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A1c Goals

Boston, Usa

Boston, Usa

8/7/2015 1 ADA Type 1 Diabetes Guidelines Pediatric and Adult Patients with T1D: Glycemic Targets and more Lori Laffel MD MPH Chief, Pediatric, Adolescent & Young Adult Section Senior Investigator, Genetics and Epidemiology Section Professor of Pediatrics Boston, USA AADE New Orleans, LA Disclosures Consultant • Johnson & Johnson, Eli Lilly, Sanofi-Aventis, NovoNordisk, Bristol Myers Squibb, Menarini, Bayer Healthcare (grant support), LifeScan/Animas, Roche Diagnostics, Oshadi, Dexcom, Boehringer Ingelheim Content of lecture unrelated to above 2014 CDC June Report • Prevalence estimates of T1D in youth 0-19 and T2D in youth 10-19 in 2001 and 2009 in 5 representative US areas in the SEARCH Study • T1D prevalence: 1.48/1000 in 2001 (1/676) 1.93/1000 in 2009 (1/518) • T2D prevalence: 0.34/1000 in 2001 (1/2941) 0.46/1000 in 2009 (1/2174) • T1D increased 21.1% (95% CI, 15.6-27.0%)* • T2D increased 30.5% (95% CI, 17.3-45.1%)* * After adjustment for case ascertainment T1D in Adults • No precise estimates of T1D in adults >20 y/o • Greatest number of patients with T1D are adults: – Increasing numbers of patients diagnosed with T1D at all ages – Patients w/ childhood onset T1D survive to adulthood • Estimated that 50-75% of T1D diagnosed in childhood (25-50% diagnosed in adulthood) • LADA: latent autoimmune diabetes in adults – ~9% of adults with diabetes ages 30-70 have +GAD ab – Prolonged period of residual beta cell function (T1DX) – Additional peak age of onset of T1D in 6th to 7th decades of life • Diabetes Care. 2015 Mar;38(3):476-81. Diabetes Care. 2015 Mar;38(3):476-81. Residual C-peptide present in 1/3 persons with T1D of 3+ years duration 8/7/2015 2 • Glycemic tar Continue reading >>

Acp Calls For Moderate Glycemic Control In Type 2 Diabetes

Acp Calls For Moderate Glycemic Control In Type 2 Diabetes

ACP Calls for Moderate Glycemic Control in Type 2 Diabetes On March 6, the American College of Physicians (ACP) published new evidence-based guidance statements in Annals of Internal Medicine(annals.org) that focus on loosening glycemic control targets. The ACP recommended patients with type 2 diabetes be treated to achieve a hemoglobin A1c (HbA1c) level between 7 percent and 8 percent rather than the widely accepted range of 6.5 percent to 7 percent. "ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms," said ACP President Jack Ende, M.D., in a news release.(www.acponline.org) "The evidence shows that for most people with type 2 diabetes, achieving an A1c between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden and costs." On March 6, the American College of Physicians (ACP) published new evidence-based guidance statements in Annals of Internal Medicine on loosening glycemic control targets. The ACP recommended patients with type 2 diabetes be treated to achieve a hemoglobin A1c between 7 percent and 8 percent rather than the widely accepted range of 6.5 percent to 7 percent. The ACP also released three other guidance statements on selecting targets for pharmacologic treatment of type 2 diabetes. Noting the policy implications of its recommendations, the ACP suggested that any physician performance measures developed to evaluate quality of care should not have a target HbA1c level below 8 percent for any patient population and should not have any HbA1c targets for elderly adults Continue reading >>

Ada Tightens A1c Goals For Children

Ada Tightens A1c Goals For Children

The ADA calls for better blood glucose control in its first-ever Type 1 diabetes position paper. Scientists from the American Diabetes Association (ADA) held an open Twitter chat to discuss new guidelines for children with Type 1 diabetes, as part of the rollout of the association’s first Type 1-only position paper. Endocrinologists Dr. Jane Chiang and Dr. Sue Kirkman fielded questions for the ADA. In a move that stirred up online chatter, the ADA tightened its A1C goals for children. Previously, ADA guidelines called for A1C goals of 8.5 or lower for children under 6 years old, 8.0 or lower for children ages 6 to 12, and then 7.5 or lower for teens. The new guidelines now call for an A1C score of 7.5 or lower for all children, regardless of age. The recently-released position paper is the first from the ADA to discuss Type 1 diabetes exclusively. In the past, Type 1 and Type 2 guidelines were lumped together. Issuing Type 1-only position papers will help physicians focus on the unique characteristics and treatment options for Type 1, Dr. Chiang said. “Diabetes is not a one-size-fits-all disease, and it’s important that we recognize that,” Dr. Chiang said A1C goals for children were tightened because new research shows that children with high blood glucose levels before puberty are at greater risk for heart and kidney problems later on in life, according to Dr. Chiang. A1C guidelines always must balance the long-term health impact of high blood glucose levels with the short-term danger of hypoglycemia. In the past, an A1C goal of 7.5 or lower for children seemed too difficult to reach without risking increased hypoglycemia. Dr. Kirkman believes that pumps and other advances in diabetes home care technology will now make such a goal more attainable without dire r Continue reading >>

Rethinking A1c Goals For Type 2 Diabetes

Rethinking A1c Goals For Type 2 Diabetes

Treat the patient, not the number. This is a very old and sound medical school teaching. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health. Uncontrolled type 2 diabetes (also known as adult-onset diabetes) is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients. One easy, accurate way for us to measure a persons blood sugar over time is the hemoglobin A1c (HbA1c) level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months. Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people (not necessarily including the elderly or very ill), with a lower goal closer to normal, or under 6.5% for younger people. We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didnt meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still werent at goal, then it was time to start insulin injections. While all this sounds very orderly and clinically rational, in practice it hasnt worked very well. I have seen firsthand how enthusiastic attention to the A1c can be help Continue reading >>

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Setting Appropriate A1c Goals For Patients With Type 2 Diabetes

Condition Center Home > Clinical Essentials Setting Appropriate A1C Goals for Patients With Type 2 Diabetes Are the ADA's A1C target recommendations for type 2 diabetes patients too conservative? Or is the AACE/ACE Consensus Statement's approach too aggressive? Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendationsand associated management philosophyto which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 According to ADA guidelines, the standard A1C goal for adults with T2DM is 7.0%, but this can vary depending on individual patient profiles. The AACE/ACE recommendations are more aggressive, with a target A1C of ?6.5% to minimize risk of diabetes-related complications. Until large clinical trials utilizing newer therapies are done to evaluate the risks and benefits of intensive therapy, it is likely that the ADA and AACE/ACE recommendations will continue to differ. The ADA suggests that physicians may lower the A1C target Continue reading >>

Healthy A1c Goal

Healthy A1c Goal

Ads by Google Don't think as unattainable by staring up the steps; you must step up the stairs to achieve. Fit non-diabetic person’s A1C percentage is always within 4.2 to 4.6%. These numbers are only from individuals who is fit, non-obese, active, and on a healthy diet. The A1C result depends upon how well you are maintaining your blood-glucose level. If you are maintaining your blood sugar at an optimal range 70-85mg/dl (3.9-4.7mmol/l) at most of the time, then your A1C be in the normal range 4.2-4.6%. A1C goal advised by American Diabetes Association (ADA) A1C goal of 6.5% or less is a more stringent goal. This A1C target is for people who does not experience many hypoglycemia episodes. This may be for individuals who have recently diagnosed with diabetes. A1C goal of 7% is reasonable. This A1C target is for many adults with diabetes who are not pregnant. A1C goal of 7.5% is for children with diabetes (0 to 18 years old). In children, younger than 6 years may be unable to recognize hypoglycemia symptoms. A1C goal of 8% or less is considered a less stringent goal. This A1C target may be for people with severe hypoglycemia experience. This may be for individuals who have many years of diabetes and who have low life expectancy. A1C goal advised by Canadian Diabetes Association (CDA) A1C goal of 6.5% or less is for type 2 diabetics to lower nephropathy and retinopathy risk further. They must balance against hypoglycemia risk. A1C goal of 7.1-8.5% is for those who has longstanding diabetes with a history of recurrent severe hypoglycemia. And for those who has limited life expectancy. This target is for those who is hard to achieve an A1C ≤7%. That too after effective doses of multiple anti-hyperglycemic agents, including intensified basal-bolus insulin therapy. A1C go Continue reading >>

Elderly A1c Targets: Should Older People Have More Relaxed Glucose Goals?

Elderly A1c Targets: Should Older People Have More Relaxed Glucose Goals?

You may have read that the lower your A1C level, the better. For best health, people with diabetes should aim for glucose as close to normal as possible. But some new research shows this may not be true for older people. According to these studies, seniors could decide not to shoot for tight control of blood sugar or cholesterol. One study from Japan showed that lower HbA1c levels (a measure of average glucose control over the previous 2–3 months) were actually linked with an increased the risk of frailty in older adults. Frailty was measured in the study as how much help a person needs in living, and how poorly he or she recovers from an illness or injury. Toshihiko Yanase, MD, PhD of Fukuoka University School of Medicine, Japan, reported, “The risk factors of metabolic syndrome, such as high blood glucose, obesity, high cholesterol, and hypertension, in middle age may shift from an unfavorable risk to favorable factors in old age.” The study was published in the Journal of Diabetes Investigation and reported by the online site Healio.com. Yanase and colleagues analyzed data from 132 adults aged at least 65 years with Type 2 diabetes Average age was 78. The subjects had had diabetes for an average of 17 years and their mean A1C was 7.3%. The subjects were categorized as frail or not on a 9-point clinical frailty scale (CFS). The CFS goes from 1 (very fit) to 9 (terminally ill). People who rated 5 or higher were classed as frail. Seventy-seven were not frail; 55 were. In those with higher frailty scores, HbA1c levels were found to be significantly lower. The causes of frailty are not well understood. In men, frailty is strongly associated with loss of muscle mass. As you get weaker and thinner, you become more fragile. The same is probably true of women, although Continue reading >>

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at Annals.org on 6 March 2018. * This paper, authored by Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; and Mary Ann Forciea, MD, was developed for the Clinical Guidelines Committee of the American College of Physicians. Individuals who served on the Clinical Guidelines Committee from initiation of the project until its approval were Mary Ann Forciea, MD (Chair); Nick Fitterman, MD; Kate Balzer, MSW; Michael J. Barry, MD; Cynthia Boyd, MD, MPH; Carrie Horwitch, MD, MPH; Linda L. Humphrey, MD, MPH; Alfonso Iorio, MD, PhD; Devan Kansagara, MD, MCR; Jennifer Lin, MD, MCR; Scott Manaker, MD, PhD; Michael Maroto, JD, MBA; Robert McLean, MD; Reem Mustafa, MD, PhD, MPH; Janice Tufte; Sandeep Vijan, MD, MS; and Timothy J. Wilt, MD, MPH. Approved by the ACP Board of Regents on 26 March 2017. Author (participated in discussion and voting). Nonauthor contributor (participated in discussion but excluded from voting). American College of Physicians, Philadelphia, Pennsylvania (A.Q.) Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.) Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.) Virginia Mason Medical Center, Seattle, Washington (C.H.) Massachusetts General Hospital, Boston, Massachusetts (M.J.B.) University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.) Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update h Continue reading >>

Whats My A1c Goal?: Diabetes Forecast

Whats My A1c Goal?: Diabetes Forecast

I am 82 years old. Im really confused because I have always read that an A1C of 7 percent and below is the norm, but my doctor says that at my age 8 percent is OK. Meek C. Kiker Jr., Cantonment, Florida The prime directive in setting diabetes treatment goals and developing a treatment plan is to individualize therapy. One size does not fit all when it comes to A1C targets. In general, we think about an A1C of less than 7 percent as a starting point. We then consider whether or not the target should be higher or lower based on a persons individual situation. Younger people have more to gain from tight control because they have decades of diabetes ahead of them and therefore more time to develop complications. Additionally, they usually have fewer health conditions, such as heart disease , that might make more aggressive treatment risky. A1C targets for younger individuals may be 6.5 or even 6 percentif they can be reached safely. Those with frequent low blood glucose and with poor warning symptoms of lows may need to have higher A1C goals. With respect to older individuals, there is evidence that too-tight glucose control is associated with a greater risk for early death, including death from cardiovascular disease. Tight control in this age group, as in others, is associated with an increased risk of hypoglycemia , which can lead to falls and injuries. Older people may not sense hypoglycemia as easily. Because complications take years to develop, older adults may not experience the long-term benefits of tight glucose control, and these risks may therefore be justified. Prevention of short-term complications of high blood glucose such as fatigue, blurry vision, and dehydration can be achieved with higher A1C targets. These considerations have led some professional organ Continue reading >>

6. Glycemic Targets

6. Glycemic Targets

Assessment of Glycemic Control Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C. Continuous glucose monitoring (CGM) may be a useful adjunct to SMBG in selected patients. Recommendations When prescribed as part of a broader educational context, SMBG results may help guide treatment decisions and/or self-management for patients using less frequent insulin injections B or noninsulin therapies. E When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results, and their ability to use SMBG data to adjust therapy. E Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. B When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥25 years) with type 1 diabetes. A Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. B CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. C Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. E When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use. E Self-monit Continue reading >>

The A1c Test & Diabetes

The A1c Test & Diabetes

What is the A1C test? The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research. How does the A1C test work? The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent. Can the A1C test be used to diagnose type 2 diabetes and prediabetes? Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes.1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes. Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis. Why should a person be tested for diabetes? Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and li Continue reading >>

Type 2 Diabetes Glucose Management Goals

Type 2 Diabetes Glucose Management Goals

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients Continue reading >>

The American College Of Physicians Recommends A1c Levels Between 7 And 8 Percent : Shots - Health News : Npr

The American College Of Physicians Recommends A1c Levels Between 7 And 8 Percent : Shots - Health News : Npr

A major medical association today suggested that doctors who treat people with Type 2 diabetes can set less aggressive blood sugar targets. But medical groups that specialize in diabetes sharply disagree. Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines. The American College of Physicians has reviewed those guidelines to provide its own recommendations , published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C. "There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets," says Dr. Jack Ende , president of the ACP. "And for that reason, this is not the kind of situation where the college could just sit back and ignore things." The ACP, which represents internists, recommends that doctors aim for an A1C in the range of 7 to 8 percent, not the lower levels that other groups recommend. For people who have already achieved a lower level, "consider de-intensifying treatment," Ende says. "That is, reducing one of the medications, stopping a medication, just allow the A1C to be between 7 and 8." This Chef Lost 50 Pounds And Reversed Prediabetes With A Digital Program Some studies have shown that people who have aggressively pushed to lower their blood sugar are at somewhat higher risk of premature death. People also suffer from low blood sugar as a result of aggressive treatment. That was the case for Valerie Pennington, a special-needs teacher who lives in Odessa, Mo. She was diagnosed in her mid-40s and put on an aggressive treatment regime. "The nurse at school because I was going low so much made me ge Continue reading >>

A1c Test And A1c Calculator | Accu-chek

A1c Test And A1c Calculator | Accu-chek

A1C levels explanation and A1C calculator Your A1C test result (also known as HbA1c or glycated hemoglobin) can be a good general gauge of your diabetes control, because it provides an average blood glucose level over the past few months. Unlike daily blood glucose test results, which are reported as mg/dL, A1C is reported as a percentage. This can make it difficult to understand the relationship between the two. For example, if you check blood glucose 100 times in a month, and your average result is 190 mg/dL this would lead to an A1C of approximately 8.2%, which is above the target of 7% or lower recommended by the American Diabetes Association (ADA) for many adults who are not pregnant. For some people, a tighter goal of 6.5% may be appropriate, and for others, a less stringent goal such as 8% may be better.1 Talk to your doctor about the right goal for you. The calculation below is provided to illustrate the relationship between A1C and average blood glucose levels. This calculation is not meant to replace an actual lab A1C result, but to help you better understand the relationship between your test results and your A1C. Use this information to become more familiar with the relationship between average blood glucose levels and A1Cnever as a basis for changing your disease management. See how average daily blood sugar may correlate to A1C levels.2 Enter your average blood sugar reading and click Calculate. *Please discuss this additional information with your healthcare provider to gain a better understanding of your overall diabetes management plan. The calculation should not be used to make therapy decisions or changes. Performed by your doctor during your regular visits, your A1C test measures your average blood sugar levels by taking a sample of hemoglobin A1C c Continue reading >>

Doctors' Group Issues Controversial Type 2 Diabetes Guidance

Doctors' Group Issues Controversial Type 2 Diabetes Guidance

The American College of Physicians (ACP) has issued new guidance on managing type 2 diabetes -- including relaxing the long-term blood sugar target called hemoglobin A1C. The A1C is a blood test that gives doctors an estimate of your blood sugar level average over the past few months. For most adults, the American Diabetes Association recommends a target A1C of below 7 percent. This goal may be altered based on individual circumstances. However, the new ACP guidance suggests that A1C should be between 7 and 8 percent for most adults with type 2 diabetes . For adults who achieve an A1C below 6.5 percent, the group suggests stepping down diabetes treatment to keep that level from going even lower. The American College of Physicians, which is a national organization of internal medicine doctors, also says that management goals should be personalized based on the benefits and risks of medications, patient preference, general health status and life expectancy. And, though the doctors' group has relaxed the suggested A1C targets, that doesn't mean type 2 diabetes isn't a serious problem. "These changes should in no way be interpreted as diabetes is unimportant," said Dr. Jack Ende, ACP's president. More than 29 million Americans have diabetes. Over time, high blood sugar levels can lead to vision loss , nerve problems, heart attacks, strokes and kidney failure. "Diabetes is such a prevalent problem, and there are so many guidelines and conflicting information out there, we wanted to do an assessment that would give our members the best possible advice," Ende said. "Also, A1C targets are being used now as a performance measure." And, when insurers expect all patients to fall under a certain A1C, that's "not always consistent with the best possible evidence," he explained. For Continue reading >>

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