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Ada A1c Goal

New Ada Position Statement: Lower Target A1c For Type 1 Diabetes

New Ada Position Statement: Lower Target A1c For Type 1 Diabetes

During the American Diabetes Association (ADA) 74th Scientific Sessions, held at the Moscone Center in San Francisco, June 13-17, 2014, David Maahs, MD, a pediatric endocrinologist at the Barbara David Center for Childhood Diabetes, Children’s Hospital Colorado, and the University of Colorado Denver, moderated a panel discussion about the ADA’s position statement on its recommendation to lower its target blood glucose levels for children with Type 1 Diabetes (T1D). Panel members: Anne Peters, MD, FACP, Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA Lori Laffel, MD, Chief, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center and Associate Professor of Pediatrics, Harvard Medical School, Boston, MA Sue Kirkman, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, SC Jane L. Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association, Alexandria, VA Identify Type 1 Diabetes Treatment Needs “This process didn’t actually begin with wanting to change a pediatric target,” rather “the interest was to create a separate position statement for the treatment of type 1 diabetes, because type 1 and type 2 diabetes are not the same disease,” stated Dr. Peters. The ADA’s position statement evolved from the creation of the Type 1 Diabetes Sourcebook, which was written by the panel members and many other authors. Dr. Peters explained the goal of the position statement is to cover the needs of people of all ages with T1D. She pointed out that “we don’t even know how many people have T1D” because many patients receive treatment through a primary care provider. Dr. Peters broadly estimated the number to be “on the ord Continue reading >>

Your A1c Levels – What Goal To Shoot For?

Your A1c Levels – What Goal To Shoot For?

Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d 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 >>

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 >>

Ada 'deeply Concerned' By New Acp Recommendations For Diabetes Management

Ada 'deeply Concerned' By New Acp Recommendations For Diabetes Management

ADA 'Deeply Concerned' by New ACP Recommendations for Diabetes Management Both groups agree that care should be individualized and that the focus should be on patients The American Diabetes Association has responded with 'deep' concern to a recent hemoglobin A1C target guidance authored by the American College of Physicians (ACP). The ACP guidance states that for 'most' diabetes patients, clinicians should aim to achieve an HbA1c level of between 7 to 8%. In their response, the ADA has called the target 'not reflective of the long-term benefits of lower A1C targets'. Although the ADA agrees with many areas of the ACP guidance, there are several significant areas that differentiate from the ADA's 2018 Standards of Care. Based on international clinical trials (ACCORD, ADVANCE, VADT and UKPDS), the ADA recommends a reasonable A1C goal for adults with type 2 diabetes of 7%. The ACP guidance does not consider the long-term benefits of lower A1C targets, which can reduce diabetes complications, says the ADA. Contrary to this, the ACP guidance states that for patients who achieve HbA1c levels of 6.5%, clinicians should consider deintensifying pharmacologic therapy. HbA1c-Lowering Effects of DPP4i Therapy May Be Blunted by Diet In patients of advanced age, both organizations generally agree on end-of-life recommendations, however the ADA disagrees with the ACP recommendation that HbA1c targets should be avoided in patients with a life expectancy of 10 years (80 years old), residence in nursing homes, or in those with chronic conditions. The ADA states that each case should be considered individually as, a person living in a nursing home or with a chronic condition may yet have some years to live, and would likely prefer to live them without diabetes complications.' By lumping Continue reading >>

Dueling Type 2 Diabetes Guidelines: Sorting It Out

Dueling Type 2 Diabetes Guidelines: Sorting It Out

Dueling Type 2 Diabetes Guidelines: Sorting It Out Hello. I'm Jay Shubrook, DO, professor in the Primary Care Department at Touro University, California. Today we're going to talk about diabetes guidelines that don't seem to all match with each other. How do we make sense of this, and what are we to do? I can remember a day when I knew metformin was the first option for treatment of type 2 diabetes, but I didn't really know what to do after metformin. There was not was a lot of guidance. Now, we have many guidelines telling us how we can move forward with the treatment, particularly in terms of pharmacotherapy. However, those guidelines don't all match, and this can be a real challenge particularly in primary care, the front line of treating diabetes. In this commentary, I hope to review these guidelines, highlight the differences and similarities, and provide some suggestions about how we move forward. I think it is important to note that all of these algorithms agree that we should be individualizing our therapy. Earlier this year, the American College of Physicians (ACP) released a guideline for pharmacotherapy of type 2 diabetes .[ 1 ] This was a provocative statement that has received a lot of media attention, and has caused some confusion in primary care. There are four major tenets in this guidance: First, ACP recommends that we should be individualizing therapy, particularly A1c goals for adults with type 2 diabetes. Second, the target A1c goal should be between 7% and 8% in most people. Third, we need to deintensify glucose control in patients whose A1c is at 6.5% or lower. Fourth, we need to deintensify treatment for people with limited life expectancy, primarily older adults, those with less than 10 years' life expectancy, or serious comorbid disorders. This 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 >>

Tailoring Treatment To Reduce Disparities:

Tailoring Treatment To Reduce Disparities:

The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

Test Id: Hba1c Hemoglobin A1c, Blood

Test Id: Hba1c Hemoglobin A1c, Blood

Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled. Hemoglobin A1c (HbA1c) is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period (approximately 8-12 weeks, depending on the individual) and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations. Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. Diagnosis of diabetes includes 1 of the following: -Fasting plasma glucose > or =126 mg/dL -Symptoms of hyperglycemia and random plasma glucose >or =200 mg/dL -Two-hour glucose > or =200 mg/dL during oral glucose tolerance test unless there is unequivocal hyperglycemia, confirmatory testing should be Continue reading >>

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 >>

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 >>

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 >>

American Diabetes Association Deeply Concerned About New Guidance From American College Of Physicians Regarding Blood Glucose Targets For People With Type 2 Diabetes

American Diabetes Association Deeply Concerned About New Guidance From American College Of Physicians Regarding Blood Glucose Targets For People With Type 2 Diabetes

American Diabetes Association Deeply Concerned About New Guidance from American College of Physicians Regarding Blood Glucose Targets for People with Type 2 Diabetes The ADA is deeply concerned by the new guidance, Hemoglobin A1C Targets for Glycemic Control with Pharmacologic Therapy for Nonpregnant Adults with Type 2 Diabetes Mellitus: A Guidance Statement Update from the American College of Physicians, published in the Annals of Internal Medicine on March 5, 2018. While there are several topics listed in the American College of Physicians (ACPs) statement on which we agree, there are several significant areas that do not align with ADAs 2018 Standards of Medical Care in Diabetes (Standards of Care). The American Diabetes Association has published the annual Standards of Care since 1989, the global resource for the optimal treatment and prevention of diabetes and diabetes-related complications. The ADA has long recommended that treatment goals be individualized based on factors both modifiable and nonmodifiable, such as age, life expectancy, duration of disease, resources and support, and comorbid conditions. The ADA recommends that a reasonable A1C goal for many nonpregnant adults with type 2 diabetes is less than 7 percent based on the available evidence to date from the ACCORD, ADVANCE, VADT and UKPDS international clinical trials, which were evaluated and incorporated into ADAs Standards of Care. ACPs new guidance does not consider the positive legacy effects of intensive blood glucose control confirmed in multiple clinical trials and, therefore, are not reflective of the long-term benefits of lower A1C targets. There is clear, convincing evidence of a long-term reduction in diabetes complications with A1Cs at and below 7 percent. ADA is also concerned by the mis Continue reading >>

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