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C
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Diab
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m
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lit
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Diab
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f
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ca
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Hea
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b
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CC B
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C
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p
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A
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:
An
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J
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elian
ti
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Dep
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m
en
t o
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s
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P
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litek
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h
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J
l.
Ma
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j
en
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.
P
r
o
f
.
Dr
.
Mo
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p
o
No
8
C
Su
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ab
a
y
a,
I
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d
o
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E
m
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a
n
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p
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k
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s
-
s
b
y
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Diab
etes
m
el
lit
u
s
(
DM
)
is
a
co
m
p
le
x
ch
r
o
n
ic
d
is
ea
s
e
t
h
at
r
eq
u
ir
es
o
n
g
o
i
n
g
m
ed
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ca
r
e
w
it
h
a
m
u
lti
f
ac
to
r
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r
is
k
r
ed
u
ctio
n
s
tr
ateg
y
b
e
y
o
n
d
g
l
y
ce
m
ic
co
n
tr
o
l.
T
h
is
d
is
ea
s
e
r
eq
u
ir
es
o
n
g
o
i
n
g
p
atien
t
s
el
f
-
m
an
a
g
e
m
e
n
t
to
p
r
ev
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n
t
ac
u
te
co
m
p
lica
tio
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s
a
n
d
r
ed
u
ce
t
h
e
r
is
k
o
f
lo
n
g
-
ter
m
co
m
p
l
icatio
n
s
[
1
]
.
T
h
e
n
u
m
b
er
o
f
p
eo
p
le
w
it
h
DM
at
th
e
a
g
e
o
f
2
0
-
7
9
in
I
n
d
o
n
e
s
ia
i
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2
0
1
7
is
s
i
x
t
h
i
n
th
e
w
o
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ld
,
a
n
d
is
e
x
p
ec
ted
to
d
ec
lin
e
to
b
e
r
an
k
ed
s
ev
en
t
h
in
2
0
4
5
[
2
]
.
T
h
e
p
r
ev
alen
ce
o
f
DM
d
iag
n
o
s
ed
b
y
d
o
cto
r
s
at
th
e
ag
e
o
f
m
o
r
e
t
h
an
1
5
y
ea
r
s
in
2
0
1
3
-
2
0
1
8
in
E
ast
J
av
a
is
2
.
6
%
an
d
is
r
an
k
ed
f
i
f
t
h
in
I
n
d
o
n
esia
[
3
]
,
w
h
ile
t
h
e
p
r
ev
alen
ce
o
f
DM
in
th
e
cit
y
o
f
Su
r
ab
a
y
a
i
s
4
.
3
%
an
d
is
r
an
k
ed
s
i
x
t
h
in
E
a
s
t
J
av
a
[
4
]
T
h
e
r
esp
o
n
s
e
o
f
t
y
p
e
2
d
iab
etes
m
elli
tu
s
(
T
2
DM
)
p
atien
ts
w
h
e
n
s
u
f
f
er
in
g
f
r
o
m
i
lln
es
s
w
a
s
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k
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n
g
tr
ea
t
m
e
n
t
s
u
ch
as
m
ed
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tr
ea
t
m
e
n
t
o
r
c
o
m
p
le
m
e
n
tar
y
an
d
alter
n
ati
v
e
m
ed
ici
n
e
[
5
]
.
T
h
e
p
r
ev
alen
ce
o
f
DM
p
atien
ts
u
s
i
n
g
h
er
b
al
alter
n
ati
v
e
m
ed
i
cin
e
in
I
n
d
o
n
e
s
ia
is
3
5
.
7
%,
w
h
ile
i
n
E
ast
J
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v
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is
2
8
.
4
%.
9
%
DM
p
atie
n
ts
d
o
n
o
t
tak
e
a
n
ti
-
d
iab
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m
e
d
icatio
n
r
eg
u
lar
l
y
,
b
ec
au
s
e
5
0
.
4
%
f
ee
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h
ea
lt
h
y
,
2
5
.
3
%
tak
e
tr
ad
itio
n
al
m
ed
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in
e,
an
d
1
2
.
6
%
ca
n
n
o
t
s
ta
n
d
th
e
s
i
d
e
ef
f
ec
t
s
o
f
m
ed
ical
d
r
u
g
s
[
3
]
.
T
h
is
co
n
d
itio
n
ca
n
lead
to
an
in
cr
ea
s
e
in
b
lo
o
d
g
lu
co
s
e
lev
e
ls
w
h
ic
h
ca
n
tr
i
g
g
er
co
m
p
lica
tio
n
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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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
.
2
,
J
u
n
e
20
21
:
265
–
271
266
C
o
m
p
le
m
en
tar
y
a
n
d
al
ter
n
ati
v
e
m
ed
ici
n
e
(
C
AM
)
t
h
at
ar
e
w
id
el
y
u
s
ed
b
y
T
2
DM
p
atien
t
s
ar
e
h
er
b
s
[6
]
,
[
7]
.
Ma
n
y
p
eo
p
le
w
it
h
d
ia
b
etes u
s
e
co
m
p
le
m
en
tar
y
m
ed
icin
e
(
to
g
et
h
er
w
it
h
)
o
r
alter
n
a
tiv
e
m
ed
icin
e
(
as a
s
u
b
s
t
itu
te)
w
it
h
co
n
v
e
n
tio
n
al
tr
ea
t
m
e
n
ts
f
o
r
d
iab
etes.
T
h
e
u
s
e
o
f
h
er
b
s
n
ee
d
s
to
co
n
s
i
d
er
asp
ec
ts
o
f
t
h
e
ef
f
icac
y
an
d
s
af
e
t
y
o
f
tr
ea
t
m
en
t.
T
h
er
e
is
in
s
u
f
f
icie
n
t
e
v
i
d
en
ce
to
m
ak
e
r
ec
o
m
m
en
d
at
io
n
s
r
e
g
ar
d
in
g
t
h
e
ef
f
icac
y
a
n
d
s
af
et
y
o
f
co
m
p
l
e
m
en
tar
y
o
r
alter
n
ativ
e
m
ed
i
cin
e
f
o
r
in
d
i
v
id
u
al
s
w
ith
d
ia
b
etes
[
8
]
.
I
n
ce
r
tain
E
aster
n
a
n
d
et
h
n
ic
c
u
lt
u
r
es,
C
A
M
tr
ea
t
m
e
n
t
p
la
y
s
an
in
te
g
r
al
p
ar
t
i
n
a
n
i
n
d
iv
id
u
al
's
h
ea
lth
b
elie
f
s
y
s
te
m
,
w
h
er
e
r
eli
g
io
u
s
teac
h
in
g
s
,
r
it
u
als,
a
n
d
f
a
m
il
y
in
f
l
u
e
n
ce
s
p
l
a
y
a
m
aj
o
r
r
o
le
in
an
i
n
d
i
v
id
u
al's
h
ea
lth
b
eh
a
v
io
r
[
9
]
.
Diab
etics
ten
d
to
u
s
e
h
e
r
b
al
r
em
ed
ies
to
m
in
i
m
ize
d
is
s
ati
s
f
ac
tio
n
w
it
h
co
n
v
e
n
tio
n
al
th
er
ap
ies,
t
h
eir
co
n
ce
r
n
s
ab
o
u
t
p
o
s
s
ib
le
s
id
e
e
f
f
ec
ts
ca
u
s
ed
b
y
co
n
v
e
n
tio
n
al
th
er
ap
ies,
an
d
b
eliev
e
t
h
at
h
er
b
al
r
em
ed
ies
f
r
o
m
n
atu
r
al
s
o
u
r
ce
s
ar
e
s
af
er
an
d
m
o
r
e
e
f
f
ec
t
iv
e
[
7
]
.
C
o
m
p
le
m
e
n
tar
y
m
ed
icin
e
h
a
s
b
ee
n
ap
p
lied
to
h
ea
lth
s
er
v
ices
in
t
h
e
ci
t
y
o
f
Su
r
ab
a
y
a
w
h
ic
h
alr
ea
d
y
h
a
v
e
a
tr
ad
itio
n
al
m
ed
icin
e
cli
n
ic,
n
a
m
e
l
y
in
2
0
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
(
P
u
s
ke
s
ma
s
)
a
n
d
at
th
e
Dr
.
So
eto
m
o
Ge
n
er
al
Ho
s
p
ital,
Su
r
ab
a
y
a.
T
h
e
h
ea
lth
s
er
v
ices
p
r
o
v
id
ed
ar
e
s
o
cializa
tio
n
o
n
t
h
e
u
s
e
o
f
h
er
b
s
,
ac
u
p
u
n
c
tu
r
e
an
d
ac
u
p
r
ess
u
r
e
[
1
0
]
.
I
n
d
iv
id
u
a
l
h
ea
l
th
b
elie
f
s
th
at
in
cl
u
d
e:
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
a
n
d
s
e
v
er
it
y
,
b
e
n
ef
its
,
b
ar
r
ier
s
o
f
b
eh
av
io
r
,
an
d
s
el
f
-
e
f
f
icac
y
,
h
er
e
in
a
f
ter
r
e
f
er
r
ed
to
as
t
h
e
h
ea
lt
h
b
elie
f
s
m
o
d
el
(
HB
M)
co
n
s
tr
u
ct
[
1
1
]
.
I
n
r
elatio
n
to
t
h
e
u
s
e
o
f
C
A
M,
c
o
n
s
tr
u
ct
s
o
f
p
er
ce
p
tio
n
s
o
f
b
e
n
ef
its
an
d
b
ar
r
ier
s
s
h
o
w
a
s
tat
is
ticall
y
s
ig
n
i
f
ica
n
t
r
elatio
n
s
h
ip
w
it
h
u
s
e
o
f
C
A
M
[
1
2
]
.
Diab
etes
s
elf
-
ca
r
e
i
s
a
f
o
r
m
o
f
s
e
lf
-
ca
r
e
b
eh
a
v
io
r
th
at
m
u
s
t
b
e
u
n
d
er
tak
e
n
b
y
T
2
DM
p
atien
ts
to
r
eg
u
late
th
eir
b
lo
o
d
s
u
g
ar
lev
el
s
[1
]
,
[
13]
.
T
h
e
p
r
o
b
lem
o
f
te
n
ex
p
e
r
ien
ce
d
b
y
T
2
DM
p
atien
ts
is
th
at
t
h
e
y
ca
n
n
o
t
ca
r
r
y
o
u
t
r
o
u
tin
e
d
iab
etes
s
elf
-
c
ar
e.
T
h
e
m
aj
o
r
ity
o
f
d
iab
etic
p
atien
ts
h
ad
a
p
o
o
r
s
co
r
e
o
f
s
elf
-
ca
r
e
an
d
th
er
e
w
er
e
p
er
ce
p
tio
n
s
th
at
d
iab
etes
s
elf
-
ca
r
e
is
d
if
f
icu
l
t
[
1
4
]
,
[
1
5
]
.
P
eo
p
le
w
it
h
T
2
D
M
as
a
ch
r
o
n
i
c
d
is
ea
s
e
also
h
a
v
e
a
ten
d
en
c
y
to
s
ee
k
o
t
h
er
tr
ea
t
m
e
n
ts
b
esid
es
m
ed
ical
tr
ea
t
m
en
t,
s
u
c
h
as
u
s
in
g
h
er
b
s
.
T
2
DM
p
atien
ts
b
eliev
e
d
th
at
u
s
i
n
g
a
co
m
b
i
n
atio
n
o
f
co
n
v
e
n
tio
n
al
a
n
d
tr
ad
itio
n
al
m
ed
icin
e
s
w
as
m
o
r
e
ef
f
ec
tiv
e
th
a
n
u
s
i
n
g
eit
h
er
t
y
p
e
o
f
m
ed
ici
n
e
alo
n
e
[
1
6
]
.
Qu
alitativ
e
r
e
s
ea
r
ch
co
n
d
u
cted
at
Dr
.
Su
to
m
o
Ge
n
er
al
Ho
s
p
ital
Su
r
ab
a
y
a
s
h
o
w
ed
th
e
r
esu
lt
s
th
a
t
T
2
DM
p
atien
ts
h
ad
n
o
t
b
ee
n
ab
le
to
d
o
d
iab
etes
s
elf
-
ca
r
e
r
eg
u
lar
l
y
an
d
i
n
t
h
e
a
s
p
ec
t
o
f
tr
ea
t
m
en
t,
p
ar
ticip
an
ts
u
s
ed
h
er
b
s
to
m
an
a
g
e
th
e
ir
d
is
ea
s
e
as
a
co
m
p
a
n
io
n
to
m
ed
ical
tr
ea
t
m
e
n
t
[
1
7
]
.
T
h
is
s
tu
d
y
i
n
te
g
r
ate
d
th
e
b
eh
a
v
io
r
o
f
u
s
i
n
g
h
er
b
s
in
s
elf
-
ca
r
e
f
o
r
T
2
DM
p
atien
ts
.
T
h
is
in
t
eg
r
atio
n
is
ca
r
r
ied
o
u
t
b
ec
au
s
e
T
2
DM
p
a
tien
t
s
w
h
o
h
a
v
e
a
h
ab
it
o
f
u
s
i
n
g
h
er
b
al
m
ed
icin
e
h
av
e
n
o
t
r
o
u
tin
el
y
p
er
f
o
r
m
ed
d
iab
etes sel
f
-
ca
r
e
b
e
h
av
io
r
s
a
n
d
ten
d
to
ab
a
n
d
o
n
co
n
v
e
n
tio
n
al
m
ed
ici
n
e
w
h
en
co
n
s
u
m
i
n
g
h
er
b
al
m
ed
icin
e,
s
o
th
is
r
esear
c
h
n
ee
d
s
to
b
e
ca
r
r
i
ed
o
u
t,
to
in
cr
ea
s
e
th
e
co
m
p
li
an
ce
o
f
T
2
DM
p
atien
ts
in
ca
r
r
y
in
g
o
u
t
d
iab
etes
s
elf
-
ca
r
e.
Ma
n
y
f
ac
to
r
s
a
f
f
ec
t
th
e
s
el
f
-
ca
r
e
b
eh
a
v
io
r
o
f
T
2
DM
p
atien
t
s
u
s
i
n
g
h
er
b
s
,
i
n
clu
d
i
n
g
i
n
d
iv
id
u
al
h
ea
lt
h
b
elie
f
s
.
Her
b
al
r
e
m
ed
ie
s
ar
e
b
eliev
ed
to
b
e
a
b
etter
c
h
o
ice
th
a
n
s
y
n
t
h
etic
d
r
u
g
s
b
ec
au
s
e
o
f
t
h
eir
f
e
w
er
s
id
e
ef
f
ec
ts
a
n
d
to
x
ic
ef
f
ec
t
s
.
Her
b
al
f
o
r
m
u
la
tio
n
s
ar
e
ea
s
y
t
o
o
b
tain
w
it
h
o
u
t a
d
o
cto
r
'
s
p
r
e
s
cr
ip
tio
n
[
1
8
]
.
T
h
is
s
tu
d
y
ai
m
ed
to
ex
p
lo
r
e
h
ea
lth
b
elief
s
as
a
p
r
ed
icto
r
o
f
th
e
b
eh
av
io
r
o
f
u
s
i
n
g
h
er
b
al
m
ed
icin
e
as
a
co
m
p
le
m
e
n
t
to
s
el
f
-
ca
r
e
i
n
T
2
DM
p
atien
ts
,
esp
ec
iall
y
i
n
th
e
a
s
p
ec
t
o
f
tr
ea
t
m
e
n
t,
s
o
as
to
o
p
tim
ize
t
h
e
r
eg
u
lat
io
n
o
f
b
lo
o
d
g
lu
co
s
e
lev
els.
Hea
lt
h
b
elie
f
s
t
h
at
w
i
ll
b
e
ex
p
lo
r
ed
ar
e
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
a
n
d
s
ev
er
it
y
,
p
er
ce
iv
ed
b
en
ef
i
ts
,
p
er
ce
iv
ed
b
ar
r
ier
s
,
an
d
p
e
r
ce
iv
ed
s
el
f
-
e
f
f
icac
y
w
h
ic
h
ar
e
co
m
p
o
n
e
n
t
s
o
f
t
h
e
Hea
lth
B
elie
f
s
M
o
d
el.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
r
esear
ch
w
a
s
an
o
b
s
er
v
atio
n
al
an
al
y
tic
s
tu
d
y
w
it
h
a
cr
o
s
s
s
ec
tio
n
al
ap
p
r
o
ac
h
w
h
ich
w
a
s
co
n
d
u
cted
b
et
w
ee
n
Ma
y
a
n
d
Octo
b
er
2
0
1
6
o
n
2
3
0
r
e
s
p
o
n
d
en
ts
.
T
h
e
r
esear
ch
lo
ca
tio
n
s
w
er
e
s
e
v
en
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
(
P
u
s
ke
s
ma
s
)
S
u
r
ab
a
y
a,
E
ast
J
av
a,
I
n
d
o
n
esia,
w
h
ic
h
w
as
r
an
d
o
m
l
y
s
elec
ted
,
in
cl
u
d
in
g
:
J
e
m
u
r
s
ar
i,
Kep
u
ti
h
,
Me
d
o
k
an
Ay
u
,
P
u
ca
n
g
S
e
w
u
,
T
am
b
ak
R
ej
o
,
T
an
ah
Kali
Ked
in
d
in
g
,
an
d
T
en
g
g
ili
s
.
T
h
e
co
m
m
u
n
it
y
h
e
alth
ce
n
ter
s
(
P
u
s
ke
s
ma
s
)
p
r
o
v
id
es
tr
ad
itio
n
al
m
ed
ical
s
er
v
i
ce
s
.
T
h
e
s
am
p
le
i
n
th
is
s
tu
d
y
w
er
e
T
2
DM
s
u
f
f
e
r
er
s
w
h
o
h
ad
b
ee
n
cli
n
icall
y
d
iag
n
o
s
ed
w
ith
T
2
DM
,
r
ec
eiv
ed
co
n
v
e
n
tio
n
a
l
tr
ea
t
m
e
n
t
an
d
u
s
ed
h
er
b
s
as
a
co
m
p
le
m
en
tar
y
tr
ea
t
m
e
n
t
wh
o
v
is
i
ted
th
e
P
u
s
ke
s
ma
s
.
T
h
e
in
clu
s
io
n
cr
iter
ia
estab
lis
h
ed
w
er
e
p
atie
n
ts
w
h
o
h
ad
T
2
DM
f
o
r
m
o
r
e
t
h
an
o
n
e
y
ea
r
,
w
er
e
i
n
s
tab
le
co
n
d
itio
n
,
ag
ed
b
et
w
ee
n
3
0
an
d
7
0
y
ea
r
s
,
a
n
d
u
s
ed
h
er
b
s
f
o
r
at
least
t
w
o
m
o
n
t
h
s
o
r
m
o
r
e
.
T
h
e
d
ata
w
a
s
co
llected
u
s
i
n
g
a
q
u
esti
o
n
n
a
ir
e
co
n
s
is
ti
n
g
o
f
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
i
s
tics
(
8
i
n
d
icato
r
s
:
ag
e,
s
ex
,
et
h
n
icit
y
,
m
o
n
t
h
l
y
f
a
m
i
l
y
i
n
co
m
e,
ed
u
ca
tio
n
,
o
cc
u
p
atio
n
,
r
elig
io
n
)
,
d
is
ea
s
e
ch
ar
ac
ter
is
tics
(
5
in
d
icato
r
s
:
co
m
p
lica
tio
n
,
co
m
p
lain
t,
d
u
r
atio
n
o
f
ill
n
ess
,
h
er
ed
itar
y
o
f
D
M,
d
r
u
g
)
,
h
ea
lt
h
b
elief
s
(
4
i
n
d
icato
r
:
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
a
n
d
s
ev
er
it
y
,
p
er
ce
i
v
ed
b
en
e
f
it,
p
er
ce
iv
ed
b
ar
r
ier
,
p
er
ce
iv
ed
s
elf
-
ef
f
icac
y
)
,
a
n
d
u
s
i
n
g
h
er
b
s
as
a
co
m
p
le
m
en
t
d
iab
etes
s
el
f
-
ca
r
e
(
5
in
d
icato
r
:
d
ie
t
r
eg
u
latio
n
,
ac
tiv
i
ties
a
n
d
e
x
er
cise,
m
o
n
ito
r
in
g
b
lo
o
d
s
u
g
ar
le
v
el,
Me
d
icatio
n
ad
h
er
e
n
ce
a
n
d
u
s
i
n
g
h
er
b
s
,
b
eh
av
io
r
to
r
ed
u
ce
d
co
m
p
l
icatio
n
s
r
is
k
)
.
T
h
e
v
alid
it
y
a
n
d
r
eliab
ilit
y
o
f
th
e
in
d
icato
r
s
w
er
e
m
ea
s
u
r
ed
b
y
co
n
v
er
g
e
n
t
v
alid
it
y
(
lo
a
d
in
g
f
ac
to
r
>
0
.
5
)
,
d
is
cr
i
m
i
n
an
t
v
alid
it
y
u
s
in
g
a
s
q
u
ar
e
r
o
o
t
o
f
av
er
ag
e
ex
tr
ac
ted
(
A
VE
)
v
alu
e
>
0
.
5
0
an
d
co
m
p
o
s
it
e
r
eliab
ilit
y
w
it
h
a
v
a
lu
e
o
f
≥
0
.
7
.
I
n
d
icato
r
s
th
at
d
o
n
o
t
m
e
e
t th
i
s
v
al
u
e
ar
e
ex
clu
d
ed
f
r
o
m
t
h
e
co
n
s
tr
u
ct
o
r
v
ar
iab
le.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
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269
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4
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H
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2
DM
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T
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A
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P
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d
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ca
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I
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ev
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y
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p
to
m
s
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m
p
lica
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s
[
1
9
]
.
T
h
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p
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th
r
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(
v
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ca
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f
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also
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[
2
0
]
,
[
21]
.
I
n
d
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id
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s
as
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M
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DM
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to
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A
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n
d
h
av
e
g
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s
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s
[
1
2
]
.
P
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elief
s
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[
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2
]
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Self
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h
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in
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h
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cc
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D
M
ar
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f
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h
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tr
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n
g
e
s
t p
r
ed
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r
o
f
s
elf
-
ca
r
e
b
eh
av
io
r
[
2
3
]
,
[
2
4
]
.
T
h
e
r
esu
lts
o
f
t
h
is
s
t
u
d
y
i
n
d
ic
ate
th
at
p
atie
n
t
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h
ar
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ter
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tic
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s
u
c
h
as
a
g
e,
f
a
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u
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s
,
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h
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is
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d
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o
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e
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ac
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s
t
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at
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e
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ciate
d
w
ith
th
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h
ea
l
th
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o
f
t
h
e
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2
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M
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atien
t.
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h
e
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lts
o
f
o
t
h
er
s
tu
d
ies
s
h
o
w
ed
th
at
all
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ed
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o
f
ag
e,
s
ex
,
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u
r
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m
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f
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e
m
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er
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th
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t
y
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o
f
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m
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f
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m
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licatio
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s
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er
e
s
t
atis
ticall
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i
g
n
if
ican
t
i
n
a
s
s
o
c
iatio
n
w
it
h
p
atien
t
b
elief
s
[
2
5
]
.
3
.
5
.
T
he
u
s
e
o
f
herbs
a
s
co
m
ple
m
e
nt
dia
bet
es self
-
ca
re
T
h
e
b
eh
av
io
r
o
f
u
s
i
n
g
h
er
b
s
a
s
a
co
m
p
le
m
en
t
to
d
iab
etes
s
e
lf
-
ca
r
e
in
th
e
a
s
p
ec
t
o
f
tr
ea
t
m
en
t
a
f
f
ec
t
s
th
e
r
e
g
u
la
tio
n
o
f
b
lo
o
d
s
u
g
ar
lev
el
s
.
P
atien
t
s
'
b
e
h
av
io
r
i
n
m
an
a
g
i
n
g
t
h
eir
d
iet,
ac
t
iv
i
ties
an
d
tr
ai
n
i
n
g
,
s
el
f
-
m
o
n
ito
r
i
n
g
s
u
g
ar
le
v
els,
m
ed
i
ca
tio
n
ad
h
er
en
ce
,
w
er
e
m
o
s
tl
y
q
u
ite
g
o
o
d
.
W
h
ile
th
e
b
e
h
a
v
io
r
o
f
r
ed
u
ci
n
g
t
h
e
r
is
k
o
f
co
m
p
licatio
n
s
is
s
till
m
o
s
tl
y
g
o
o
d
.
Dietar
y
r
eg
u
la
ti
o
n
in
DM
p
atien
t
s
is
th
e
m
a
in
ele
m
e
n
t
i
n
DM
m
an
a
g
e
m
e
n
t,
w
h
ic
h
i
n
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u
d
es
r
eg
u
lat
io
n
i
n
ter
m
s
o
f
n
u
m
b
er
o
f
m
ea
ls
,
m
ea
l
s
c
h
ed
u
les
a
n
d
t
y
p
es
o
f
f
o
o
d
[
2
6
]
,
[
27]
.
T
h
e
r
esu
lts
o
f
th
i
s
s
tu
d
y
i
n
d
icate
th
a
t
s
el
f
-
ca
r
e
b
eh
a
v
io
r
in
T
2
DM
p
atien
ts
u
s
in
g
h
er
b
s
is
s
till
lo
w
.
P
ati
en
ts
h
a
v
e
n
o
t
b
ee
n
ab
le
to
ca
r
r
y
o
u
t
d
iet,
ac
tiv
it
y
,
b
lo
o
d
s
u
g
ar
m
o
n
i
to
r
in
g
,
a
n
d
m
e
d
icatio
n
ad
h
er
en
ce
r
eg
u
lar
l
y
.
P
atien
t
s
co
n
s
id
er
t
h
at
m
ed
ical
tr
ea
t
m
e
n
t
ca
n
ca
u
s
e
co
m
p
licatio
n
s
b
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au
s
e
t
h
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y
co
n
tain
ch
e
m
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s
,
w
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ile
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er
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al
m
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s
co
n
s
id
er
ed
to
co
n
tain
n
at
u
r
al
i
n
g
r
ed
ien
ts
w
h
ic
h
ar
e
s
a
f
er
t
h
an
m
ed
ical
tr
ea
t
m
e
n
t,
s
o
th
at
p
atie
n
t
s
lea
v
e
m
ed
ical
tr
ea
t
m
e
n
t
a
n
d
d
o
n
o
t
ca
r
r
y
o
u
t
r
eg
u
lar
s
el
f
-
ca
r
e.
T
2
DM
p
atien
t
s
u
s
ed
h
er
b
al
m
ed
icin
e
co
m
b
i
n
ed
w
ith
m
ed
i
ca
tio
n
,
s
o
m
e
o
f
th
e
m
m
ad
e
ch
an
g
e
s
to
th
eir
tr
ea
t
m
e
n
t
w
ith
o
u
t
r
ep
o
r
tin
g
to
th
e
d
o
cto
r
w
h
o
p
r
o
v
id
es
th
er
ap
y
[
2
8
]
,
[
2
9
]
.
Mo
s
t
p
atien
ts
d
id
n
o
t
co
n
s
u
lt
a
d
o
cto
r
b
ef
o
r
e
u
s
in
g
co
m
p
le
m
e
n
tar
y
an
d
alter
n
at
iv
e
m
ed
ici
n
e
[
3
0
]
.
T
h
e
b
eh
av
io
r
o
f
T
2
DM
p
atien
ts
in
c
h
o
o
s
i
n
g
co
m
p
le
m
en
t
ar
y
an
d
alter
n
ati
v
e
m
ed
icin
e
w
a
s
b
ased
o
n
th
eir
b
elief
th
at
t
h
is
tr
ea
t
m
e
n
t
ca
n
i
m
p
r
o
v
e
th
eir
h
ea
lth
s
tat
u
s
,
e
x
p
er
ien
ce
tr
ea
t
m
e
n
t
f
ail
u
r
e,
f
a
m
il
y
h
i
s
to
r
y
o
f
u
s
i
n
g
C
A
M,
an
d
s
id
e
ef
f
ec
t
s
o
f
tr
ea
t
m
e
n
t
[
3
1
]
.
I
n
cr
ea
s
in
g
t
h
e
p
er
ce
p
tio
n
o
f
t
h
e
co
m
p
o
n
e
n
ts
o
f
h
ea
lt
h
b
eli
ef
s
m
u
s
t
b
e
co
m
p
r
eh
e
n
s
i
v
e
s
o
th
at
th
e
s
elf
-
ca
r
e
b
eh
a
v
io
r
o
f
T
2
DM
p
atie
n
ts
u
s
i
n
g
h
er
b
s
ca
n
b
e
ca
r
r
ied
o
u
t
r
eg
u
lar
l
y
.
Fu
r
t
h
er
m
o
r
e,
it
co
u
ld
b
e
p
r
o
p
o
s
ed
th
at
h
er
b
s
co
u
ld
b
e
u
s
ed
i
n
co
n
j
u
n
ctio
n
w
it
h
an
t
i
-
d
iab
etic
d
r
u
g
s
to
h
av
e
b
etter
t
h
er
ap
eu
tic
p
o
ten
t
ial,
m
i
n
i
m
ize
t
h
e
d
o
s
ag
e
o
f
o
r
al
h
y
p
o
g
l
y
ce
m
ic
d
r
u
g
s
,
a
n
d
as
an
e
f
f
ec
t
iv
e
s
u
p
p
o
r
tiv
e
th
er
ap
y
i
n
t
h
e
p
r
ev
en
tio
n
an
d
m
a
n
ag
e
m
e
n
t o
f
lo
n
g
-
ter
m
co
m
p
licat
io
n
s
o
f
d
iab
etes
[
2
9
]
,
[
3
2
]
.
C
o
m
p
le
m
en
tar
y
-
alter
n
a
tiv
e
m
ed
icin
e
is
ca
r
r
ied
o
u
t
as
a
c
o
n
tin
u
o
u
s
s
er
v
ice
e
f
f
o
r
t
s
tar
t
in
g
f
r
o
m
p
r
o
m
o
ti
v
e,
p
r
ev
en
ti
v
e,
cu
r
ati
v
e
an
d
r
eh
ab
ilit
at
iv
e
e
f
f
o
r
ts
.
T
y
p
es
o
f
co
m
p
le
m
e
n
tar
y
-
alte
r
n
ativ
e
m
ed
ici
n
e
i
n
I
n
d
o
n
esia
ca
n
b
e
i
n
teg
r
ated
i
n
h
ea
lth
ca
r
e
f
ac
ilit
ie
s
as
s
t
ip
u
l
ated
b
y
a
Mi
n
is
ter
ial
Dec
r
ee
[
3
3
]
.
Nu
r
s
es
as
p
ar
t
o
f
h
ea
lt
h
w
o
r
k
er
s
h
av
e
t
h
e
a
u
th
o
r
it
y
to
ca
r
r
y
o
u
t
co
m
p
le
m
en
tar
y
an
d
alter
n
ati
v
e
n
u
r
s
i
n
g
m
a
n
ag
e
m
e
n
t
i
n
ca
r
r
y
i
n
g
o
u
t
th
eir
d
u
ties
a
s
n
u
r
s
in
g
ca
r
e
p
r
o
v
id
er
s
in
th
e
f
iel
d
o
f
p
u
b
lic
h
ea
lth
e
f
f
o
r
ts
[
3
4
]
.
T
h
is
r
esear
ch
ca
n
b
e
u
s
ed
as
a
t
h
eo
r
y
d
ev
elo
p
m
en
t
o
f
h
ea
lt
h
b
e
h
av
io
r
in
i
m
p
r
o
v
in
g
h
ea
lt
h
s
tat
u
s
t
h
r
o
u
g
h
p
r
o
m
o
ti
v
e
a
n
d
p
r
ev
en
ti
v
e
ef
f
o
r
ts
.
P
r
o
m
o
tio
n
al
ef
f
o
r
ts
ar
e
in
cr
ea
s
in
g
k
n
o
wled
g
e
ab
o
u
t
th
e
u
s
e
o
f
h
er
b
s
as
a
co
m
p
le
m
e
n
t
to
s
elf
-
ca
r
e
b
eh
av
io
r
w
h
ich
i
s
a
p
illar
o
f
T
2
DM
m
an
a
g
e
m
e
n
t.
P
r
ev
en
tiv
e
ef
f
o
r
ts
ar
e
th
e
u
s
e
o
f
h
er
b
s
as
a
co
m
p
le
m
e
n
tar
y
tr
ea
t
m
e
n
t
ca
r
r
ied
o
u
t
to
g
eth
er
w
it
h
d
iab
etes
s
el
f
-
ca
r
e
b
eh
a
v
io
r
th
at
is
ap
p
r
o
p
r
iate
an
d
r
eg
u
lar
l
y
w
il
l
p
r
ev
e
n
t
co
m
p
l
icatio
n
s
,
r
ed
u
ce
co
m
p
lai
n
ts
an
d
r
eg
u
late
b
lo
o
d
s
u
g
ar
le
v
els
o
p
ti
m
al
l
y
.
T
h
e
li
m
ita
tio
n
o
f
t
h
is
s
t
u
d
y
i
s
t
h
at
it
d
o
es
n
o
t
tes
t
t
h
e
ef
f
ec
ti
v
e
n
e
s
s
o
f
u
s
in
g
h
er
b
s
,
b
u
t
o
n
l
y
k
n
o
w
s
th
e
b
e
h
av
io
r
o
f
T
2
DM
p
atien
ts
i
n
u
s
in
g
h
er
b
s
as a
co
m
p
le
m
e
n
t o
r
co
m
p
an
io
n
to
co
n
v
e
n
tio
n
a
l tr
ea
t
m
e
n
t.
4.
CO
NCLU
SI
O
N
T
2
DM
s
u
f
f
er
er
s
as
c
h
r
o
n
ic
d
i
s
ea
s
e
s
u
f
f
er
er
s
h
av
e
a
te
n
d
en
c
y
to
u
s
e
h
er
b
s
to
m
a
n
ag
e
t
h
e
ir
d
is
ea
s
e.
Hea
lth
b
elie
f
s
co
n
s
is
ti
n
g
o
f
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
an
d
s
ev
er
it
y
,
p
er
ce
iv
ed
b
en
e
f
its
,
p
er
ce
iv
ed
in
h
ib
itio
n
,
an
d
p
er
ce
iv
ed
s
elf
-
e
f
f
icac
y
ar
e
s
tr
o
n
g
p
r
ed
icto
r
s
ass
o
ciate
d
w
it
h
t
h
e
u
s
e
o
f
h
er
b
s
as
a
co
m
p
le
m
en
t
to
d
iab
etes
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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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
.
2
,
J
u
n
e
20
21
:
265
–
271
270
s
elf
-
ca
r
e
i
n
r
eg
u
lati
n
g
b
lo
o
d
g
lu
co
s
e
le
v
els.
Fa
m
il
y
s
u
p
p
o
r
t
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ed
to
s
u
p
p
o
r
t
th
e
p
atien
t's
h
ea
lth
b
elie
f
s
i
n
o
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d
er
to
ad
h
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e
to
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iab
etes
s
elf
-
ca
r
e
w
h
e
n
u
s
in
g
h
er
b
s
as
a
c
o
m
p
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e
n
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to
tr
ea
t
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e
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Hea
lt
h
w
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er
s
(
d
o
cto
r
s
o
r
n
u
r
s
es)
m
u
s
t
b
e
a
w
ar
e
o
f
T
2
DM
p
atien
ts
u
s
i
n
g
h
er
b
s
.
T
h
is
s
er
v
e
s
to
i
m
m
ed
iatel
y
id
e
n
ti
f
y
c
h
a
n
g
e
s
i
n
t
h
e
q
u
alit
y
o
f
li
f
e
ex
p
er
ien
ce
d
b
y
T
2
DM
p
atien
ts
r
elate
d
to
h
er
b
al
u
s
e.
Fu
r
t
h
er
r
esear
ch
o
n
t
h
e
ef
f
icac
y
,
s
a
f
et
y
,
i
m
p
ac
t o
n
t
h
e
q
u
alit
y
o
f
li
f
e
o
f
p
atien
ts
,
an
d
h
er
b
al
d
r
u
g
in
ter
ac
tio
n
s
n
ee
d
to
b
e
d
o
n
e.
ACK
NO
WL
E
D
G
E
M
E
NT
S
W
e
w
o
u
ld
l
ik
e
to
t
h
a
n
k
th
e
Dir
ec
to
r
o
f
P
o
ltek
k
es
Ke
m
e
n
k
es
Su
r
ab
a
y
a
f
o
r
h
i
s
s
u
p
p
o
r
t
an
d
T
2
DM
p
atien
ts
w
h
o
h
a
v
e
co
n
tr
ib
u
ted
to
th
is
r
esear
ch
.
RE
F
E
R
E
NC
E
S
[1
]
Am
e
rica
n
Dia
b
e
tes
As
so
c
iatio
n
,
“
G
l
y
c
e
m
ic
T
a
r
g
e
ts
:
S
tan
d
a
rd
s
o
f
M
e
d
ica
l
Ca
re
in
Dia
b
e
tes
d
2
0
1
9
,
”
Di
a
b
e
tes
Ca
re
,
v
o
l.
42
,
n
o
.
1
,
p
p
.
61
-
7
0
,
2
0
1
9
,
d
o
i:
h
tt
p
s:
//
d
o
i.
o
rg
/1
0
.
2
3
3
7
/d
c
1
9
-
S
0
0
6
.
[2
]
In
tern
a
ti
o
n
a
l
Dia
b
e
tes
F
e
d
e
ra
ti
o
n
,
“
IDF
Dia
b
e
tes
At
l
a
s
Ei
g
h
th
e
d
i
ti
o
n
2
0
1
7
,
”
2
0
1
7
,
[
O
n
li
n
e
]
.
A
v
a
il
a
b
le:
h
tt
p
s:/
/d
o
i.
o
rg
/h
tt
p
:/
/d
x
.
d
o
i
.
o
rg
/
1
0
.
1
0
1
6
/S
0
1
4
0
-
6
7
3
6
(
1
6
)
3
1
6
7
9
-
8.
[3
]
RI
M
in
istry
o
f
He
a
lt
h
,
"
M
a
in
Re
su
lt
s o
f
Ba
sic
He
a
lt
h
Re
se
a
rc
h
2
0
1
8
,
"
2
0
1
8
.
[4
]
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
,
"
M
a
in
Re
su
lt
s
o
f
Risk
e
sd
a
s 2
0
1
8
,
Eas
t
Ja
v
a
P
r
o
v
in
c
e
,
"
2
0
1
8
[5
]
T
h
o
rse
n
,
R.
S
a
n
d
P
o
u
li
o
t,
M
.
,
“
T
ra
d
it
io
n
a
l
m
e
d
icin
e
f
o
r
th
e
ric
h
a
n
d
k
n
o
w
led
g
e
a
b
le:
Ch
a
ll
e
n
g
in
g
a
ss
u
m
p
ti
o
n
s
a
b
o
u
t
trea
tm
e
n
t
-
se
e
k
in
g
b
e
h
a
v
io
u
r
in
ru
ra
l
a
n
d
p
e
ri
-
u
r
b
a
n
Ne
p
a
l,
”
He
a
lt
h
P
o
li
c
y
Pl
a
n
n
in
g
,
v
o
l.
31
,
n
o
.
3
,
p
p
.
3
1
4
-
3
2
4
,
2
0
1
6
,
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i:
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tt
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s:/
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.
1
0
9
3
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h
e
a
p
o
l/
c
z
v
0
6
0
.
[6
]
Ra
ja,
R
e
t
a
l.
,
“
Kn
o
w
led
g
e
,
A
t
ti
tu
d
e
,
a
n
d
P
ra
c
ti
c
e
s
o
f
Co
m
p
le
m
e
n
tar
y
a
n
d
A
lt
e
rn
a
ti
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7
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A
l
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.
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[8
]
G
ro
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L
.
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a
n
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k
,
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.
R.
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n
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a
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e
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tary
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lt
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f
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r
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o
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[9
]
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o
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t
a
l.
,
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l
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tu
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in
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tar,”
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ter
n
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l
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o
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1
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lan
z
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a
n
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e
r,
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a
n
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th
,
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[1
2
]
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n
g
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-
Y.A
.
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.
a
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o
,
E.
,
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tes
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o
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Ad
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[1
3
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v
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[1
4
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[1
5
]
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e
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tes
:
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li
tativ
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tu
d
y
,
”
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o
u
rn
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l
o
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N
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in
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Res
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,
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[1
6
]
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so
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,
M
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,
H.D.
,
a
n
d
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i
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we
,
J.,
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ra
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t
o
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iab
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it
u
s:
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p
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a
n
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p
e
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s
”
,”
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e
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se
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mp
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ry
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ter
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.
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.
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7
]
Jo
e
li
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n
ti
n
a
,
A
a
n
d
A
n
u
g
ra
h
in
i,
H.
N.,
“
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e
lf
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re
Be
h
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v
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r
in
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b
e
tes
M
e
ll
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s
P
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ti
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ts
Us
in
g
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Co
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p
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e
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to
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re
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t
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”
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a
lt
h
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l.
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.
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p
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tt
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4
.
[1
8
]
V
e
rm
a
,
S
.
,
G
u
p
ta,
M
.
,
P
o
p
li
,
H.,
a
n
d
A
g
g
a
r
wa
l,
G
.
,
“
Dia
b
e
tes
m
e
l
li
tu
s
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tm
e
n
t
u
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n
g
h
e
rb
a
l
d
r
u
g
s,”
In
t
e
rn
a
ti
o
n
a
l
J
o
u
rn
a
l
P
h
y
to
me
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ici
n
e
,
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l.
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o
.
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p
.
1
-
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,
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o
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tt
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3
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9
7
5
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5
.
2
1
8
1
.
[1
9
]
E
t
e
s
a
m
i
f
a
r
d
,
T
e
t
a
l
.
,
“
I
s
t
h
e
h
e
a
l
t
h
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e
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f
m
o
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e
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i
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t
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e
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t
s
?
,
”
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o
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n
a
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y
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d
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o
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s
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,
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.
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.
12
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p
p
.
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-
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.
[2
0
]
V
a
z
in
i,
H.
a
n
d
Ba
ra
ti
,
M
.
,
“
T
h
e
h
e
a
lt
h
b
e
li
e
f
m
o
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e
l
a
n
d
se
lf
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c
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r
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b
e
h
a
v
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rs
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m
o
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y
p
e
2
,
”
Ira
n
ia
n
J
o
u
rn
a
l
o
f
Dia
b
e
tes
a
n
d
O
b
e
sity
,
v
o
l.
6
,
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o
.
3
,
p
p
.
1
0
7
-
1
1
3
,
2
0
1
4
.
[2
1
]
A
d
e
jo
h
,
S
.
O.,
“
Dia
b
e
tes
Kn
o
w
led
g
e
,
He
a
lt
h
Be
li
e
f
,
a
n
d
Dia
b
e
tes
M
a
n
a
g
e
m
e
n
t
Am
o
n
g
th
e
Ig
a
la
,
Nig
e
ria,”
S
AGE
Op
e
n
,
v
o
l.
4
,
n
o
.
2
,
p
p
.
1
-
8
,
2
0
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4
,
d
o
i
:
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t
tp
s://
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5
8
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4
4
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5
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9
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6
6
.
[2
2
]
M
o
h
e
b
i,
S
.
e
t
a
l.
,
“
S
tru
c
tu
ra
l
ro
le
o
f
p
e
rc
e
iv
e
d
b
e
n
e
f
it
s
a
n
d
b
a
rrier
s
to
se
l
f
-
c
a
r
e
in
p
a
ti
e
n
ts
w
it
h
d
iab
e
tes
,
”
J
o
u
rn
a
l
Ed
u
c
a
ti
o
n
He
a
lt
h
Pr
o
mo
t
i
o
n
,
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l.
2
,
p
.
3
7
,
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0
1
3
,
d
o
i
:
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t
tp
s://
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2
7
7
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9
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3
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.
1
1
5
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3
1
[2
3
]
W
a
lk
e
r,
R.
J
e
t
a
l.
,
“
Ef
f
e
c
t
o
f
d
iab
e
tes
se
l
f
-
e
ff
ica
c
y
o
n
g
l
y
c
e
m
ic
c
o
n
tro
l
,
m
e
d
ica
ti
o
n
a
d
h
e
re
n
c
e
,
se
lf
-
c
a
re
b
e
h
a
v
io
rs,
a
n
d
q
u
a
li
ty
o
f
li
f
e
in
a
p
re
d
o
m
in
a
n
tl
y
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w
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in
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o
m
e
,
m
in
o
rit
y
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Evaluation Warning : The document was created with Spire.PDF for Python.