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Classification Of Diabetes Mellitus New Criteria

Evaluation Of The New Ada And Who Criteria For Classification Of Diabetes Mellitus In Young Adult People (15–34 Yrs) In The Diabetes Incidence Study In Sweden (diss)

Evaluation Of The New Ada And Who Criteria For Classification Of Diabetes Mellitus In Young Adult People (15–34 Yrs) In The Diabetes Incidence Study In Sweden (diss)

Abstract We aimed to evaluate how an aetiology-based classification, as recommended in the ADA and WHO guidelines for classification of diabetes mellitus, matches clinical judgement in the Diabetes Incidence Study in Sweden (DISS), a study covering incident cases of diabetic patients aged 15 to 34 years. During a 1-year period (1998), blood samples were taken at diagnosis and 4 months (median) thereafter. Patients were classified according to clinical judgement by the reporting physicians and assessments of islet antibodies (ICA, GADA, and IA-2A) and plasma C-peptide. In 1998, 422 patients were registered in DISS. Among the 313 patients participating in the follow-up, most with clinical Type 1 diabetes (185/218, 85%, 95% CI 79–89%) were islet antibody positive (ab+) at diagnosis. In addition, 14 out of 58 (24%, 14–37%) with clinical Type 2 diabetes and 21 out of 37 (57%, 40–73%) with unclassifiable diabetes were antibody positive at diagnosis. Further to this, 4 out of 33 (12%, 3–28%) were antibody negative with clinical Type 1 diabetes and 4 out of 44 (9%, 3–22%) with Type 2 had converted to antibody positive at follow-up. Among those who were constantly antibody negative, 10 out of 29 (34%, 18–54%) with clinical Type 1 and 1 out of 16 (6%, 0–30%) with unclassifiable diabetes had fasting plasma C-peptide concentrations below the normal range (<0.25 nmol/l) at follow-up. Conclusion/interpretation Most young adults with clinical Type 1 diabetes (199/218, 91%) had objective Type 1 (ab+ at diagnosis/follow-up and/or low fasting plasma C-peptide concentrations at follow-up), as did one third (18/58, 31%) with clinical Type 2 diabetes and more than half (22/37, 59%) with unclassifiable diabetes. About 10% of those who were antibody negative converted to antibod Continue reading >>

Diagnosis And Classification Of Diabetes Mellitus

Diagnosis And Classification Of Diabetes Mellitus

Go to: DEFINITION AND DESCRIPTION OF DIABETES MELLITUS Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of differentorgans, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia. Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome. Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascul Continue reading >>

Diagnosis And Classification Of Diabetes Mellitus: New Criteria

Diagnosis And Classification Of Diabetes Mellitus: New Criteria

New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms “type 1” and “type 2” instead of “IDDM” and “NIDDM” to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease. Diabetes mellitus is a group of metabolic disorders with one common manifestation: hyperglycemia. Chronic hyperglycemia causes damage to the eyes, kidneys, nerves, heart and blood vessels. The etiology and pathophysiology leading to the hyperglycemia, however, are markedly different among patients with diabetes mellitus, dictating different prevention strategies, diagnostic screening methods and treatments. The adverse impact of hyperglycemia and the rationale for aggressive treatment have recently been reviewed.1 In June 1997, an international Continue reading >>

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

Clinical Presentation And Diagnosis Of Diabetes Mellitus In Adults

INTRODUCTION The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. Every few years, the diabetes community reevaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice. The American Diabetes Association (ADA) issued diagnostic criteria for diabetes mellitus in 1997, with follow-up in 2003 and 2010 [1-3]. The diagnosis is based on one of four abnormalities: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose tolerance test (OGTT) (table 1). Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as having increased risk for diabetes or prediabetes. (See 'Diagnostic criteria' below.) Screening for and prevention of diabetes is reviewed elsewhere. The etiologic classification of diabetes mellitus is also discussed separately. (See "Screening for type 2 diabetes mellitus" and "Prevention of type 2 diabetes mellitus" and "Prevention of type 1 diabetes mellitus" and "Classification of diabetes mellitus and genetic diabetic syndromes".) CLINICAL PRESENTATION Type 2 diabetes is by far the most common type of diabetes in adults (>90 percent) and is characterized by hyperglycemia and variable degrees of insulin deficiency and resistance. The majority of patients are asymptomatic, and hyperglycemia is noted on routine laboratory evaluation, prompting further testing. The frequency of symptomatic diabetes has been decreasing in parallel wi Continue reading >>

Report Of The Committee On The Classification And Diagnostic Criteria Of Diabetes Mellitus☆

Report Of The Committee On The Classification And Diagnostic Criteria Of Diabetes Mellitus☆

Abstract In 1995, the Japan Diabetes Society (JDS) appointed the Committee for the Classification and Diagnosis of Diabetes Mellitus. The Committee presented a final report in May 1999 in Japanese. This is the English version with minor modifications for readers outside Japan.Concept of diabetes mellitus: Diabetes mellitus represents a group of diseases of heterogeneous etiology, characterized by chronic hyperglycemia and other metabolic abnormalities, which are due to deficiency of insulin effect. After a long duration of metabolic derangement, specific complications of diabetes (retinopathy, nephropathy, and neuropathy) may occur. Arteriosclerosis is also accelerated. Depending on the severity of the metabolic abnormality, diabetes may be asymptomatic, or may be associated with symptoms (thirst, polyuria, and weight loss), or may progress to ketoacidosis and coma.Classification (cf. Tables 1 and 2 and Fig. 1): Both etiological classification and staging of pathophysiology by the degree of deficiency of insulin effect need to be considered. The etiological classification of diabetes and related disorders of glycemia includes, (1) type 1; (2) type 2; (3) those due to specific mechanisms and diseases; and (4) gestational diabetes mellitus. Type 1 is characterized by destructive lesions of pancreatic β cells either by an autoimmune mechanism or of unknown cause. Type 2 diabetes is characterized by combinations of decreased insulin secretion and decreased insulin sensitivity (insulin resistance). Category (3) includes two subgroups; subgroup A is diabetes in which specific mutations have been identified as a cause of genetic susceptibility, while subgroup B is diabetes associated with other pathologic conditions or diseases. The staging of glucose metabolism includes norm Continue reading >>

Classification And Diagnosis Of Diabetes

Classification And Diagnosis Of Diabetes

Historically, diabetes has been broken down into two main categories: type 1 diabetes, previously called juvenile diabetes, and type 2 diabetes, previously called adult onset diabetes. Much has been learned about the underlying nature of diabetes in recent years and the classification and diagnosis of diabetes has changed to reflect this new knowledge. Doctors no longer refer to just two types of diabetes, and though most people with diabetes have either type 1 or type 2, diabetes comes in many forms. The two main types of diabetes -- type 1 and type 2 -- are fundamentally different conditions that can require very different treatments to achieve the common goal of keeping blood glucose levels as close to normal as possible. Focus on the cause of diabetes rather than the treatment regimen Develop a standard that can be used worldwide Eliminate the confusion surrounding the use of insulin In addition, declaring fasting blood sugar levels above 126 mg/dl (7.0 mmol/l) to be diabetes reflects data that indicates that the risk of microvascular complications from high blood sugar levels increases significantly around 126 mg/dl. The Committee hopes that the new diagnostic guidelines will bring up to two million Americans with diabetes into the health care system for treatment before they develop complications. Note that the new classification guidelines use Arabic numbers (1 and 2) rather than Roman numerals (I and II), and that the terms insulin-dependent diabetes and noninsulin-dependent diabetes are no longer used. Classification of Diabetes Type 1 Characterized by beta cell destruction, usually leading to absolute insulin deficiency. Type 1 diabetes accounts for 5-10% of people with diabetes. It has two forms: Immune-Mediated Diabetes Mellitus: Results from a cellular medi Continue reading >>

Report Of The Committee

Report Of The Committee

Report of the Committee on the classification and diagnostic criteria of diabetes mellitus The Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus Yutaka Seino • Kishio Nanjo • Naoko Tajima • Takashi Kadowaki • Atsunori Kashiwagi • Eiichi Araki • Chikako Ito • Nobuya Inagaki • Yasuhiko Iwamoto • Masato Kasuga • Toshiaki Hanafusa • Masakazu Haneda • Kohjiro Ueki � The Japan Diabetes Society 2010 Keywords Diabetes mellitus � Clinical diagnosis � HbA1c Summary Concept of diabetes mellitus Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long-term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder. Classification (Tables 1, 2; Fig. 1) The classification of glucose metabolism disorders is principally derived from etiology, and includes staging of pathophysiology based on the degree of deficiency of insulin action. These disorders are classified into four groups: (i) type 1 diabetes mellitus; (ii) type 2 diabetes mellitus; (iii) diabetes mellitus those due to other specific mechanisms or diseases; and (iv) gestational diabetes mellitus. Type 1 diabetes is characterized by destruction of pancreatic b-cells. Type 2 diabetes is characterized by combinations of decreased insulin secretion and decreased insulin sensitivity (insulin Continue reading >>

New Diagnostic Criteria New Classification Of Dm And Modern Therapy Approach

New Diagnostic Criteria New Classification Of Dm And Modern Therapy Approach

Ivana Pavlić-Renar, Ph.D. Vuk Vrhovac University Clinic, Zagreb, Croatia 1.1 Introduction The current classification of diabetes mellitus, proposed by the American Diabetic Association (ADA) in 1997 (1,2), and accepted in a slightly revised form as a working classification by World Health Organisation (WHO) (3), is an attempt of staging diabetes mellitus. This takes into account current knowledge on the aetiology and natural history of the disease and has therapeutic implications. Figure 1 shows the natural history of various types of diabetes regarding the need for insulin treatment. Since another speaker will discus diagnostic criteria and classification in more details, this talk is more treatment-oriented. Figure 1. Types and stages of diabetes ((2) - modified) 1.2. Type 1 diabetes treatment Type 1 diabetes is less common (less than 10% of total number of diabetics have this type of disease) and its basic characteristic is lack of insulin caused predominantly by autoimmune destruction of pancreatic b-cells. The younger the affected individual is the more rapid is the destruction. However, it is clear that before signs and symptoms develop each patient goes through glucose intolerance stages caused by relative lack of insulin. Finally, all type 1 diabetics inevitably require insulin for survival. The essence of treatment of type 1 diabetes is adequate insulin supplementation. It is not possible without proper education, meal planning (diet) and exercise � cornerstones of diabetes regulation. A landmark study (Diabetes Control Complication Trial - DCCT) confirmed that basal � bolus insulin treatment is a treatment of choice for type 1 patients (3). Insulin is delivered by multiple injections: 1-3 doses of intermediate or long acting insulin or insulin analogue fo Continue reading >>

New Classification And Diagnostic Criteria For Diabetes Mellitus.

New Classification And Diagnostic Criteria For Diabetes Mellitus.

Abstract There has been an explosive growth in knowledge about diabetes mellitus since the National Diabetes Data Group promulgated diagnostic criteria and a classification system in 1979 that was largely adopted by the World Health Organization. However, recent findings regarding the levels of glucose associated with development of retinopathy, and growing confusion caused by a system of classification of diabetes based largely on the treatment used have led to a new assessment of the diagnosis and classification of diabetes mellitus. Using new data from population-based studies, and placing emphasis on a pathophysiology-based system of classification, in 1997, the Expert Committee of the American Diabetes Association released its recommendations for the classification and diagnosis of diabetes. The major changes from the 1979 report include: (a) the preferred use of the terms "type 1" and "type 2" instead of "insulin-dependent" and "non-insulin-dependent" to designate the two major types of diabetes mellitus; (b) a simplification of the diagnostic test to two fasting plasma glucose (FPG) determinations; and (c) a lower cutoff for FPG (126 mg/dL) to diagnose diabetes (this level of FPG having been found equivalent to the 200-mg/dL value in the oral glucose tolerance test for diagnosis). These changes provide an easier and more reliable means of diagnosing persons at risk of complications of hyperglycemia. Even though the fasting criterion was lowered, the total number of persons who will be diagnosed with diabetes by exclusive reliance on FPG will actually be somewhat less than with the old criteria. Moreover, epidemiologic data support the recommendation that screening for diabetes should start at age 45 and be repeated every 3 years in persons without risk factors, a Continue reading >>

2. Classification And Diagnosis Of Diabetes

2. Classification And Diagnosis Of Diabetes

Classification Diabetes can be classified into the following general categories: Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (due to a progressive loss of insulin secretion on the background of insulin resistance) Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS or after organ transplantation) This section reviews most common forms of diabetes but is not comprehensive. For additional information, see the American Diabetes Association (ADA) position statement “Diagnosis and Classification of Diabetes Mellitus” (1). Type 1 diabetes and type 2 diabetes are heterogeneous diseases in which clinical presentation and disease progression may vary considerably. Classification is important for determining therapy, but some individuals cannot be clearly classified as having type 1 or type 2 diabetes at the time of diagnosis. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both cohorts. Occasionally, patients with type 2 diabetes may present with diabetic ketoacidosis (DKA). Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia and approximately one-third with DKA (2). The onset of type 1 diabetes may be more variable in adults, and they may not present with t Continue reading >>

New Diagnostic Criteria For Diabetes And Mortality In Older Adults

New Diagnostic Criteria For Diabetes And Mortality In Older Adults

Sir We found the report by Patricia Wahl and co-workers1 and the accompanying commentary by Harry Keen2 of interest. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus has published a report last year that lays out new criteria for assigning meaning to blood sugars.3 The new diagnostic criteria were revised to avoid the discrepancy between the fasting plasma glucose and 2 h plasma glucose after oral glucose tolerance test cutpoint values and to facilitate and encourage the use of a simpler and equally accurate test-fasting plasma glucose- for diagnosing diabetes.3 The most obvious reason for developing new criteria was to take advantage of the new and better information about the predictive power of blood sugar concentrations that has become available during the past 20 years. The Committee did find a statistical relation between glycosylated haemoglobin and blood sugar concentrations as predictors of risk for microvascular and macrovascular complications in individual patients and populations. We used the new diagnostic criteria of diabetes in a previously published cross-sectional study of the prevalence and distribution of diabetes among people aged 40-69 years in Galicia (northwest Spain).4 We studied 1275 people randomly chosen from the electoral roll. Diabetes was diagnosed by previous history or if fasting plasma glucose was 7·8 mmol/L or more. The prevalence of diabetes was 7·5% irrespective of sex or habitat (urban or rural) and increased significantly with age and body-mass index. For epidemiological studies, estimates of diabetes prevalence and incidence with the new diagnostic criteria, could be based on one fasting plasma glucose value of 7 mmol/L or more.3 With this new diagnostic criteria, we found a prevalence of diabetes of Continue reading >>

Diagnosis And Classification Of Diabetes Mellitus: New Criteria.

Diagnosis And Classification Of Diabetes Mellitus: New Criteria.

Abstract New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms "type 1" and "type 2" instead of "IDDM" and "NIDDM" to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease. Continue reading >>

Will New Diagnostic Criteria For Diabetes Mellitus Change Phenotype Of Patients With Diabetes? Reanalysis Of European Epidemiological Data

Will New Diagnostic Criteria For Diabetes Mellitus Change Phenotype Of Patients With Diabetes? Reanalysis Of European Epidemiological Data

Since scans are not currently available to screen readers, please contact JSTOR User Support for access. We'll provide a PDF copy for your screen reader. Objective: To evaluate the impact of the revised diagnostic criteria for diabetes mellitus adopted by the American Diabetes Association on prevalence of diabetes and on classification of patients. For epidemiological purposes the American criteria use a fasting plasma glucose concentration ≥ 7.0 mmol/l in contrast with the current World Health Organisation criteria of 2 hour glucose concentration ≥ 11.1 mmol/l. Design: Data were collected from 13 populations and three occupational based studies from eight European countries. All studies used a 75 g oral glucose tolerance test to measure fasting and 2 hour glucose concentrations. Subjects: 17 881 men; 8309 women; age range 17-92 years. Main outcome measures: Classification of diabetes according to both sets of criteria. Results: The application of the American criteria on European populations induced changes in prevalence of diabetes ranging from a reduction of 4.0% to an increase of 13.2%. A total of 1517 previously undiagnosed individuals had diabetes according to either the WHO or the American criteria. Among 1044 with diabetes according to American criteria, only 45% had 2 hour values fulfilling the WHO criteria. The risk of disagreement of classification decreased with increasing body mass index (P < 0.00001) and increasing age (P < 0.0001); the impact of sex was not significant (P = 0.08). Conclusions: This shift in strategy from using 2 hour to fasting plasma glucose will cause an increase in the prevalence of diabetes in some European populations. A high degree of disagreement in the classification was observed between the two recommendations. Prospective da Continue reading >>

Who Diagnostic Criteria As A Validation Tool For The Diagnosis Of Diabetes Mellitus: A Study In Five European Countries

Who Diagnostic Criteria As A Validation Tool For The Diagnosis Of Diabetes Mellitus: A Study In Five European Countries

Objective: In 1999, the World Health Organization (WHO) published new diagnostic criteria for diabetes mellitus (DM). The cut-off value of the fasting plasma glucose concentration was lowered from 7.8 to 7.0 mmol/l. The WHO criteria were used to validate the diagnosis made by the general practitioner, and to compare the diagnostic validity of diabetes mellitus in different countries. Methods: We retrospectively analysed 2556 newly diagnosed diabetics. Incidence was calculated according to the 1999 WHO criteria. Data were collected in general practice networks in five European countries or regions (Belgium, England, the Netherlands, Portugal, Spain). Results: According to the WHO criteria, 82% of the cases were valid diagnoses. Compared to the total group, in Spain, significantly more diagnoses were in agreement with the WHO criteria, whereas this number was significantly lower in England and Portugal. From the patients whose diagnosis was not in agreement with the WHO criteria, significantly more were women than men. Conclusion: By using the WHO diagnostic criteria, the international standard, as a validation tool, we show that the diagnoses of diabetes mellitus made in primary care are valid. Furthermore, we show that these diagnoses are comparable between countries. Therefore, information from general practice registration networks is a valuable and valid source for international comparisons. Continue reading >>

International Textbook Of Diabetes Mellitus, 4th Ed., Excerpt #1: Classification Of Diabetes Mellitus And Other Categories Of Glucose Intolerance Part 1 Of 6

International Textbook Of Diabetes Mellitus, 4th Ed., Excerpt #1: Classification Of Diabetes Mellitus And Other Categories Of Glucose Intolerance Part 1 Of 6

Introduction A critical requirement for orderly epidemiologic, genetic and clinical research, and indeed for the management of diabetes mellitus and other forms of glucose intolerance is an appropriate classification system. Furthermore, a hallmark in the process of understanding the etiology of a disease and studying its natural history is the ability to identify and differentiate its various forms and place them into a rational etiopathologic framework. While there have been a number of sets of nomenclature and diagnostic criteria proposed for diabetes, no systematic categorization existed until the mid 1960s [1]. Now diabetes mellitus is recognized as being a syndrome, a collection of disorders that have hyperglycemia and glucose intolerance as their hallmark, due either to insulin deficiency or to impaired effectiveness of insulin’s action, or to a combination of these. Historical perspective and current classifications Previous classifications In 1965, an Expert Committee on Diabetes Mellitus published the first World Health Organization (WHO) report on diabetes classification [1]. The report includes one of the first attempts at international consensus on a classification. They decided to classify diabetes: “… based on the age of recognized onset, which seemed to be the only reliable means of classification for universal use.” The report also recognized certain specific types of diabetes including brittle, insulin-resistant, gestational, pancreatic, endocrine, and iatrogenic diabetes. Since then, several pathogenic mechanisms have been described and long-term studies have shown different courses and outcomes of different types of diabetes. A revised classification of glucose intolerance, was formulated by the National Diabetes Data Group (NDDG) [2]. This w Continue reading >>

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