
tes
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a
ste
rn
Ug
a
n
d
a
;
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c
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o
ss
se
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ti
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n
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stu
d
y
,
”
BM
C
He
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D.
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