I
n
t
e
r
n
at
ion
al
Jou
r
n
a
l
of
P
u
b
l
ic
Hea
l
t
h
S
c
ience
(
I
JP
HS
)
Vo
l
.
9
,
N
o
.
4,
De
c
e
m
b
e
r
2020
,
pp.
3
03
~
3
06
I
S
S
N:
2252
-
8806,
DO
I
:
10
.
11591/i
j
p
h
s
.
v
9
i
4
.
20586
303
J
our
nal
home
page
:
htt
p:
//
ij
phs
.
iaes
c
or
e
.
c
om
Do
d
e
sc
e
n
d
an
t
s of
f
am
i
li
e
s c
on
t
r
ib
u
t
e
t
o
t
y
p
e
2 d
ia
b
e
t
e
s
m
e
l
li
t
u
s
?
F
at
m
a
Nur
ai
s
yah
,
S
ol
ik
h
ah
S
ol
i
k
h
ah
,
Roc
h
an
a
Rul
iy
an
d
a
r
i
F
a
c
u
l
t
y
o
f
P
ubli
c
He
a
l
t
h
,
Uni
ve
r
s
i
t
a
s
Ahm
a
d
Da
hlan
,
I
n
do
n
e
s
i
a
Ar
t
ic
l
e
I
n
f
o
AB
S
T
RA
CT
A
r
ti
c
le
h
is
tor
y
:
R
e
c
e
i
ve
d
J
u
l
1
9
,
2020
R
e
vi
s
e
d
S
e
p
5,
2020
A
c
c
e
pt
e
d
S
e
p
12
,
20
20
D
i
ab
e
t
e
s
i
s
a
p
u
b
l
i
c
h
e
a
l
t
h
p
ro
b
l
em
i
n
I
n
d
o
n
e
s
i
a
t
h
at
h
as
b
e
e
n
i
n
c
r
e
as
i
n
g
i
n
rece
n
t
d
ec
a
d
e
s
.
Sc
r
een
i
n
g
f
o
r
d
i
ab
e
t
e
s
w
as
u
s
u
a
l
l
y
i
d
en
t
i
fi
ed
as
p
re
g
n
an
t
w
o
me
n
,
ad
o
l
e
s
cen
t
s
,
ad
u
l
t
s
,
ch
i
l
d
r
en
,
o
l
d
e
r
an
d
o
b
e
s
i
t
y
,
w
h
i
l
e
b
as
ed
o
n
i
n
v
e
s
t
i
g
at
i
o
n
d
e
s
cen
d
e
n
t
w
as
y
e
t
.
T
h
i
s
c
ro
s
s
-
s
ec
t
i
o
n
al
s
t
u
d
y
ai
me
d
t
o
k
n
o
w
t
h
e
ran
d
o
m
l
e
v
e
l
b
l
o
o
d
g
l
u
co
s
e
o
f
fa
mi
l
y
h
i
s
t
o
r
y
t
y
p
e
2
d
i
ab
e
t
e
s
mel
l
i
t
u
s
(T
2
D
M).
T
h
e
t
arg
e
t
g
r
o
u
p
fo
r
s
c
r
een
i
n
g
w
as
p
eo
p
l
e
w
i
t
h
a
fam
i
l
y
h
i
s
t
o
r
y
i
n
o
n
e
o
f
t
h
ei
r
d
e
s
cen
t
o
f
T
2
D
M
w
i
t
h
ag
e
>
2
0
y
e
ars
i
n
K
u
l
o
n
P
ro
g
o
,
D
IY
,
I
n
d
o
n
e
s
i
a
.
W
e
c
o
n
d
u
c
t
ed
a
d
e
t
ec
t
i
o
n
o
f
ran
d
o
m
l
e
v
el
b
l
o
o
d
g
l
u
co
s
e
fro
m
a
v
en
o
u
s
b
l
o
o
d
s
am
p
l
e.
A
h
i
g
h
l
e
v
el
o
f
b
l
o
o
d
g
l
u
c
o
s
e
w
as
d
i
a
g
n
o
s
ed
w
h
en
ran
d
o
m
b
l
o
o
d
g
l
u
co
s
e
r
e
a
ch
e
s
≥
2
0
0
m
g
/
d
l
.
T
h
e
p
art
i
ci
p
an
t
w
i
t
h
h
i
g
h
l
ev
e
l
o
f
b
l
o
o
d
g
l
u
co
s
e
w
as
2
9
.
0
%
,
w
h
i
l
e
b
o
rd
e
r
l
i
n
e
b
l
o
o
d
g
l
u
co
s
e
(≥
1
1
0
-
1
9
9
m
g
/
d
l
)
w
as
r
ev
e
a
l
e
d
3
8
.
7
%
o
f
1
5
.
3
%
s
u
b
j
ec
t
i
n
d
i
c
at
e
d
w
i
t
h
mo
t
h
e
r
h
i
s
t
o
r
y
.
D
e
s
ce
n
d
an
t
s
c
r
ee
n
i
n
g
o
f
fa
m
i
l
y
h
i
s
t
o
r
y
T
2
D
M
i
s
e
ar
l
y
d
e
t
ec
t
e
d
r
e
s
p
o
n
d
e
n
t
w
i
t
h
h
i
g
h
g
l
u
c
o
s
e
l
e
v
el
an
d
r
ed
u
ced
t
h
e
s
e
v
e
r
e
co
m
p
l
i
c
a
t
i
o
n
.
K
e
y
w
o
r
d
s
:
De
s
c
e
n
da
n
t
s
D
i
a
b
e
t
e
s
m
e
l
li
t
u
s
F
a
mi
ly
hi
s
t
o
r
y
S
c
r
e
e
ni
ng
Th
i
s
i
s
a
n
o
p
en
a
c
ces
s
a
r
t
i
c
l
e
u
n
d
e
r
t
h
e
CC
B
Y
-
SA
l
i
cen
s
e.
C
or
r
e
s
pon
din
g
A
u
th
or
:
S
o
l
i
k
h
a
h
S
o
l
i
k
h
a
h
,
F
a
c
u
l
t
y
o
f
P
ubli
c
He
a
l
t
h
,
Uni
ve
r
s
i
t
a
s
Ahm
a
d
Da
hl
a
n
,
Jl
.
P
r
o
f
S
o
e
p
o
m
o
J
a
n
t
ur
a
n
W
a
r
un
g
b
o
to
Y
o
gy
a
ka
r
t
a
55166,
I
n
do
n
e
s
i
a
.
E
m
a
i
l
:
s
o
l
i
k
h
a
h
@i
k
m
.
ua
d.
a
c
.
i
d
1.
I
NT
RODU
C
T
I
ON
T
y
pe
2
D
i
a
b
e
t
e
s
M
e
ll
i
t
us
(
T
2DM
)
i
s
o
n
e
o
f
t
he
c
h
r
o
ni
c
d
i
s
e
a
s
e
pr
o
bl
e
m
s
f
o
ur
t
h
i
n
I
n
do
n
e
s
i
a
.
T
h
e
e
s
t
i
m
a
t
e
d
pr
e
v
a
l
e
n
c
e
o
f
d
i
a
b
e
t
e
s
a
m
o
n
g
a
du
l
t
s
i
n
t
h
e
I
n
do
n
e
s
i
a
po
pu
l
a
t
i
o
n
i
s
n
o
w
7.
0%
i
n
2
017
[
1]
.
B
a
s
e
d
o
n
r
e
po
r
t
e
d
di
a
b
e
t
e
s
,
t
h
e
hi
g
h
e
r
c
o
un
t
r
y
i
s
I
n
d
i
a
i
n
As
i
a
[
1,
2]
.
Di
a
b
e
t
e
s
o
n
e
o
f
t
h
e
r
i
s
k
f
a
c
t
or
s
pr
e
s
e
n
t
i
n
a
n
i
n
d
i
v
i
dua
l
;
t
h
e
hi
g
h
e
r
t
h
e
c
h
a
n
c
e
o
f
t
h
a
t
i
n
d
i
v
i
dua
l
h
a
vi
ng
d
i
a
be
t
e
s
w
i
t
h
o
ut
s
y
m
pt
o
m
s
.
M
a
ny
pe
o
p
l
e
d
e
s
c
e
n
d
a
n
t
s
o
f
d
i
a
b
e
t
e
s
u
n
d
i
a
g
n
o
s
e
d
o
f
T
2DM
.
I
de
a
ll
y
,
s
c
r
e
e
ni
ng
be
f
o
r
e
t
h
e
pa
t
i
e
n
t
r
e
po
r
t
s
s
y
m
pt
o
m
s
[2
-
6]
.
W
i
t
h
o
ut
s
c
r
e
e
ni
n
g,
m
o
r
e
a
ny
r
i
s
k
w
i
t
h
r
i
s
k
u
n
d
i
a
gn
o
s
e
d
T
2DM
[
7]
S
c
r
e
e
ni
ng
f
o
r
de
s
c
e
n
d
a
n
t
s
o
f
pa
t
i
e
n
t
T
2DM
i
s
n
o
t
wi
de
ly
u
n
de
r
t
a
ke
n
due
t
o
t
h
e
hi
g
h
c
o
s
t
s
a
n
d
d
i
d
n
o
t
h
a
ve
c
a
r
e
h
e
a
l
t
h
[
8]
.
S
c
r
e
e
n
i
ng
i
s
a
n
a
s
ym
pto
m
a
t
i
c
t
e
s
t
to
c
l
a
s
s
if
y
a
pe
r
s
o
n
f
o
r
t
h
e
i
r
li
k
e
l
i
h
o
o
d
o
f
h
a
vi
ng
a
pa
r
t
i
c
u
l
a
r
d
i
s
e
a
s
e
[
7]
.
S
c
r
e
e
nin
g
wo
ul
d
b
e
m
o
r
e
us
e
f
u
l
a
n
d
e
f
f
i
c
i
e
n
t
wh
e
n
d
i
r
e
c
t
e
d
a
t
t
a
r
ge
t
p
o
pul
a
t
i
o
ns
a
t
hi
g
h
r
i
s
k
[
5,
9]
.
B
e
s
i
de
s
,
a
hi
g
h
-
r
i
s
k
po
pul
a
t
i
o
n
i
s
ge
n
e
r
a
ll
y
m
o
r
e
m
o
t
i
v
a
t
e
d
to
pa
r
t
i
c
i
pa
t
e
i
n
s
c
r
e
e
ni
ng
pr
o
gr
a
m
s
a
n
d
t
e
n
d
t
o
f
o
l
l
o
w
up
o
n
t
h
e
a
c
t
i
o
n
i
f
t
h
e
r
e
c
o
m
m
e
n
da
t
i
o
n
s
po
s
i
t
i
v
e
r
e
s
u
l
t
s
[
9]
.
S
c
r
e
e
ni
n
g
de
s
c
e
n
da
n
t
s
o
f
T
2DM
a
r
e
us
e
f
u
l
f
o
r
t
h
e
pr
e
v
e
n
t
i
o
n
o
f
c
o
m
p
li
c
a
t
i
o
ns
a
n
d
e
a
r
ly
de
t
e
c
t
i
o
n
[
5,
6,
1
0
]
.
R
e
c
o
m
m
e
n
de
d
s
c
r
e
e
ni
ng
f
o
r
t
y
pe
2
d
i
a
b
e
t
e
s
b
e
c
a
us
e
i
t
i
s
c
h
r
o
ni
c
,
a
n
d
pa
t
i
e
n
t
s
o
f
t
e
n
do
n
ot
r
e
a
l
i
z
e
t
h
a
t
t
h
e
c
o
m
p
l
a
i
n
t
s
t
h
a
t
a
r
i
s
e
a
r
e
c
l
i
n
i
c
a
l
s
ym
pt
om
s
,
s
o
t
h
e
y
a
r
e
n
e
w
ly
d
i
a
g
n
o
s
e
d
d
i
a
b
e
t
e
s
if
i
t
a
ppe
a
r
e
d
c
o
m
p
li
c
a
t
i
o
n
s
[
7,
1
1
]
.
M
o
s
t
pa
t
i
e
n
t
s
w
i
t
h
T
2DM
h
a
d
c
o
m
p
li
c
a
t
i
o
n
s
(
e
.
g.
,
c
a
r
di
o
v
a
s
c
u
l
a
r
,
k
i
d
n
e
y
d
i
s
e
a
s
e
,
e
t
c
.
)
,
a
n
d
i
t
s
c
o
m
p
li
c
a
t
i
o
n
i
s
t
he
l
e
a
d
i
ng
c
a
us
e
o
f
m
o
r
bi
d
i
t
y
a
n
d
m
o
r
t
a
l
i
t
y
i
n
t
he
s
e
pa
t
i
e
n
t
s
[
1
2
-
14]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
,
Vo
l
.
9,
No.
4
,
De
c
e
m
b
e
r
20
20
:
3
03
–
3
06
304
S
c
r
e
e
ni
ng
d
i
a
b
e
t
e
s
m
e
ll
i
t
us
i
s
t
h
e
pr
i
m
a
r
y
o
f
s
u
c
c
e
s
s
f
u
l
d
i
a
b
e
t
e
s
m
a
n
a
g
e
m
e
n
t
f
o
r
h
e
l
p
i
ng
t
h
e
s
e
pa
t
i
e
n
t
s
to
m
o
d
i
f
y
a
n
d
r
e
duc
i
ng
t
h
e
r
i
s
k
f
a
c
t
o
r
s
o
f
t
hi
s
c
o
m
p
l
i
c
a
t
i
o
n
[
15]
.
A
s
o
ur
b
e
s
t
o
ur
kn
o
wl
e
dge
,
to
da
te,
m
a
ny
pr
e
vi
o
us
s
t
ud
i
e
s
c
o
n
s
i
de
r
i
ng
d
i
a
b
e
t
e
s
s
c
r
e
e
ni
ng
,
n
o
r
e
por
t
i
n
g
s
c
r
e
e
ni
ng
a
m
o
n
g
d
e
s
c
e
n
d
a
n
t
s
of
f
a
m
il
y
d
i
a
b
e
t
e
s
,
e
s
pe
c
i
a
ll
y
i
n
I
n
do
n
e
s
i
a
.
T
hi
s
s
t
udy
wa
s
u
n
de
r
t
a
ke
n
t
o
s
c
r
e
e
ni
ng
t
h
e
n
u
m
be
r
o
f
p
e
o
pl
e
i
n
h
a
vi
ng
r
i
s
k
hi
g
h
g
l
uc
o
s
e
de
s
c
e
n
da
n
t
s
o
f
T
2DM
.
T
hi
s
a
ppr
o
a
c
h
h
a
s
t
h
e
a
d
va
n
t
a
ge
t
h
a
t
t
h
e
e
xi
s
t
e
n
c
e
o
f
e
a
r
ly
d
e
t
e
c
t
i
o
n
,
pr
e
v
e
n
t
c
o
m
p
l
i
c
a
t
i
o
n
a
n
d
i
n
t
e
r
v
e
n
t
i
o
n
t
r
e
a
t
m
e
n
t
f
o
r
a
hi
g
h
g
l
uc
o
s
e
l
e
v
e
l
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
2.
1
.
S
t
u
d
y
s
e
t
t
in
g
an
d
p
o
p
u
l
at
ion
A
c
r
o
s
s
-
s
e
c
t
i
o
n
a
l
s
t
udy
w
a
s
do
n
e
in
J
u
n
e
2015
y
e
a
r
.
T
h
e
po
pul
a
t
i
o
n
w
as
a
t
y
p
e
2
d
i
a
b
e
t
i
c
pa
t
i
e
n
t
s
wh
o
we
n
t
to
t
h
e
P
a
nj
a
t
a
n
I
I
P
ubli
c
He
a
l
t
h
C
e
n
t
e
r
.
T
h
e
s
u
bj
e
c
t
s
we
r
e
de
s
c
e
n
da
n
t
s
o
f
pa
t
i
e
n
t
s
w
i
t
h
t
y
pe
2
d
i
a
b
e
t
e
s
,
m
e
n
a
n
d
wo
m
e
n
,
a
ge
d
>
20
y
e
a
r
s
,
i
s
s
u
e
s
h
a
ve
n
o
t
b
e
e
n
d
i
a
g
n
o
s
e
d
by
a
he
a
l
t
h
wo
r
ke
r
a
n
d
w
i
ll
i
ng
to
b
e
a
r
e
s
po
n
de
n
t
.
T
h
e
de
t
e
r
m
i
ne
s
a
m
p
l
e
s
i
z
e
b
a
s
e
d
e
r
r
o
r
r
a
t
e
o
f
10%
[1
6
,
17]
,
t
h
e
pr
e
va
l
e
n
c
e
o
f
P
a
nj
a
t
a
n
I
I
h
e
a
l
t
h
c
e
n
t
e
r
wa
s
0.
25%
.
T
h
e
s
a
m
p
l
e
s
i
z
e
wa
s
62
r
e
s
po
n
de
n
t
s
-
l
o
c
a
t
i
o
n
s
o
f
s
c
r
e
e
ni
ng
i
n
K
u
l
o
n
p
r
o
go
D
i
s
t
r
i
c
t
.
2.
2
Dat
a
c
ol
l
e
c
t
ion
an
d
a
n
al
ys
is
I
n
t
hi
s
s
t
ud
y
,
i
n
c
o
m
e
da
t
a
we
r
e
r
a
n
do
m
bl
o
o
d
gl
u
c
o
s
e
f
r
o
m
v
e
n
o
us
bl
o
o
d.
M
e
t
h
o
d
e
n
z
ym
a
t
i
c
us
e
d
to
a
u
to
a
n
a
ly
z
e
r
C
o
b
a
s
C
111
a
s
t
h
e
go
l
d
s
t
a
n
da
r
d.
H
i
g
h
g
l
uc
o
s
e
l
e
v
e
l
w
a
s
de
f
i
ne
d
a
s
h
a
vi
ng
r
a
n
d
o
m
bl
o
o
d
g
l
uc
o
s
e
(
R
B
G
)
r
e
a
c
h
e
s
≥
200
m
g/d
l
[
1,
5,
1
8
,
19
]
.
W
e
de
s
c
r
i
be
d
t
h
e
r
e
s
po
n
d
e
n
t
’
s
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
w
i
t
h
pe
r
c
e
n
t
a
ge
s
.
W
e
s
e
t
hi
g
h
-
r
i
s
k
f
a
c
t
o
r
T
D2M
i
s
a
hi
g
h
g
l
uc
o
s
e
l
e
v
e
l
,
a
n
d
we
i
d
e
n
t
i
f
i
e
d
w
h
o
h
a
d
a
f
a
m
il
y
hi
s
t
o
r
y
w
i
t
h
T
2DM
(
e
x
:
m
o
t
h
e
r
,
f
a
t
he
r
,
or
b
o
t
h
)
.
I
n
d
i
v
i
dua
l
s
w
i
t
h
hi
g
h
g
l
u
c
o
s
e
l
e
v
e
l
s
/
hy
pe
r
g
ly
c
e
mi
c
a
r
e
s
i
g
nif
i
c
a
n
t
l
y
hi
g
h
e
r
r
i
s
k
f
a
c
t
or
T
2DM
t
h
a
n
g
l
uc
o
s
e
a
v
e
r
a
ge
[
2
0,
21
]
.
E
a
r
l
y
de
t
e
c
t
i
o
n
a
n
d
pr
o
m
pt
tr
e
a
t
m
e
n
t
m
e
t
h
o
d
we
r
e
r
e
c
o
m
m
e
n
de
d
by
W
HO
t
o
r
e
du
c
e
t
h
e
b
ur
de
n
o
f
d
i
a
b
e
t
e
s
a
n
d
c
o
m
p
li
c
a
t
i
o
n
s
[
5,
2
2
]
.
T
h
e
s
t
ud
y
wa
s
a
ppr
o
v
e
d
by
t
he
P
o
l
i
t
e
k
ni
k
Ke
s
e
h
a
t
a
n
Yo
g
y
a
ka
r
t
a
r
e
s
e
a
r
c
h
e
t
hi
c
s
c
o
m
m
i
t
t
e
e
n
u
m
be
r
L
B
.
01.
01/K
E
-
02/XXX
V/767/2018.
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ON
T
h
e
r
e
s
u
l
t
o
f
t
hi
s
s
t
ud
y
s
h
o
we
d
t
h
a
t
i
de
n
t
i
f
yi
ng
p
e
o
pl
e
a
t
hi
g
h
-
r
i
s
k
f
a
c
to
r
T
2DM
(
f
a
mi
ly
hi
s
t
o
r
y
)
.
A
t
ot
a
l
o
f
62
r
e
s
po
n
de
n
t
s
m
e
t
t
h
e
i
n
c
l
us
i
o
n
c
r
i
t
e
r
i
a
f
o
r
t
hi
s
s
t
ud
y
,
whi
c
h
a
r
e
27
m
a
l
e
s
a
n
d
35
f
e
m
a
l
e
s
.
M
o
s
t
o
f
t
h
e
r
e
s
po
n
de
n
t
s
a
r
e
i
n
31
-
40
y
e
a
r
s
o
l
d
a
n
d
i
n
b
o
r
de
r
l
i
ne
hi
g
h
o
f
bl
o
o
d
gl
uc
o
s
e
l
e
v
e
l
a
n
d
h
a
v
e
a
f
a
c
t
o
r
o
f
T
2DM
f
r
o
m
m
o
t
h
e
r
.
I
n
o
ur
s
t
udy
,
o
f
hi
g
h
gl
u
c
o
s
e
l
e
v
e
l
(
30.
6%
)
,
t
h
e
r
a
t
e
o
f
r
a
n
do
m
bl
o
o
d
g
l
uc
o
s
e
pe
r
f
o
r
m
e
r
s
i
nc
r
e
a
s
e
d
w
i
t
h
a
ge
≥
40
y
e
a
r
s
a
ha
d
gr
e
a
t
e
r
a
s
s
h
o
wn
i
n
T
a
bl
e
1
.
S
c
r
e
e
ni
n
g
de
s
c
e
n
da
n
t
s
of
T
2D
M
(
f
a
mi
ly
hi
s
t
o
r
y
)
c
o
n
s
i
s
t
o
f
26
h
e
a
d
s
o
f
f
a
mi
li
e
s
s
h
o
we
d
t
h
a
t
t
h
e
h
o
us
e
h
o
l
ds
(
34.
4%
)
w
i
t
h
r
a
n
do
m
bl
o
o
d
s
uga
r
l
e
v
e
l
s
≥
200
m
g/d
L
a
s
s
h
o
wn
i
n
T
a
bl
e
2
i
nc
l
ude
o
f
T
2DM
f
a
mi
ly
hi
s
t
o
r
y
o
f
a
f
a
t
h
e
r
,
m
o
t
h
e
r
o
r
b
ot
h
a
s
s
h
o
wn
i
n
T
a
bl
e
3
.
T
a
bl
e
1
.
B
a
s
e
l
i
ne
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
s
e
x
,
a
n
d
a
ge
gr
o
up
(
n=
62
)
C
ha
r
a
c
te
r
is
ti
c
s
P
e
r
c
e
nt
a
ge
(
%
)
S
e
x
M
e
n
43.54
W
o
m
e
n
56.45
a.
A
ge
G
r
ou
p
s
20
-
30
y
e
a
r
s
14.52
31
-
40
y
e
a
r
s
33
.87
41
-
50
y
e
a
r
s
29.03
≥ 5
1
y
e
a
r
s
22.58
T
a
bl
e
2.
R
a
n
do
m
bl
o
o
d
g
l
uc
o
s
e
l
e
v
e
l
w
i
t
h
a
ut
o
a
n
a
ly
z
e
r
t
e
s
t
s
A
r
e
s
ul
t
f
r
om
r
a
nd
o
m
bl
oo
d gl
u
c
o
s
e
T
e
s
t
R
e
s
ul
t
t
e
s
t
(
%
)
D
e
s
ir
abl
e
(
<
11
0 m
g/
dl
)
30.6
B
or
de
r
li
ne
hi
gh
(
≥
11
0
-
199
m
g/
dl
)
38.7
H
ig
h
(
≥
200
m
g/
dl
)
30.7
D
a
ta
a
r
e
pr
e
s
e
nt
e
d a
s
pe
r
c
e
nt
a
ge
s
(
%)
.
A
ll
pa
r
ti
c
ip
a
nt
s
ha
d a
f
a
m
il
y
hi
s
to
r
y
of
T
2D
M
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
I
S
S
N:
2252
-
8806
Do
de
s
c
e
ndants
of
f
amili
e
s
c
ontr
ibut
e
to
type
2
dia
be
tes
me
ll
it
us
?
(
F
atma
N
u
r
ais
y
ah
)
305
I
n
o
ur
s
t
udy
,
o
f
hi
g
h
g
l
u
c
o
s
e
l
e
ve
l
(
30.
6%
)
,
t
h
e
r
a
t
e
o
f
r
a
n
do
m
bl
o
o
d
g
l
uc
o
s
e
pe
r
f
o
r
m
e
r
s
i
nc
r
e
a
s
e
d
w
i
t
h
a
ge
≥
40
y
e
a
r
s
a
h
a
d
gr
e
a
t
e
r
a
s
s
h
o
wn
i
n
T
a
bl
e
3
.
S
c
r
e
e
ni
n
g
d
e
s
c
e
n
d
a
n
t
s
o
f
T
2DM
(
f
a
mi
ly
hi
s
t
o
r
y
)
c
o
n
s
i
s
t
o
f
26
h
e
a
d
s
o
f
f
a
mi
li
e
s
s
h
o
we
d
t
h
a
t
t
h
e
h
o
us
e
h
o
l
ds
(
34.
4%
)
w
i
t
h
r
a
n
do
m
bl
o
o
d
s
uga
r
l
e
ve
l
s
≥
20
0
m
g/dL
a
s
s
h
o
wn
i
n
T
a
bl
e
2
i
nc
l
ude
o
f
T
2DM
f
a
mi
ly
hi
s
t
or
y
o
f
a
f
a
t
h
e
r
,
m
o
t
h
e
r
or
b
ot
h
.
S
c
r
e
e
ni
n
g
s
h
o
u
l
d
b
e
m
o
r
e
pr
o
duc
t
i
v
e
a
n
d
e
f
f
i
c
i
e
n
t
whe
n
d
i
r
e
c
t
e
d
a
t
t
a
r
ge
t
p
o
pul
a
t
i
o
ns
a
t
hi
g
h
r
i
s
k.
I
n
a
dd
i
t
i
o
n
,
a
hi
g
h
-
r
i
s
k
po
pul
a
t
i
o
n
i
s
ge
n
e
r
a
ll
y
m
o
r
e
m
o
t
i
v
a
t
e
d
to
pa
r
t
i
c
i
p
a
t
e
i
n
s
c
r
e
e
ni
ng
pr
o
gr
a
m
s
a
n
d
t
e
n
d
t
o
f
o
l
l
o
w
t
h
e
a
c
t
i
o
n
if
t
h
e
r
e
c
o
m
m
e
n
da
t
i
o
n
s
po
s
i
t
i
v
e
r
e
s
u
l
t
s
[
4,
23
]
.
T
a
bl
e
3
.
Di
s
t
r
i
b
ut
i
o
n
o
f
t
h
e
s
a
m
p
l
e
a
c
c
o
r
di
n
g
t
o
s
e
x
,
a
n
d
a
ge
C
ha
r
a
c
te
r
is
ti
c
s
B
l
oo
d
r
a
nd
o
m
gl
u
c
o
s
e
≥ 200 mg/
d
L
V
a
lu
e
(
n)
%
S
e
x
W
o
m
e
n
10
16.1
M
e
n
9
14.5
A
ge
G
r
ou
p
s
20
-
30
y
e
a
r
s
0
0
31
-
40
y
e
a
r
s
5
8.0
≥
41
y
e
a
r
s
14
22.5
F
am
il
y
H
is
t
o
r
y
F
a
th
e
r
1
3.8
M
o
th
e
r
4
15.3
F
a
th
e
r
a
nd M
o
th
e
r
4
15.3
S
e
v
e
r
a
l
s
t
udi
e
s
h
a
ve
b
e
e
n
s
c
r
e
e
ni
ng
i
n
va
r
i
o
us
po
pu
l
a
t
i
o
n
s
.
T
h
e
m
a
j
o
r
i
t
y
o
f
pr
e
vi
o
u
s
r
e
s
e
a
r
c
h
f
o
un
d
t
h
a
t
r
e
s
p
o
n
de
n
t
s
r
e
c
r
u
i
t
e
d
we
r
e
n
o
t
de
s
c
e
n
da
n
t
s
of
T
2DM
pa
t
i
e
n
t
s
[
7,
20,
24
,
25]
,
bl
o
o
d
s
uga
r
l
e
ve
l
s
we
r
e
m
o
r
e
o
f
t
e
n
i
n
pr
e
g
n
a
n
t
wo
m
e
n
[
1
,
23,
26
-
28]
,
c
hi
ldr
e
n
[
29]
,
HbA
1c
c
o
m
pa
r
e
d
w
i
t
h
o
r
a
l
g
l
uc
o
s
e
t
o
l
e
r
a
n
c
e
f
o
r
T
2DM
pa
t
i
e
n
t
s
a
n
d
pr
e
-
d
i
a
b
e
t
e
s
[1
1
]
,
HbA
1c
f
o
r
s
c
r
e
e
ni
ng
a
n
d
d
i
a
g
n
o
s
i
s
o
f
d
i
a
b
e
t
e
s
m
e
ll
i
t
us
[
30]
.
T
hi
s
r
e
s
e
a
r
c
h
wa
s
c
o
n
duc
t
e
d
i
n
t
h
e
po
pu
l
a
t
i
o
n,
a
n
d
t
h
e
s
a
m
p
l
e
s
i
z
e
wa
s
m
o
r
e
f
o
c
us
e
d
a
n
d
s
pe
c
i
f
i
c
.
T
o
t
h
e
b
e
s
t
o
f
o
ur
kn
o
wl
e
dge
,
s
c
r
e
e
ni
ng
de
s
c
e
n
da
n
t
s
o
f
T
2DM
a
r
e
w
i
de
ly
y
e
t
do
n
e
i
n
a
po
pul
a
t
i
o
n
-
b
a
s
e
d
o
n
s
a
m
p
l
e
f
a
m
il
y
hi
s
t
o
r
y
o
f
T
2DM
pa
t
i
e
n
t
s
.
T
h
e
r
e
f
o
r
e
,
t
h
e
a
im
o
f
t
hi
s
s
ur
v
e
y
i
s
e
x
pe
c
t
e
d
to
b
e
a
bl
e
t
o
de
t
e
c
t
e
a
r
l
y
a
n
d
pr
e
v
e
n
t
pe
o
p
l
e
w
i
t
h
hi
g
h
-
r
i
s
k
f
a
c
t
or
T
2
DM
a
n
d
c
o
m
p
li
c
a
t
i
o
n
s
.
Our
r
e
s
e
a
r
c
h
h
a
s
a
f
e
w
li
mi
t
a
t
i
o
n
s
t
h
a
t
n
e
e
d
to
b
e
d
i
s
c
u
s
s
e
d.
T
h
e
f
i
r
s
t
i
s
t
h
e
l
e
v
e
l
o
f
l
o
w
a
wa
r
e
n
e
s
s
c
o
n
c
e
r
ni
ng
e
a
r
l
y
de
t
e
c
t
i
o
n
,
a
n
d
h
e
a
l
t
h
s
e
l
f
s
o
t
h
a
t
i
n
s
e
e
k
i
ng
pa
r
t
i
c
i
p
a
t
i
o
n
r
e
qu
i
r
e
s
m
o
r
e
e
f
f
o
r
t
.
T
h
e
s
e
c
o
n
d
m
o
s
t
l
y
u
n
e
x
p
l
o
r
e
d
i
n
po
pu
l
a
t
i
o
n
-
b
a
s
e
d
s
a
m
p
l
e
s
i
n
As
i
a
n
c
o
un
t
r
i
e
s
,
s
uc
h
a
s
I
n
do
n
e
s
i
a
a
n
d
n
o
f
u
n
de
r
r
e
c
e
i
ve
d.
T
hi
s
s
t
udy
d
if
f
e
r
e
n
t
f
r
o
m
ot
h
e
r
r
e
s
e
a
r
c
h
pa
r
t
i
c
i
p
a
t
i
o
n
i
n
e
a
r
ly
de
t
e
c
t
i
o
n
s
c
r
e
e
ni
n
g
o
f
T
2DM
[
7,
1,
9,
19
,
24,
28]
,
t
hi
s
r
e
s
e
a
r
c
h
s
c
r
e
e
ni
ng
f
o
l
l
o
we
d
o
f
d
e
s
c
e
n
da
n
t
s
(
f
a
m
il
y
hi
s
t
o
r
y
)
T
2DM
.
W
e
do
c
u
m
e
n
t
e
d
t
h
e
e
n
z
ym
a
t
i
c
t
e
s
t
.
T
hi
s
r
e
s
e
a
r
c
h
a
l
s
o
s
h
o
ws
m
u
s
t
b
e
f
o
l
l
o
w
-
up
s
c
r
e
e
ni
ng
e
n
a
bl
e
s
h
a
vi
ng
a
hi
g
h
r
i
s
k
o
f
T
2DM
.
Our
s
t
udy
f
ur
t
h
e
r
m
o
r
e
de
m
o
n
s
t
r
a
t
e
s
t
h
e
e
n
o
r
m
o
us
pot
e
n
t
i
a
l
o
f
m
o
ni
t
o
r
i
n
g
t
r
e
a
t
m
e
n
t
h
a
vi
ng
a
hi
g
h
g
l
u
c
o
s
e
l
e
v
e
l
.
4.
CONC
L
USI
ON
I
n
t
h
is
r
e
s
e
a
r
c
h
s
c
r
e
e
ni
ng
de
s
c
e
n
da
n
t
o
f
t
y
p
e
2
d
i
a
b
e
t
e
s
m
e
ll
i
t
us
i
n
K
u
l
o
n
pr
o
go
di
s
t
r
i
c
t
,
we
f
o
un
d
19
c
a
s
e
s
(
29%
)
hi
g
h
r
a
n
do
m
bl
o
o
d
g
l
uc
o
s
e
l
e
v
e
l
r
e
a
c
h
e
s
≥
200
m
g/d
l
a
n
d
o
nly
15.
3%
s
ubj
e
c
t
s
i
nd
i
c
a
t
e
d
w
i
t
h
m
o
t
h
e
r
hi
s
t
o
r
y
o
f
t
hi
s
d
i
s
e
a
s
e
.
T
hi
s
s
t
ud
y
h
a
s
do
c
u
m
e
n
t
e
d
t
h
e
n
e
e
d
f
o
r
pr
e
v
e
n
t
i
v
e
he
a
l
t
h
to
e
n
s
ur
e
t
h
e
e
a
r
l
y
d
e
t
e
c
t
i
o
n
o
f
b
a
s
e
d
o
n
f
a
mi
ly
hi
s
to
r
y
d
i
a
b
e
t
e
s
a
n
d
i
ni
t
i
a
t
i
o
n
f
o
r
tr
e
a
t
m
e
n
t
.
AC
K
NOWL
E
DGE
M
E
NT
S
T
h
e
a
ut
h
o
r
s
t
h
a
n
k
f
o
r
t
h
e
s
uppo
r
t
a
n
d
h
e
l
p
pr
o
vi
de
t
h
e
P
a
nj
a
t
a
n
I
I
P
ubl
i
c
He
a
l
t
h
C
e
n
t
e
r
,
r
e
s
po
n
de
n
t
s
’
p
a
r
t
i
c
i
pa
t
i
o
n
a
n
d
E
p
i
d
e
m
i
o
l
o
g
y
Gr
o
up,
De
pa
r
t
m
e
n
t
o
f
He
a
l
t
h
S
c
i
e
n
c
e
,
U
ni
ve
r
s
i
t
y
Ga
d
j
a
h
M
a
da
,
a
n
d
U
ni
ve
r
s
i
t
y
Ahm
a
d
Da
hl
a
n
,
I
n
do
n
e
s
i
a
.
RE
F
E
R
E
NC
E
S
[1
]
I
n
t
e
rn
at
i
o
n
a
l
D
i
ab
e
t
e
s
F
e
d
e
rat
i
o
n
.
ID
F
D
i
a
b
et
es
A
t
l
a
s
.
Bru
s
s
e
l
s
:
In
t
e
r
n
at
i
o
n
al
D
i
ab
e
t
e
s
F
ed
e
rat
i
o
n
,
2
0
1
7
.
[2
]
H
u
C
.
,
J
i
a
W
.
,
“
D
i
ab
e
t
e
s
i
n
C
h
i
n
a:
E
p
i
d
emi
o
l
o
g
y
an
d
G
e
n
e
t
i
c
R
i
s
k
Fa
c
t
o
rs
an
d
T
h
e
i
r
Cl
i
n
i
c
al
U
t
i
l
i
t
y
i
n
Pe
rs
o
n
a
l
i
z
ed
M
ed
i
c
at
i
o
n
,
”
D
i
a
b
et
es
,
v
o
l
.
6
7
,
n
o
.
1
,
p
p
.
3
-
1
1
,
J
an
2
0
1
8
.
[3
]
Su
b
ram
an
i
S
K
,
Y
ad
a
v
D
.
,
Mi
s
h
ra
M
.
,
Pak
k
i
ri
s
a
my
U
.
,
Mat
h
i
y
al
a
g
e
n
P
.
,
Pras
ad
G
.
,
“
Pre
v
al
e
n
ce
o
f
T
y
p
e
2
D
i
ab
e
t
e
s
an
d
Pr
e
d
i
ab
e
t
e
s
i
n
t
h
e
G
w
al
i
o
r
-
C
h
a
m
b
al
Reg
i
o
n
o
f
Ce
n
t
ral
I
n
d
i
a
,”
I
n
t
er
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
E
n
v
i
r
o
n
m
e
n
t
a
l
R
es
ea
r
c
h
a
n
d
P
u
b
l
i
c
H
ea
l
t
h
.,
v
o
l
.
1
6
,
n
o
.
2
3
,
p
.
4
7
0
8
,
D
ec
2019
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
,
Vo
l
.
9,
No.
4
,
De
c
e
m
b
e
r
20
20
:
3
03
–
3
06
306
[4
]
Ch
en
R
.
,
O
v
b
i
a
g
e
l
e
B
.
,
Fen
g
W
.
,
“
D
i
ab
e
t
e
s
an
d
St
ro
k
e:
E
p
i
d
em
i
o
l
o
g
y
,
Pat
h
o
p
h
y
s
i
o
l
o
g
y
,
Ph
ar
m
a
ce
u
t
i
c
a
l
s
an
d
O
u
t
c
o
me
s
,
”
Th
e
A
m
er
i
ca
n
J
o
u
r
n
a
l
o
f
T
h
e
M
ed
i
c
a
l
S
ci
e
n
ces
,
v
o
l
.
3
5
1
,
n
o
.
4
,
p
p
.
3
8
0
-
6
,
A
p
r
2
0
1
6
.
[
5
]
M
a
rc
o
u
x
V
.
,
Ch
o
u
i
n
a
rd
M
-
C
.
,
D
i
ad
i
o
u
F
.
,
D
u
fo
u
r
I
.
,
H
u
d
o
n
C.
,
“
Sc
re
e
n
i
n
g
t
o
o
l
s
t
o
i
d
e
n
t
i
fy
p
a
t
i
e
n
t
s
w
i
t
h
c
o
m
p
l
e
x
h
e
al
t
h
n
e
e
d
s
a
t
ri
s
k
o
f
h
i
g
h
u
s
e
o
f
h
e
al
t
h
c
a
re
s
e
rv
i
c
e
s
:
A
s
c
o
p
i
n
g
re
v
i
ew
,
”
P
l
o
S
O
n
e
,
v
o
l
.
1
2
,
n
o
.
1
1
,
p
p
.
1
-
1
4
,
2
0
1
7
.
[6
]
Sh
arp
SA
,
Ri
c
h
SS,
W
o
o
d
A
R,
J
o
n
e
s
SE
,
B
e
a
u
m
o
n
t
RN
,
H
arri
s
o
n
J
W
,
e
t
al
.
,
“
D
e
v
el
o
p
me
n
t
an
d
St
an
d
ard
i
zat
i
o
n
o
f
an
Im
p
ro
v
e
d
T
y
p
e
1
D
i
ab
e
t
e
s
G
e
n
e
t
i
c
R
i
s
k
Sco
r
e
fo
r
U
s
e
i
n
N
ew
b
o
r
n
S
c
r
e
en
i
n
g
a
n
d
I
n
ci
d
en
t
D
i
ag
n
o
s
i
s
,
”
D
i
a
b
e
t
e
s
Ca
r
e
,
v
o
l
.
4
2
,
n
o
.
2
,
p
p
.
2
0
0
-
7
,
2
0
1
9
.
[7
]
W
o
n
d
em
ag
eg
n
A
T
.
,
Bi
z
u
a
y
eh
u
H
M
.
,
A
b
i
e
D
D
.
,
A
y
al
n
eh
G
M
.
,
T
i
r
u
y
e
T
Y
.
,
T
e
s
s
em
a
MT
.,
“
U
n
d
i
ag
n
o
s
e
d
D
i
ab
et
e
s
Me
l
l
i
t
u
s
an
d
Rel
at
ed
Fac
t
o
rs
i
n
E
as
t
G
o
j
j
am
(N
W
E
t
h
i
o
p
i
a)
i
n
2
0
1
6
:
A
Co
mm
u
n
i
t
y
-
Bas
ed
St
u
d
y
,
”
J
o
u
r
n
a
l
of
P
u
b
l
i
c
H
ea
l
t
h
R
es
ea
r
ch
.,
v
o
l
.
6
,
n
o
.
1
,
p
p
.
1
8
-
23
,
2
0
1
7
.
[8
]
K
at
u
l
an
d
a
P
.
,
H
i
l
l
N
R
.
,
St
rat
t
o
n
I
.
,
Sh
e
ri
ff
R
.
,
D
e
S
i
l
v
a
SD
N
.
,
Mat
t
h
ew
s
D
R.
,
“
D
e
v
el
o
p
me
n
t
a
n
d
v
al
i
d
at
i
o
n
o
f
a
D
i
ab
e
t
e
s
Ri
s
k
S
c
o
r
e
fo
r
s
c
r
ee
n
i
n
g
u
n
d
i
a
g
n
o
s
ed
d
i
ab
e
t
e
s
i
n
Sr
i
L
an
k
a
(SL
D
R
I
S
K
)
,
”
B
M
C
E
n
d
o
cr
i
n
e
D
i
s
o
r
d
er
s
,
v
o
l
.
1
6
,
n
o
.
1
,
p
p
.
4
-
9
,
J
u
l
2
0
1
6
.
[9
]
Pi
p
p
i
t
t
K
.
,
L
i
M
.
,
G
u
r
g
l
e
H
E
.
,
“
D
i
ab
e
t
e
s
Me
l
l
i
t
u
s
:
S
c
r
een
i
n
g
a
n
d
D
i
a
g
n
o
s
i
s
,
”
A
m
er
i
ca
n
F
a
m
i
l
y
P
h
ys
i
ci
a
n
.
,
v
o
l
.
9
3
,
n
o
.
2
,
p
p
.
1
0
3
-
9
,
J
an
2
0
1
6
.
[
1
0
]
Be
rn
s
t
e
i
n
J
A
,
Q
u
i
n
n
E
,
A
m
e
l
i
O
,
Cr
ai
g
M,
H
e
e
re
n
T
,
L
e
e
-
P
ar
ri
t
z
A
,
e
t
al
.
,
“
F
o
l
l
o
w
-
u
p
a
f
t
e
r
g
e
s
t
a
t
i
o
n
al
d
i
a
b
et
e
s
:
a
fi
x
a
b
l
e
g
a
p
i
n
w
o
m
e
n
’s
p
re
v
e
n
t
i
v
e
h
e
al
t
h
c
are
,
”
B
M
J
O
p
e
n
D
i
a
b
e
t
e
s
R
e
s
e
a
r
c
h
C
a
r
e
,
v
o
.
5
,
n
o
.
1
,
p
p
.
1
-
1
0
,
Se
p
2
0
1
7
.
[1
1
]
Pu
n
t
h
a
k
ee
Z
.
,
G
o
l
d
e
n
b
e
rg
R
.
,
K
at
z
P.
,
“
D
e
f
i
n
i
t
i
o
n
,
Cl
as
s
i
fi
c
at
i
o
n
a
n
d
D
i
ag
n
o
s
i
s
o
f
D
i
ab
e
t
e
s
,
Pr
e
d
i
ab
e
t
e
s
an
d
Me
t
ab
o
l
i
c
S
y
n
d
r
o
me
,
”
Ca
n
a
n
d
i
a
n
J
o
u
r
n
a
l
D
i
a
b
e
t
es
,
v
o
l
.
1
,
n
o
.
4
2
,
p
p
.
S1
0
-
5,
A
p
r
2
0
1
8
.
[1
2
]
J
i
t
rak
n
at
ee
J
.
,
R
u
e
n
g
o
r
n
C
.
,
N
o
ch
ai
w
o
n
g
S.
,
“
Pre
v
a
l
e
n
ce
a
n
d
R
i
s
k
Fa
c
t
o
rs
o
f
Ch
r
o
n
i
c
K
i
d
n
ey
D
i
s
e
as
e
a
mo
n
g
T
y
p
e
2
D
i
ab
e
t
e
s
Pat
i
e
n
t
s
:
A
Cro
s
s
-
S
e
c
t
i
o
n
a
l
St
u
d
y
i
n
Pr
i
mary
Car
e
Pra
c
t
i
ce
,
”
S
ci
en
t
i
f
i
c
R
ep
o
r
t
s
,
v
o
l
.
1
0
,
n
o
.
6
2
0
5
,
p
p
.
1
-
1
0
,
2
0
2
0
.
[1
3
]
Ch
a
w
l
a
A
.
,
Ch
a
w
l
a
R
.
,
J
ag
g
i
S.
,
“
Mi
c
ro
v
as
u
l
ar
an
d
m
ac
ro
v
as
cu
l
ar
co
m
p
l
i
c
at
i
o
n
s
i
n
d
i
ab
e
t
e
s
mel
l
i
t
u
s
:
D
i
s
t
i
n
c
t
o
r
c
o
n
t
i
n
u
u
m
?
,”
In
d
i
a
n
J
E
n
d
o
c
r
i
n
o
l
o
g
y
M
et
a
b
o
l
i
s
m
.
,
v
o
l
.
2
0
,
n
o
.
4
,
p
p
.
5
4
6
-
5
1
,
2
0
1
6
.
[1
4
]
A
l
i
ci
c
R
Z
.
,
R
o
o
n
ey
MT
.
,
“
T
u
t
t
l
e
K
R.
D
i
ab
e
t
i
c
K
i
d
n
ey
D
i
s
e
as
e:
Ch
a
l
l
en
g
e
s
,
Pro
g
r
e
s
s
,
an
d
P
o
s
s
i
b
i
l
i
t
i
e
s
,
”
Cl
i
n
i
ca
l
Jo
u
r
n
a
l
o
f
t
h
e
A
m
er
i
ca
n
S
o
c
i
et
y
o
f
Nep
h
r
o
l
o
g
y
,
vo
l
.
1
2
,
n
o
.
1
2
,
p
p
.
2
0
3
2
-
4
5
,
2
0
1
7
.
[1
5
]
E
k
o
e
J
-
M
.
,
G
o
l
d
e
n
b
e
rg
R
.
,
K
a
t
z
P
.
,
“
S
c
r
e
e
n
i
n
g
f
o
r
D
i
a
b
e
t
e
s
i
n
A
d
u
l
t
s
,
”
C
a
n
a
d
i
a
n
J
o
u
r
n
a
l
D
i
a
b
e
t
e
s
,
v
o
l
.
4
2
,
n
o
.
1
,
p
p
.
S
1
6
-
9
,
2
0
1
8
.
[1
6
]
Sp
e
ech
l
ey
M
.
,
K
u
n
n
i
l
at
h
u
A
.
,
A
l
u
ck
al
E
.
,
Bal
a
k
ri
s
h
n
a
MS
.
,
Mat
h
ew
B
.
,
G
eo
rg
e
E
K
.
,
“
Sc
r
ee
n
i
n
g
i
n
Pu
b
l
i
c
H
eal
t
h
an
d
Cl
i
n
i
c
al
Car
e
:
S
i
m
i
l
ari
t
i
e
s
an
d
D
i
ff
e
r
e
n
ce
s
i
n
D
e
fi
n
i
t
i
o
n
s
,
T
y
p
e
s
,
an
d
A
i
m
s
-
A
S
y
s
t
em
at
i
c
R
e
v
i
ew
,
”
J
o
u
r
n
a
l
Cl
i
n
i
c
a
l
D
i
a
g
n
o
s
t
i
c
R
es
e
a
r
c
h
JCD
R
.
,
v
o
l
.
1
1
,
n
o
.
3
,
p
p
.
L
E
0
1
-
4
,
Mar
2
0
1
7
.
[1
7
]
V
ei
l
l
e
t
-
Ch
o
w
d
h
u
r
y
M
.
,
Bl
a
n
k
s
t
ei
n
R.
,
“
I
s
t
h
e
r
e
a
r
o
l
e
f
o
r
s
c
r
een
i
n
g
as
y
m
p
t
o
m
at
i
c
p
at
i
en
t
s
w
i
t
h
d
i
ab
e
t
e
s
?
,”
E
x
p
er
t
R
evi
ew
o
f
Ca
r
d
i
o
v
a
s
c
u
l
a
r
Th
e
r
a
p
y
,
v
o
l
.
1
3
,
n
o
.
6
,
p
p
.
5
8
9
-
9
1
,
J
u
n
2
0
1
5
.
[1
8
]
V
al
k
en
g
o
e
d
I
G
M
v
a
n
,
V
l
aar
E
MA
,
N
i
e
rk
en
s
V
.
,
M
i
d
d
el
k
o
o
p
BJ
C,
St
ro
n
k
s
K
.
,
“
T
h
e
U
p
t
ak
e
o
f
S
c
r
een
i
n
g
fo
r
T
y
p
e
2
D
i
ab
e
t
e
s
an
d
Pr
ed
i
ab
e
t
e
s
b
y
M
e
an
s
o
f
G
l
y
c
at
e
d
H
emo
g
l
o
b
i
n
v
e
rs
u
s
t
h
e
O
ral
G
l
u
co
s
e
T
o
l
e
ran
ce
T
e
s
t
amo
n
g
1
8
t
o
6
0
-
Y
e
ar
-
O
l
d
P
eo
p
l
e
o
f
So
u
t
h
A
s
i
an
O
ri
g
i
n
:
A
C
o
m
p
arat
i
v
e
St
u
d
y
,
”
P
l
o
S
O
n
e
.
v
o
l
.
1
0
,
n
o
.
8
,
p
p
.
1
-
12,
2
0
1
5
.
[1
9
]
A
n
d
e
rs
o
n
A
E
,
K
e
rr
W
T
,
T
h
ame
s
A
,
L
i
T
.
,
X
i
ao
J
.
,
Co
h
en
MS.
,
“
E
l
ec
t
r
o
n
i
c
h
e
al
t
h
r
ec
o
r
d
p
h
en
o
t
y
p
i
n
g
i
m
p
ro
v
e
s
d
e
t
ec
t
i
o
n
an
d
s
c
reen
i
n
g
o
f
t
y
p
e
2
d
i
ab
e
t
e
s
i
n
t
h
e
g
e
n
e
r
al
U
n
i
t
ed
St
at
e
s
p
o
p
u
l
at
i
o
n
:
A
c
ro
s
s
-
s
ec
t
i
o
n
al
,
u
n
s
e
l
ec
t
e
d
,
re
t
ro
s
p
ec
t
i
v
e
s
t
u
d
y
,
”
J
o
u
r
n
a
l
B
i
o
m
ed
i
c
a
l
In
f
o
r
m
a
t
i
cs
,
v
o
l
.
6
0
,
p
p
.
1
6
2
-
8
.
2
0
1
6
.
[2
0
]
Be
l
l
o
u
V
.
,
B
e
l
b
as
i
s
L
.
,
T
zo
u
l
a
k
i
I
.
,
E
v
a
n
g
el
o
u
E
.
,
“
Ri
s
k
fac
t
o
rs
fo
r
t
y
p
e
2
d
i
ab
e
t
e
s
me
l
l
i
t
u
s
:
A
n
e
x
p
o
s
u
r
e
-
w
i
d
e
u
m
b
re
l
l
a
r
ev
i
ew
o
f
me
t
a
-
an
al
y
s
e
s
,
”
P
l
o
S
O
n
e
,
v
o
l
.
1
3
,
n
o
.
3
,
p
p
.
1
-
27
,
Mar
2
0
1
8
[2
1
]
Si
u
A
L
.
,
“
Sc
r
ee
n
i
n
g
f
o
r
A
b
n
o
r
m
al
Bl
o
o
d
G
l
u
co
s
e
a
n
d
T
y
p
e
2
D
i
ab
e
t
e
s
Mel
l
i
t
u
s
:
U
.
S.
Pr
e
v
e
n
t
i
v
e
S
e
rv
i
ce
s
T
as
k
Fo
rce
R
ec
o
mmen
d
at
i
o
n
St
at
emen
t
,
”
A
n
n
a
l
s
o
f
In
t
er
n
a
l
M
ed
i
ci
n
e
,
v
o
l
.
1
6
3
,
n
o
.
1
1
,
p
p
.
8
6
1
-
8
,
O
c
t
2
0
1
5
.
[2
2
]
L
e
R
o
i
t
h
D
.
,
Bi
e
s
s
el
s
G
J
.
,
Brai
t
h
w
a
i
t
e
SS
.
,
Cas
an
u
e
v
a
F
F
.
,
D
razn
i
n
B
.
,
H
al
t
e
r
J
B
.
,
e
t
al
.
,
“
T
re
at
me
n
t
o
f
D
i
ab
e
t
es
i
n
O
l
d
e
r
A
d
u
l
t
s
:
A
n
E
n
d
o
c
r
i
n
e
So
ci
e
t
y
Cl
i
n
i
c
al
Pra
c
t
i
ce
G
u
i
d
el
i
n
e
,
”
Th
e
Jo
u
r
n
a
l
o
f
C
l
i
n
i
c
a
l
E
n
d
o
cr
i
n
o
l
o
g
y
a
n
d
M
et
a
b
o
l
i
s
m
,
v
o
l
.
1
0
4
,
n
o
.
5
,
p
p
.
1
5
2
0
-
74,
May
2019.
[2
3
]
Ro
t
h
J
A
.
,
Cart
e
r
-
H
arri
s
L
.
,
Bra
n
d
z
el
S
.
,
B
u
i
s
t
D
SM
.
,
W
e
rn
l
i
K
J
.
,
“
A
q
u
al
i
t
at
i
v
e
s
t
u
d
y
e
x
p
l
o
ri
n
g
p
at
i
en
t
m
o
t
i
v
at
i
o
n
s
fo
r
s
c
r
een
i
n
g
f
o
r
l
u
n
g
c
a
n
ce
r,
”
P
l
o
S
O
n
e
,
v
o
l
.
1
3
,
n
o
.
7
,
p
p
.
1
-
1
0
,
J
u
l
2
0
1
8
.
[2
4
]
A
m
e
r
i
c
an
D
i
ab
e
t
e
s
A
s
s
o
c
i
at
i
o
n
,
“
Cl
as
s
i
fi
c
at
i
o
n
a
n
d
D
i
ag
n
o
s
i
s
o
f
D
i
ab
e
t
e
s
,
”
D
i
a
b
et
es
C
a
r
e
,
v
o
l
.
3
8
,
n
o
.
Su
p
p
l
em
en
t
1
,
p
p
.
S8
-
1
6
,
J
an
2
0
1
5
.
[2
5
]
A
t
y
ab
i
V
C,
K
r
ei
d
e
r
K
E
.
,
“
Sc
reen
i
n
g
fo
r
D
i
ab
e
t
e
s
an
d
S
e
l
f
-
Car
e
i
n
Pat
i
e
n
t
s
W
i
t
h
S
e
v
e
r
e
M
en
t
al
Il
l
n
es
s
,
”
Th
e
Jo
u
r
n
a
l
f
o
r
N
u
r
s
e
P
r
a
ct
i
t
i
o
n
e
r
s
,
v
o
l
.
1
6
,
n
o
.
1
,
p
p
.
e5
-
8
,
J
an
2
0
2
0
.
[2
6
]
Pat
ak
a
A
.
,
K
al
a
m
aras
G
.
,
D
as
k
al
o
p
o
u
l
o
u
E
.
,
A
rg
y
r
o
p
o
u
l
o
u
P.
,
“
Sl
ee
p
q
u
e
s
t
i
o
n
n
ai
r
e
s
fo
r
t
h
e
s
c
reen
i
n
g
o
f
o
b
s
t
ru
c
t
i
v
e
s
l
ee
p
ap
n
e
a
i
n
p
at
i
e
n
t
s
w
i
t
h
t
y
p
e
2
d
i
ab
e
t
e
s
m
el
l
i
t
u
s
co
m
p
ared
w
i
t
h
n
o
n
-
d
i
ab
e
t
i
c
p
at
i
en
t
s
,
”
J
o
u
r
n
a
l
D
i
a
b
e
t
es
,
v
o
l
.
1
1
,
n
o
.
3
,
p
p
.
2
1
4
-
2
2
,
Mar
2
0
1
9
.
[2
7
]
Bo
y
l
e
D
I
R,
V
e
rs
ace
V
L
.
,
D
u
n
b
ar
J
A
.
,
Sch
e
i
l
W
.
,
J
a
n
u
s
E
.
,
O
at
s
J
J
N
.
,
e
t
al
.
,
“
Re
s
u
l
t
s
o
f
t
h
e
fi
rs
t
r
e
co
r
d
ed
e
v
a
l
u
at
i
o
n
o
f
a
n
at
i
o
n
al
g
e
s
t
at
i
o
n
a
l
d
i
ab
e
t
e
s
mel
l
i
t
u
s
reg
i
s
t
e
r:
Ch
a
l
l
en
g
e
s
i
n
s
c
r
een
i
n
g
,
reg
i
s
t
rat
i
o
n
,
an
d
fo
l
l
o
w
-
up
fo
r
d
i
ab
e
t
e
s
ri
s
k
,
”
P
l
o
S
O
n
e
,
v
o
l
.
1
3
,
n
o
.
8
,
p
p
.
1
-
1
5
,
2
0
1
8
.
[2
8
]
D
i
C
i
an
n
i
G
.
,
G
u
a
l
d
a
n
i
E
.
,
B
e
r
n
i
C
.
,
M
e
u
cci
A
.
,
Ro
t
i
L
.
,
L
en
c
i
o
n
i
C
.
,
e
t
a
l
.
,
“
Sc
r
ee
n
i
n
g
f
o
r
g
e
s
t
at
i
o
n
al
d
i
ab
e
t
es
i
n
T
u
s
c
an
y
,
I
t
al
y
.
A
p
o
p
u
l
at
i
o
n
s
t
u
d
y
,
”
D
i
a
b
et
e
s
R
es
ea
r
c
h
Cl
i
n
i
c
a
l
P
r
a
ct
i
ce
,
v
o
l
.
132
,
p
p
.
1
4
9
-
5
6
.
O
c
t
2
0
1
7
.
[2
9
]
T
e
mn
e
an
u
O
.
,
T
ran
d
af
i
r
L
.
,
P
u
r
c
ar
e
a
M.
,
“
T
y
p
e
2
d
i
ab
e
t
e
s
mel
l
i
t
u
s
i
n
ch
i
l
d
r
en
an
d
a
d
o
l
e
s
cen
t
s
:
a
r
e
l
at
i
v
e
l
y
n
ew
c
l
i
n
i
c
al
p
r
o
b
l
em
w
i
t
h
i
n
p
e
d
i
at
ri
c
p
rac
t
i
ce
,
”
J
o
u
r
n
a
l
M
ed
i
ca
l
Li
f
e
,
v
o
l
.
9
,
n
o
.
3
,
p
p
.
2
3
5
-
9
,
2
0
1
6
.
[3
0
]
H
an
n
a
FW
.
,
W
i
l
k
i
e
V
.
,
I
s
s
a
BG
,
Fr
y
e
r
A
A
.
,
“
Rev
i
s
i
t
i
n
g
s
c
r
ee
n
i
n
g
fo
r
t
y
p
e
2
d
i
ab
e
t
e
s
me
l
l
i
t
u
s
:
t
h
e
c
as
e
f
o
r
an
d
ag
ai
n
s
t
u
s
i
n
g
H
b
A
1
c,
”
B
r
i
t
i
s
h
Jo
u
r
n
a
l
o
f
G
en
er
a
l
P
r
a
ct
i
ce
,
v
o
l
.
6
5
,
n
o
.
6
3
3
,
p
p
.
e
2
7
8
-
8
0
,
A
p
r
2
0
1
5
.
Evaluation Warning : The document was created with Spire.PDF for Python.