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1,
4]
.
A
ppr
o
xi
m
a
t
e
l
y
70
-
80
pe
r
c
e
n
t
o
f
pa
t
i
e
n
t
s
w
i
t
h
d
i
a
be
t
e
s
m
e
ll
i
t
u
s
d
i
e
d
o
f
v
a
s
c
u
l
a
r
d
i
s
e
a
s
e
a
s
a
c
o
m
p
l
i
c
a
t
i
o
n
o
f
d
i
a
b
e
t
e
s
[
2]
.
T
r
e
a
t
m
e
n
t
f
o
r
t
y
pe
2
d
i
a
b
e
t
e
s
s
h
o
u
l
d
b
e
c
o
n
du
c
t
e
d
i
n
a
s
us
t
a
i
n
a
bl
e
m
a
nn
e
r
f
o
r
a
l
o
n
g
pe
r
i
o
d.
P
a
t
i
e
n
t
s
w
i
t
h
t
y
p
e
2
d
i
a
b
e
t
e
s
c
a
n
t
a
ke
n
ot
o
nl
y
c
o
nv
e
n
t
i
o
n
a
l
m
e
d
i
c
i
ne
,
b
ut
a
l
s
o
c
o
m
p
l
e
m
e
n
t
a
r
y
m
e
d
i
c
i
ne
a
s
a
c
o
m
p
l
e
m
e
n
t
o
f
t
h
e
c
o
nve
n
t
i
o
na
l
t
r
e
a
t
m
e
n
t
s
t
h
a
t
h
a
v
e
be
e
n
c
a
r
r
i
e
d
o
ut.
T
h
e
r
e
i
s
a
t
e
n
d
e
n
c
y
gr
o
wi
ng
a
l
l
o
v
e
r
t
h
e
wo
r
l
d
t
h
a
t
pa
t
i
e
n
t
s
w
i
t
h
t
y
pe
2
d
i
a
b
e
t
e
s
us
e
o
r
c
h
o
o
s
e
C
o
m
p
l
e
m
e
n
t
a
r
y
a
n
d
A
l
t
e
r
n
a
t
i
v
e
M
e
d
i
c
i
ne
(
C
A
M
)
i
n
o
r
de
r
to
i
m
pr
o
v
e
t
h
e
i
r
h
e
a
l
t
h
s
t
a
t
us
.
C
o
m
p
l
e
m
e
n
t
a
r
y
m
e
d
i
c
i
ne
i
s
o
f
t
e
n
u
s
e
d
i
n
c
o
nj
u
n
c
t
i
o
n
w
i
t
h
c
o
n
v
e
n
t
i
o
n
a
l
m
e
d
i
c
i
ne
b
ut
n
o
t
a
s
a
s
u
b
s
t
i
t
ut
e
f
o
r
c
o
n
v
e
n
t
i
o
n
a
l
m
e
d
i
c
i
ne
.
M
e
a
n
w
hil
e
,
a
l
t
e
r
n
a
t
i
v
e
m
e
d
i
c
i
ne
is
us
e
d
a
s
r
e
p
l
a
c
e
m
e
n
t
o
f
c
o
nv
e
n
t
i
o
n
a
l
t
r
e
a
t
m
e
n
t
[4
-
8]
.
Of
t
h
e
pa
t
i
e
n
t
s
wh
o
s
u
f
f
e
r
f
r
o
m
c
h
r
o
ni
c
d
i
s
e
a
s
e
s
,
d
i
a
b
e
t
e
s
i
s
t
h
e
hi
g
h
e
s
t
C
AM
us
e
r
s
w
hi
c
h
a
r
e
63
%
,
f
o
l
l
o
we
d
by
42.
7%
o
f
R
A
,
2
6.
2%
o
f
HI
V,
a
n
d
7.
7%
o
f
e
p
i
l
e
p
s
y
[
9]
.
P
a
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
a
r
e
r
a
n
ke
d
a
s
t
h
e
s
e
c
o
n
d
f
o
r
C
A
M
u
s
e
r
s
,
whi
c
h
i
s
62.
1%
a
f
t
e
r
hy
pe
r
t
e
n
s
i
o
n
(
63.
8%
)
,
f
o
l
l
o
we
d
by
mi
gr
a
i
ne
,
c
h
r
o
ni
c
o
b
s
t
r
uc
t
i
v
e
d
i
s
e
a
s
e
,
ga
s
t
r
o
i
n
t
e
s
t
i
n
a
l
t
r
a
c
t
di
s
e
a
s
e
,
a
n
d
r
he
u
m
a
t
o
i
d
a
r
t
h
r
i
t
i
s
i
n
u
s
i
ng
C
A
M
[
10]
.
NC
C
I
H
c
a
t
e
gor
i
z
e
s
C
AM
i
n
t
o
t
h
r
e
e
m
a
i
n
do
m
a
i
ns
:
n
a
t
ur
a
l
pr
o
duc
t
s
,
m
i
nd
a
n
d
b
o
d
y
pr
a
c
t
i
c
e
s
,
a
n
d
o
t
h
e
r
c
o
m
p
l
e
m
e
n
t
a
r
y
h
e
a
l
t
h
a
ppr
o
a
c
h
e
s
.
Na
t
ur
a
l
pr
o
duc
t
s
i
n
c
l
ude
a
v
a
r
i
e
t
y
o
f
pr
o
duc
t
s
,
s
uc
h
a
s
h
e
r
b
s
(
a
l
s
o
k
n
o
wn
a
s
b
o
t
a
ni
c
a
l
s
)
,
vi
t
a
m
i
ns
a
n
d
m
i
ne
r
a
ls
,
a
n
d
pr
o
bi
o
t
i
c
s
.
T
h
e
y
a
r
e
w
i
de
ly
m
a
r
ke
t
e
d,
a
v
a
il
a
bl
e
to
c
o
n
s
u
m
e
r
s
,
a
n
d
o
f
t
e
n
s
o
l
d
a
s
a
d
i
e
t
a
r
y
s
upp
l
e
m
e
n
t
.
T
h
e
m
i
n
d
a
n
d
b
o
d
y
pr
a
c
t
i
c
e
s
i
n
c
l
ude
a
l
a
r
ge
a
n
d
d
i
v
e
r
s
e
gr
o
up
o
f
pr
o
c
e
dur
e
s
or
t
e
c
h
ni
que
s
t
h
a
t
a
r
e
gi
v
e
n
or
t
a
ugh
t
by
t
r
a
i
n
e
d
pr
a
c
t
i
t
i
o
ne
r
s
o
r
i
n
s
t
r
uc
tor
s
,
s
uc
h
a
s
:
y
o
ga
,
c
hi
r
o
pr
a
c
t
i
c
a
n
d
o
s
t
e
o
pa
t
hi
c
m
a
ni
pu
l
a
t
i
o
n
,
m
e
d
i
t
a
t
i
o
n
,
m
a
s
s
a
ge
t
h
e
r
a
p
y
,
a
c
upu
n
c
t
ur
e
,
a
n
d
r
e
l
a
x
a
t
i
o
n
t
e
c
h
ni
que
s
.
Ot
h
e
r
a
ppr
o
a
c
h
e
s
t
o
c
o
m
p
l
e
m
e
n
t
a
r
y
m
e
d
i
c
i
ne
c
o
m
pr
i
s
e
t
h
e
tr
a
di
t
i
o
n
a
l
m
e
d
i
c
i
ne
pr
a
c
t
i
c
e
s
,
Ay
ur
v
e
d
i
c
m
e
d
i
c
i
ne
,
C
hi
ne
s
e
t
r
a
di
t
i
o
n
a
l
m
e
d
i
c
i
ne
,
h
o
m
e
o
pa
t
hy
,
a
n
d
n
a
t
ur
o
pa
t
hy
[
11]
.
T
h
e
o
bj
e
c
t
i
v
e
s
o
f
t
his
a
r
t
i
c
l
e
a
r
e
t
o
(
a
)
D
e
t
e
r
m
i
ne
t
h
e
pr
e
v
a
l
e
n
c
e
,
s
u
mm
a
r
i
z
e
,
a
n
d
e
x
p
l
o
r
e
t
o
t
h
e
b
e
h
a
vi
o
r
o
f
us
i
ng
c
o
m
p
le
m
e
n
t
a
r
y
a
n
d
a
l
t
e
r
n
a
t
i
v
e
m
e
d
i
c
i
ne
i
nc
l
ud
i
ng:
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
,
pa
tt
e
r
n
s
,
t
y
pe
s
a
n
d
r
e
a
s
o
n
s
f
o
r
t
h
e
us
e
i
n
pa
t
i
e
n
t
s
w
i
t
h
t
y
pe
2
d
i
a
b
e
t
e
s
b
a
s
e
d
o
n
v
a
r
i
o
us
t
h
e
o
r
i
e
s
a
n
d
r
e
s
e
a
r
c
h
.
(
b
)
P
r
o
p
o
s
e
a
c
o
n
c
e
pt
ua
l
m
o
de
l
a
s
s
o
c
i
a
t
e
d
w
i
t
h
t
h
e
us
e
c
o
m
p
l
e
m
e
n
t
a
r
y
a
n
d
a
l
t
e
r
n
a
t
i
v
e
m
e
d
i
c
i
ne
by
pa
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
T
hi
s
li
t
e
r
a
t
ur
e
r
e
vi
e
w
w
a
s
s
e
a
r
c
h
e
d
by
us
i
n
g
a
n
e
l
e
c
t
r
o
ni
c
da
t
a
ba
s
e
s
uc
h
a
s
P
r
o
-
Que
s
t
,
Goo
gl
e
S
c
h
o
l
a
r
,
P
ub
M
e
d,
S
c
i
e
nc
e
-
D
i
r
e
c
t
,
a
n
d
h
a
n
d
-
s
e
a
r
c
hi
n
g.
T
h
e
li
t
e
r
a
t
ur
e
r
e
vi
e
w
u
s
e
d
a
r
e
a
r
t
i
c
l
e
s
publi
s
h
e
d
f
r
o
m
2005
-
2015.
K
e
y
wo
r
ds
us
e
d
to
s
e
a
r
c
h
we
r
e
c
o
m
p
l
e
m
e
n
t
a
r
y
a
n
d
a
l
t
e
r
n
a
t
i
v
e
m
e
d
i
c
i
ne
,
d
i
a
b
e
t
e
s
m
e
ll
i
t
us
,
t
r
a
d
i
t
i
o
na
l
m
e
d
i
c
i
ne
,
a
n
d
t
he
pa
tt
e
r
n
o
f
c
o
m
p
l
e
m
e
n
t
a
r
y
a
n
d
a
l
t
e
r
n
a
t
i
v
e
m
e
d
i
c
i
ne
.
L
i
t
e
r
a
t
ur
e
w
o
r
ks
c
o
l
l
e
c
t
e
d
we
r
e
a
s
m
a
n
y
a
s
28
0
a
bs
t
r
a
c
t
s
s
ub
s
e
qu
e
n
t
l
y
s
e
l
e
c
t
e
d
a
c
c
o
r
d
i
n
g
t
o
i
n
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
pr
e
s
e
t
to
c
o
m
p
i
l
e
t
hi
s
li
t
e
r
a
t
ur
e
r
e
vi
e
w.
T
he
i
n
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
i
n
t
hi
s
s
t
udy
we
r
e
s
t
ud
i
e
s
t
h
a
t
e
x
p
l
o
r
e
d
C
AM
us
e
by
d
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
publi
s
h
e
d
b
e
t
we
e
n
2
005
-
2015.
E
x
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
we
r
e
s
t
udi
e
s
publi
s
he
d
b
e
f
o
r
e
2005,
n
o
t
us
i
n
g
E
n
g
li
s
h
,
a
n
d
t
y
pe
s
o
f
qua
li
t
a
t
i
v
e
r
e
s
e
a
r
c
h
.
F
r
o
m
t
h
e
s
e
a
r
c
h
f
o
u
n
d
17
a
r
t
i
c
l
e
s
c
o
r
r
e
s
po
n
d
i
n
g
qua
n
t
i
t
a
t
i
v
e
r
e
s
e
a
r
c
h
.
T
h
e
r
e
vi
e
w
s
e
l
e
c
t
i
o
n
pr
o
c
e
s
s
c
a
n
be
s
e
e
n
i
n
F
i
gur
e
1.
F
i
gur
e
1.
S
e
l
e
c
t
i
o
n
pr
o
c
e
s
s
o
f
l
i
t
e
r
a
t
ur
e
r
e
vi
e
w
I
ni
ti
a
l
c
i
ta
ti
o
n
li
s
ts
f
r
o
m
a
ll
da
ta
ba
s
e
s
by
k
e
y
w
o
r
ds
, n =
280
e
xc
lu
de
d:
n
o
a
bs
tr
a
c
t,
in
it
ia
l
s
c
r
e
e
ni
ng
of
a
bs
tr
a
c
t
no
t
r
e
la
t
e
d t
o
C
A
M
, no
t
f
it
ti
ng k
e
y
t
e
r
ms
o
f
in
c
lu
s
i
o
n c
r
it
e
r
ia
, n =
218
F
ul
l
-
t
e
x
t
a
r
ti
c
l
e
s
a
s
s
e
s
s
e
d f
o
r
e
li
gi
bi
l
it
y
,
n =
62 (
in
de
p
e
nde
nt
l
y
)
E
xc
lu
d
e
d:
kua
li
ta
ti
f
s
tu
d
y
,
n
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3.
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4.
RE
S
UL
T
S
AN
D
AN
AL
YSI
S
4
.
1.
T
h
e
p
r
e
val
e
n
c
e
of
c
a
m
u
s
e
T
h
e
r
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s
u
l
t
s
o
f
t
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t
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h
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pr
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s
t
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g
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f
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m
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n
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o
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da
n
up
to
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i
n
t
h
e
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r
i
l
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n
gk
a
[
4,
8]
.
T
hi
s
v
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r
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due
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ny
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t
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ue
n
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ini
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o
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f
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AM
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n
d
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m
e
t
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us
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d
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s
e
a
r
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e
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s
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F
i
gur
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1
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o
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l
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n
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o
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M
f
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14
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o
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t
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l
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e
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A
M
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t
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be
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e
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s
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e
r
40%
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n
12
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o
un
t
r
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e
s
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o
t
h
a
t
i
t
c
a
n
b
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i
d
t
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t
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l
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f
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C
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M
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by
pa
t
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n
t
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h
d
i
a
b
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t
e
s
i
s
r
e
l
a
t
i
v
e
ly
hi
g
h
[
4
-
5
,
12
-
21]
.
T
h
e
pr
e
va
l
e
n
c
e
o
f
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AM
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s
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i
n
t
hi
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li
t
e
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t
ur
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t
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a
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t
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s
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s
f
r
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m
17%
up
to
72
.
8%
[
22]
.
4
.2
.
CA
M
u
s
e
p
a
t
t
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r
n
s
C
AM
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pa
t
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a
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a
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ng
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s
a
c
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p
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to
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nde
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ke
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h
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t
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s
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o
w
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by
d
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a
be
t
i
c
pa
t
i
e
n
t
s
a
r
e
:
(
a
)
M
o
s
t
l
y
,
C
A
M
i
s
u
s
e
d
i
n
c
o
nj
u
n
c
t
i
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w
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h
c
o
nv
e
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a
l
m
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d
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c
i
ne
/a
ll
o
pa
t
hy
.
(
b
)
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t
d
o
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s
n
o
t
c
h
a
n
ge
t
h
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i
r
tr
e
a
t
m
e
n
t
,
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ot
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n
t
h
e
t
r
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a
t
m
e
n
t
s
c
he
du
l
e
o
r
do
s
e
s
.
(
c
)
R
e
duc
i
n
g
o
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e
do
s
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o
r
m
o
r
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o
f
c
o
nv
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n
t
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o
n
a
l
t
r
e
a
t
m
e
n
t
.
(
d
)
U
s
i
n
g
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o
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e
n
t
i
o
n
a
l
m
e
d
i
c
i
ne
a
n
d
C
AM
i
n
d
if
f
e
r
e
n
t
t
i
m
e
s
,
a
n
d
(
e
)
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t
o
ppi
n
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t
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k
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t
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n
t
i
o
n
a
l
m
e
d
i
c
i
ne
w
h
e
n
u
s
i
ng
C
A
M
[
12
-
13
,
18
,
23
-
25]
.
D
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
,
m
o
s
t
us
e
C
AM
a
s
a
c
o
m
p
l
e
m
e
n
t
a
r
y
o
r
s
upp
l
e
m
e
n
t
a
r
y
t
o
t
h
e
i
r
c
o
nv
e
n
t
i
o
n
a
l
t
r
e
a
t
m
e
n
t
[
8
,
23
,
26
]
,
a
n
d
s
m
a
ll
pe
r
c
e
n
t
a
ge
us
e
C
AM
o
nl
y
[
8]
.
Di
a
b
e
t
i
c
pa
t
i
e
n
t
s
us
e
a
t
l
e
a
s
t
o
n
e
t
y
pe
o
f
C
A
M
m
o
da
li
t
i
e
s
,
o
r
c
o
m
bi
n
i
ng
t
w
o
o
r
m
o
r
e
o
f
t
h
e
C
AM
m
o
da
l
i
t
i
e
s
[
15
,
19
,
22
-
23]
.
Of
a
ll
p
a
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
in
S
r
i
L
a
n
ka
u
s
i
ng
C
AM
,
49
pa
t
i
e
n
t
s
us
e
d
o
n
e
t
y
p
e
o
f
C
AM
,
86
pa
t
i
e
n
t
s
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e
d
t
h
e
t
wo
t
y
pe
s
,
52
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e
d
t
h
r
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e
t
y
pe
s
,
a
n
d
6
pa
t
i
e
n
t
s
us
e
d
m
o
r
e
t
h
a
n
3
d
i
f
f
e
r
e
n
t
t
y
pe
s
[
4]
.
Ov
e
r
60%
o
f
p
a
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
w
h
o
us
e
d
C
AM
m
o
da
l
i
t
i
e
s
d
i
d
n
o
t
i
nf
o
r
m
t
h
e
i
r
do
c
tor
s
o
r
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
s
.
O
nly
24.
6%
-
45%
d
i
d
s
o
[
12
,
16
,
18
,
20
,
22
,
25
-
26]
.
S
o
m
e
o
ne
w
h
o
s
t
a
t
e
s
t
h
a
t
a
t
l
e
a
s
t
63%
o
f
t
h
e
ge
ne
r
a
l
po
pu
l
a
t
i
o
n
do
e
s
n
o
t
di
s
c
l
o
s
e
t
h
e
C
A
M
us
e
t
h
e
r
a
p
i
e
s
t
o
t
h
e
i
r
do
c
to
r
s
b
e
c
a
us
e
:
a
)
T
h
e
y
h
a
v
e
n
e
ve
r
t
h
o
ugh
t
o
f
i
t
.
b
)
T
h
e
y
f
e
e
l
t
h
e
C
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u
s
e
i
s
s
e
c
u
r
e
,
s
o
t
h
e
r
e
i
s
n
o
n
e
e
d
t
o
di
s
c
u
s
s
i
t
s
u
s
e
.
c
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e
a
l
t
h
c
a
r
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o
f
e
s
s
i
o
n
a
l
s
do
n
o
t
a
s
k
a
b
o
ut
t
h
e
i
r
us
i
ng
C
AM
.
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)
H
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
w
il
l
pr
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v
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n
t
t
h
e
C
A
M
us
e
.
e
)
T
h
e
r
e
i
s
n
o
t
e
n
o
ugh
t
i
m
e
to
di
s
c
us
s
t
h
e
C
AM
us
e
.
f
)
H
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
s
do
n
ot
h
a
v
e
a
de
qua
t
e
kn
o
w
l
e
d
ge
a
b
o
ut
C
AM
[
7,
13]
.
M
e
a
n
w
hil
e
,
pa
t
i
e
n
t
s
w
i
t
h
d
i
a
be
t
e
s
wh
o
i
nf
o
r
m
e
d
t
h
e
i
r
de
c
i
s
i
o
n
to
us
e
C
A
M
h
a
v
e
r
e
c
e
i
v
e
d
r
e
l
a
t
i
v
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ly
n
e
ga
t
i
v
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r
e
s
po
n
s
e
s
f
r
o
m
he
a
l
t
h
pr
o
f
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s
s
i
o
na
l
s
,
n
a
m
e
ly
a
)
T
he
y
s
t
a
t
e
t
h
a
t
i
t
i
s
e
n
t
i
r
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ly
pa
t
i
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n
t
s
b
us
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ne
s
s
a
n
d
o
f
f
e
r
s
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o
t
to
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o
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m
e
n
t
o
n
t
h
e
C
AM
u
s
e
.
b
)
T
h
e
y
wa
r
n
t
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(
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,
2006)
,
US
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104
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r
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p
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C
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=
60
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it
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,
2011)
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A
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im
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2006
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e
br
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e
f
or
e
:
22
.
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N
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74)
A
f
t
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r
:
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N
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197)
T
h
e
pr
e
v
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hs
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e
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c
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s
he
r
ba
l
m
e
di
c
in
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s
27.9%
,
nut
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l
s
uppl
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m
e
nt
41.1%
, di
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t
mo
di
f
ic
a
ti
o
n 13.2
%
, n
o
n
-
c
hi
n
e
s
he
r
bs
3.4%
, c
uppi
ng, s
c
r
a
pi
ng 6.4%
,
ma
ni
pul
a
ti
ve
-
ba
s
e
d t
h
e
r
a
p
y
13.5%
,
f
o
lk
th
e
r
a
pi
e
s
0.6%
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o
-
f
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ld
t
h
e
r
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9.2%
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o
-
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le
c
t
r
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ma
gne
ti
c
ba
s
e
d
th
e
r
a
pi
e
s
10.1%
, s
upe
r
na
tu
r
a
l
he
a
li
ngs
11.0%
, mi
nd
-
b
o
d
y
t
h
e
r
a
pi
e
s
3.7%
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W
a
z
a
i
f
y
,
e
t
al
., 2011)
,
J
o
r
da
n
1000
C
r
o
s
s
-
s
e
c
ti
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l
s
ur
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y
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m
s
a
mpl
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g
M
a
r
c
h
2009 to
S
e
pt
e
mb
e
r
2009
16.6%
N
=
166
F
=
99
M
=
67
NM
H
e
r
ba
l
93
.
4%
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e
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a
nt
s
i
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f
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i
o
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v
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s
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im
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al
.,
2011)
,
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o
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a
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K
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P
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.
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N
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677
F
=
290
M
=
387)
T
h
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li
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h,
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a
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a
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2012)
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ti
ni
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n
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r
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c
ti
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r
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m
s
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mpl
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g
A
ugus
t
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l
M
a
y
2011
51.9%
N
=
977
F
=
519
M
=
457
NM
T
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e
ma
in
h
e
r
b a
s
C
A
M
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r
ig
o
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e
ll
a
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r
y
th
e
a
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n=
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,
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o
s
ma
r
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f
i
c
in
a
li
s
13.5%
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n=
132)
,
T
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r
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m
c
a
pi
ta
tu
m 11.4
%
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n=
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in
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z
e
y
la
ni
c
um 10.8%
(
n=
105)
, o
th
e
r
s
pl
a
n 44.7%
(
n=
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O
th
e
r
C
A
M
mo
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li
t
ie
s
:
P
r
a
y
e
r
70
%
(
n=
684)
,
v
it
a
mi
ns
a
nd
mi
ne
r
a
l
9.9%
(
n=
97)
, e
xe
r
c
is
e
9.2%
(
n=
90)
, o
th
e
r
s
(
n=
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(
M
a
n
y
a
,
C
ha
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n
a
nd D
unni
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2012)
,
S
y
dn
e
y
69
A
c
r
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s
s
-
s
e
c
ti
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na
l
s
ur
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ta
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s
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s
ig
n
J
une
a
nd
A
ugus
t
2008
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N
=
32
F
=
15
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=
17
NM
T
h
e
m
o
s
t
c
o
mm
o
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A
M
t
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a
t
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a
b
e
t
e
s
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ul
ti
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it
a
mi
n 40%
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in
na
m
o
n 25%
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-
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n
z
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Q
10 25
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r
a
y
e
r
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o
th
e
r
s
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C
hi
ng
e
t
al
,
2013)
,
M
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la
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ia
240
A
c
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s
s
-
s
e
c
ti
o
na
l
s
tu
d
y
,
r
a
ndo
m
s
a
mpl
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g
me
th
o
d
M
a
y
2011
62.5%
N
=
150
F
=
96
M
=
54
NM
B
i
o
l
o
gi
c
a
l
ba
s
e
d t
h
e
r
a
p
y
l
ik
e
he
r
ba
l
pr
o
du
c
ts
80%
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n=
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, ma
ni
pul
a
ti
ve
a
nd bo
d
y
-
ba
s
e
d s
y
s
t
e
ms
14.7%
(
n=
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,
a
lt
e
r
na
ti
ve
m
e
di
c
a
l
s
y
s
te
m 7.3%
(
n=
11)
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n
e
r
g
y
t
h
e
r
a
pi
e
s
14%
(
n=
21)
,
mi
nd
-
b
o
d
y
i
nt
e
r
ve
nt
i
o
ns
2.7%
(
n=
4)
(
F
a
n
e
t
al
.,
2013)
,
S
in
ga
po
r
e
304
A
C
r
o
s
s
-
s
e
c
ti
o
na
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de
s
c
r
ip
ti
v
e
de
s
ig
n,
c
o
n
ve
ni
e
n
c
e
s
a
mpl
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g
NM
43.4%
N
=
132
F
=
67
M
=
64
NM
N
ut
r
it
i
o
na
l
s
uppl
e
m
e
nt
s
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n=
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C
hi
ne
s
e
h
e
r
ba
l
m
e
di
c
in
e
29.5
%
(
n=
39)
, ma
s
s
a
ge
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(
n=
37)
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M
it
ha
,
e
t
al
.,
201)
3,
M
a
la
y
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ia
256
C
r
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s
s
-
s
e
c
ti
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na
l
s
tu
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c
o
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ni
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n
c
e
s
a
mpl
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g
A
ugus
t
2012 to
O
c
t
o
b
e
r
2012
N
=
256
F
=
164
M
=
92
T
h
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s
t
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hs
T
C
M
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me
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M
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it
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a
li
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, N
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8806
In
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8,
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ugus
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N
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F
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M
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v
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s
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r
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v
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s
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a
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ia
r
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t
ic
ul
a
t
e
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,
f
e
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e
e
k 2
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n=
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N
a
ja
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e
t
al
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2014)
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C
r
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c
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ugus
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r
y
2011
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=
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l
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tu
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a
l
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du
c
t
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pi
r
it
ua
l
he
a
li
ng 11
.
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it
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mi
n a
nd
mi
n
e
r
a
l
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s
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mpu
r
e
t
al
., 2015)
,
I
r
a
ni
a
n
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C
r
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s
s
s
e
c
ti
o
na
l
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tu
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c
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ni
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nt
s
a
mpl
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g
J
une
t
o
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e
pt
e
mb
e
r
2011
75.3%
N
=
180
F
=
123
M
=
56
T
h
e
l
a
s
t
y
e
a
r
H
e
r
ba
l
pr
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pa
r
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ti
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ns
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,
c
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n=
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=
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t
a
mi
ns
a
n
d
mi
ne
r
a
l
s
)
,
a
n
d
mi
nd
b
o
d
y
t
h
e
r
a
p
i
e
s
[
7]
.
Ov
e
r
a
ll
,
T
a
bl
e
1
s
h
o
ws
t
h
e
t
y
p
e
s
o
f
C
AM
us
e
d
by
m
a
n
y
d
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
i
n
m
a
ny
c
o
un
tr
i
e
s
.
I
n
T
ur
ke
y
m
a
ny
u
s
e
s
h
e
r
b
a
l
pr
e
pa
r
a
t
i
o
n
s
s
uc
h
a
s
Or
iganum
v
ulga
r
e
,
po
m
e
gr
a
n
a
t
e
s
y
r
up,
s
t
i
ng
i
n
g
ne
tt
l
e
(
n
e
t
t
l
e
l
e
a
f
)
,
do
g
r
o
s
e
(
r
os
a
c
anina
)
,
C
he
r
vil
,
C
i
nna
m
o
n
,
a
n
d
bi
t
t
e
r
a
l
m
o
n
d
[
15]
.
I
n
B
a
h
r
a
i
n
,
t
h
e
na
t
ur
a
l
i
ngr
e
d
i
e
n
t
s
us
e
d
a
r
e
ga
r
l
i
c
,
bi
t
t
e
r
m
e
l
o
n
,
c
i
nn
a
m
o
n
,
a
n
d
f
e
n
ugr
e
e
k.
T
r
igonella
be
r
y
thea,
R
os
mar
ius
off
icinali
s
,
T
e
uc
r
ium
c
apit
atum
,
a
n
d
C
innamomun
z
e
y
lani
c
um
a
r
e
f
o
ur
m
a
i
n
h
e
r
bs
t
h
a
t
a
r
e
wi
de
ly
us
e
d
by
pa
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
i
n
P
a
l
e
s
t
i
n
e
,
o
ut
o
f
1
00
p
l
a
n
t
s
f
r
o
m
44
b
o
t
a
ni
c
a
l
f
a
m
il
i
e
s
.
I
n
S
y
d
n
e
y
,
h
e
r
b
s
u
s
e
d
a
r
e
c
i
nna
m
o
n
,
ga
r
l
i
c
,
gy
mne
na
s
lyv
e
s
te
,
f
e
n
ugr
e
e
k,
a
n
d
Am
e
r
i
c
a
n
g
i
ns
e
n
g.
He
r
b
u
s
e
d
i
n
M
a
l
a
y
s
i
a
is
bi
t
t
e
r
go
ur
d
,
c
a
t
’
s
whi
s
ke
r
s
,
ga
r
li
c
,
S
a
ba
h
s
n
a
ke
gr
a
s
s
,
b
a
s
i
l
l
e
a
f
,
a
n
d
g
i
ns
e
n
g.
B
i
t
t
e
r
g
o
ur
d,
c
r
e
pe
gi
n
ge
r
,
i
v
y
go
ur
d,
f
e
n
ugr
e
e
k,
a
n
d
Salacia
r
e
ti
c
ulat
e
a
r
e
h
e
r
b
s
us
e
d
by
pa
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
i
n
S
r
i
L
a
n
ka
.
I
n
I
r
a
nian
,
4
m
a
i
n
h
e
r
b
s
us
e
d
a
r
e
c
i
nn
a
m
o
n
,
g
i
n
ge
r
,
f
e
n
ugr
e
e
k,
a
n
d
c
ame
ll
ia
s
inens
i
s
.
F
r
o
m
t
h
e
s
e
s
t
ud
i
e
s
,
i
t
c
a
n
be
c
o
n
c
l
ude
d
t
h
a
t
t
h
e
m
o
s
t
w
i
d
e
ly
us
e
d
h
e
r
b
s
a
r
e
c
inn
a
m
o
n
,
ga
r
l
i
c
,
bi
t
t
e
r
go
u
r
d,
gi
ns
e
n
g,
f
e
n
ugr
e
e
k,
g
i
nge
r
,
a
n
d
a
n
d
n
ut
r
i
t
i
o
n
a
l
s
upp
l
e
m
e
n
t
s
[
4
-
5
,
15
-
16
,
18
-
19
,
23]
.
C
h
r
o
ni
c
d
i
s
e
a
s
e
s
,
s
uc
h
a
s
d
i
a
b
e
t
e
s
,
a
r
e
a
s
s
o
c
i
a
t
e
d
wi
t
h
de
c
r
e
a
s
i
ng
qua
li
t
y
o
f
l
if
e
,
a
n
d
ps
y
c
h
o
l
o
g
i
c
a
l
pr
o
bl
e
m
s
,
s
uc
h
a
s
a
nxi
e
t
y
a
n
d
de
pr
e
s
s
i
o
n
.
M
i
nd
-
b
o
d
y
t
h
e
r
a
p
i
e
s
h
a
v
e
a
ps
y
c
h
o
l
o
g
i
c
a
l
e
f
f
e
c
t
t
h
a
t
c
a
n
h
e
l
p
pa
t
i
e
n
t
s
c
o
pe
wi
t
h
t
h
e
d
i
s
e
a
s
e
a
n
d
i
m
pr
o
v
e
t
h
e
i
r
moo
d
a
n
d
qua
l
i
t
y
o
f
l
if
e
.
P
a
t
i
e
n
t
s
w
i
t
h
d
i
a
b
e
t
e
s
,
b
a
s
e
d
o
n
t
h
e
cl
i
n
i
c
a
l
t
r
i
a
l
s
,
h
a
v
e
s
h
o
w
n
i
m
pr
o
v
e
d
qua
li
t
y
o
f
l
if
e
a
n
d
s
t
r
e
s
s
r
e
duc
t
i
o
n
w
i
t
h
y
o
ga
a
n
d
t
a
i
c
hi
.
T
h
e
i
n
t
e
ns
i
t
y
o
f
y
o
ga
a
n
d
t
a
i
c
hi
pr
a
c
t
i
c
e
s
h
a
s
b
e
e
n
c
a
t
e
go
r
i
z
e
d
a
s
a
l
o
w
to
m
e
d
i
u
m
i
n
t
e
ns
i
t
y
.
Dur
i
n
g
t
h
e
c
li
n
i
c
a
l
t
r
i
a
l
s
w
i
t
h
c
o
n
t
r
o
l
s
,
e
i
t
h
e
r
y
o
ga
o
r
t
a
i
c
hi
c
o
n
s
i
s
t
e
n
t
l
y
s
h
o
ws
a
s
i
g
ni
f
i
c
a
n
t
l
o
n
g
-
t
e
r
m
im
pr
o
v
e
m
e
n
t
i
n
c
o
n
t
r
o
l
l
in
g
bl
o
o
d
g
l
uc
o
s
e
o
r
A
1C
[
7]
.
T
h
e
s
a
f
e
t
y
C
A
M
us
e
i
s
im
po
r
t
a
n
t
f
o
r
pa
t
i
e
n
t
s
w
h
o
t
a
ke
t
h
e
s
e
m
e
d
i
c
a
t
i
o
ns
,
a
s
w
e
l
l
a
s
f
o
r
h
e
a
l
t
h
c
a
r
e
pr
o
f
e
s
s
i
o
n
a
l
s
,
e
s
pe
c
i
a
ll
y
b
e
c
a
u
s
e
o
f
t
h
e
gr
o
w
i
n
g
po
pu
l
a
r
i
t
y
o
f
C
AM
u
s
e
by
d
i
a
b
e
t
i
c
s
.
A
c
o
ns
i
de
r
a
bl
e
pe
r
c
e
n
t
a
ge
o
f
d
i
a
b
e
t
e
s
pa
t
i
e
n
t
s
wh
o
us
e
d
C
AM
i
n
c
o
nj
u
nc
t
i
o
n
w
i
t
h
c
o
nve
n
t
i
o
na
l
m
e
d
i
c
i
ne
r
a
t
h
e
r
t
h
a
n
a
s
a
s
u
bs
t
i
t
u
t
e
.
T
hi
s
s
i
t
ua
t
i
o
n
a
l
l
o
w
s
f
o
r
s
i
de
e
f
f
e
c
t
s
i
n
t
e
r
a
c
t
i
o
ns
o
f
C
AM
w
i
t
h
m
e
d
i
c
a
l
t
r
e
a
t
m
e
n
t
,
s
o
t
hi
s
s
h
o
u
l
d
b
e
c
o
n
s
i
de
r
e
d
[
28]
.
4.
5
.
Re
s
ou
r
c
e
s
of
CA
M
T
h
e
i
nf
o
r
m
a
t
i
o
n
a
l
b
e
li
e
f
s
a
r
e
due
t
o
t
h
e
di
r
e
c
t
,
po
s
i
t
i
ve
e
x
pe
r
i
e
n
c
e
s
o
f
i
n
f
o
r
m
a
t
i
o
n
s
o
ur
c
e
s
a
b
o
ut
t
h
e
C
AM
us
e
.
I
nf
o
r
m
a
t
i
o
n
s
o
ur
c
e
s
a
b
o
ut
t
h
e
C
A
M
u
s
e
,
m
o
s
t
l
y
o
b
t
a
i
n
e
d
f
r
o
m
a
f
r
i
e
n
d,
a
r
e
s
h
o
wn
by
5
s
t
udi
e
s
,
n
a
m
e
ly
,
t
h
e
o
n
e
i
n
B
e
i
r
ut
,
a
n
o
t
h
e
r
i
n
S
i
n
g
a
po
r
e
(
57.
44%
)
,
a
n
ot
h
e
r
i
n
M
a
l
a
y
s
i
a
(
32.
1%
)
,
a
n
d
t
h
e
ot
h
e
r
i
n
I
n
d
i
a
(
36.
4%
)
[
5
,
13
,
20
,
26
-
27
]
.
M
e
a
n
w
hi
l
e
,
t
h
e
i
nf
o
r
m
a
t
i
o
n
s
o
ur
c
e
s
t
h
a
t
c
o
m
e
m
o
s
t
l
y
f
r
o
m
f
a
mi
li
e
s
a
r
e
s
h
o
w
n
by
3
s
t
ud
i
e
s
,
n
a
m
e
ly
,
o
n
e
s
t
ud
y
i
n
P
a
l
e
s
t
i
n
e
(
40.
2%
)
,
a
n
ot
h
e
r
i
n
J
o
r
da
n
(
41%
)
,
a
n
d
t
h
e
ot
h
e
r
in
T
a
i
wa
n
(
36%
)
[
18
,
21
-
22
]
.
O
t
h
e
r
s
o
u
r
c
e
s
o
f
i
nf
o
r
m
a
t
i
o
n
a
r
e
o
b
t
a
i
n
e
d
f
r
o
m
t
h
e
m
e
d
i
a
a
n
d
C
A
M
p
r
a
c
t
i
c
e
s
.
C
o
n
c
l
u
s
i
o
n
de
r
i
v
e
d
f
r
o
m
t
h
e
s
o
ur
c
e
s
o
f
i
nf
o
r
m
a
t
i
o
n
i
s
t
h
a
t
f
r
i
e
n
d
s
a
r
e
t
h
e
m
a
i
n
s
o
ur
c
e
o
f
i
nf
o
r
m
a
t
i
o
n
t
h
a
t
c
a
n
a
f
f
e
c
t
di
a
b
e
t
i
c
pa
t
i
e
n
t
s
to
us
e
C
A
M
.
4.
6
.
Re
as
on
f
or
u
s
in
g
CA
M
C
AM
us
e
r
s
e
x
pr
e
s
s
e
d
a
v
a
r
i
e
t
y
o
f
r
e
a
s
o
n
s
w
hy
t
h
e
y
a
r
e
us
i
ng
C
A
M
.
T
hi
s
l
i
t
e
r
a
t
ur
e
r
e
vi
e
w
w
il
l
o
u
t
l
i
ne
t
h
o
s
e
v
a
r
i
o
us
r
e
a
s
o
ns
.
D
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
’
r
e
a
s
o
n
s
o
n
us
i
ng
C
A
M
i
s
t
h
e
qua
li
t
y
a
n
d
s
a
f
e
t
y
o
f
C
A
M
(
63.
2%
)
,
a
n
a
dd
i
t
i
o
na
l
t
r
e
a
t
m
e
n
t
f
o
r
t
h
e
i
r
d
i
a
b
e
t
e
s
(
53.
5%
)
,
f
a
mi
ly
hi
s
t
o
r
y
i
n
us
i
ng
C
A
M
(
21
.
9%
)
,
f
e
we
r
s
i
d
e
e
f
f
e
c
t
s
o
f
C
AM
(
20.
2%
)
,
a
l
l
o
pa
t
hi
c
t
r
e
a
t
m
e
n
t
f
a
il
ur
e
(
16.
7%
)
,
a
n
d
s
o
m
e
o
t
h
e
r
r
e
a
s
o
n
s
[
26]
.
A
b
e
li
e
f
t
h
a
t
C
AM
c
a
n
c
o
n
t
r
o
l
d
i
a
be
t
e
s
,
t
h
e
goo
d
e
x
a
m
p
l
e
o
f
o
t
h
e
r
C
AM
us
e
r
s
,
t
h
e
e
a
s
e
o
f
ge
t
t
i
n
g
C
A
M
,
a
n
d
t
h
e
a
f
f
o
r
da
bl
e
pr
i
c
e
a
r
e
a
l
s
o
t
h
e
r
e
a
s
o
n
s
f
o
r
d
i
a
be
t
i
c
pa
t
i
e
n
t
s
to
us
e
C
A
M
[
5]
.
T
h
e
d
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
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[
22]
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5.
DI
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[
22
,
29]
.
P
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us
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C
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.
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NC
C
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(
2015)
s
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f
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[
20
,
22]
.
T
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C
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[5
,
26
-
27
,
30
]
.
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F
i
gur
e
2.
F
a
c
t
o
r
s
o
f
s
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c
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a
l
s
uppo
r
t
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n
d
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dua
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be
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pa
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w
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C
AM
o
r
n
o
t
[
22
]
.
I
t
i
s
g
e
n
e
r
a
l
ly
be
li
e
v
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d
t
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h
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v
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po
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ve
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vi
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r
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d
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duc
t
a
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f
f
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n
d
c
h
r
o
ni
c
d
i
s
e
a
s
e
s
[
31]
.
F
a
mi
ly
s
up
po
r
t
a
l
s
o
i
n
f
l
u
e
n
c
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s
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p
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h
oo
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d
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ne
o
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t
h
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y
pe
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o
f
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c
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t
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h
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m
a
ni
pu
l
a
t
i
o
n
o
f
t
h
e
b
o
d
y
[
32]
.
F
a
mi
ly
s
uppo
r
t
f
o
r
T
2DM
pa
t
i
e
n
t
s
w
h
o
us
e
h
e
r
b
s
i
s
to
gi
v
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pe
r
m
i
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o
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us
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h
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r
b
s
,
r
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m
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nd
t
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m
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o
f
h
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r
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l
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pr
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de
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h
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r
b
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pr
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pa
r
a
t
i
o
n
s
[
33]
.
P
e
o
pl
e
w
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t
h
po
s
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t
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ve
a
t
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t
ude
s
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C
A
M
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w
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t
h
hi
g
h
f
a
m
il
y
s
up
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t
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m
o
r
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ke
ly
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[
34
]
.
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[
34
].
7.
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