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Metformin Effective Dose

Metformin

Metformin

Postmarketing cases of Metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of Metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and Metformin plasma levels generally >5 mcg/mL (see PRECAUTIONS). Risk factors for Metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g. carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage Metformin-associated lactic acidosis in these high risk groups are provided (see DOSAGE AND ADMINISTRATION, CONTRAINDICATIONS, and PRECAUTIONS). If Metformin-associated lactic acidosis is suspected, immediately discontinue Metformin and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended (see PRECAUTIONS). Table 1: Select Mean (±S.D.) Metformin Pharmacokinetic Parameters Following Single or Multiple Oral Doses of Metformin Hydrochloride Tablets Subject Groups: Metformin hydrochloride tablets dose* (number of subjects) Cmax† (mcg/mL) Tmax‡ (hrs) Renal Clearance (mL/min) * All doses given fasting except the first 18 doses of the multiple dose studies † Peak plasma concentration ‡ Time to peak plasma concentration § Co Continue reading >>

Variations In Metformin Prescribing For Type 2 Diabetes

Variations In Metformin Prescribing For Type 2 Diabetes

Abstract Background: Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. Methods: An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. Results: There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Conclusions: Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. Methods A 14-item survey was developed and modified based on feedback from a small focus group of pr Continue reading >>

Metformin, Oral Tablet

Metformin, Oral Tablet

Metformin oral tablet is available as both a generic and brand-name drug. Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza. Metformin is also available as an oral solution but only in the brand-name drug Riomet. Metformin is used to treat high blood sugar levels caused by type 2 diabetes. FDA warning: Lactic acidosis warning This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. Lactic acidosis is a rare but serious side effect of this drug. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking this drug and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include tiredness, weakness, unusual muscle pain, trouble breathing, unusual sleepiness, stomach pains, nausea (or vomiting), dizziness (or lightheadedness), and slow or irregular heart rate. Alcohol use warning: You shouldn’t drink alcohol while taking this drug. Alcohol can affect your blood sugar levels unpredictably and increase your risk of lactic acidosis. Kidney problems warning: If you have moderate to severe kidney problems, you have a higher risk of lactic acidosis. You shouldn’t take this drug. Liver problems warning: Liver disease is a risk factor for lactic acidosis. You shouldn’t take this drug if you have liver problems. Metformin oral tablet is a prescription drug that’s available as the brand name drugs Glucophage, Glucophage XR, Fortamet, and Glumetza. Glucophage is an immediate-release tablet. All of the other brands are extended-r Continue reading >>

A Comprehensive Guide To Metformin

A Comprehensive Guide To Metformin

Metformin is the top of the line medication option for Pre-Diabetes and Type 2 Diabetes. If you must start taking medication for your newly diagnosed condition, it is then likely that your healthcare provider will prescribe this medication. Taking care of beta cells is an important thing. If you help to shield them from demise, they will keep your blood sugar down. This medication is important for your beta cell safety if you have Type 2 Diabetes. Not only does Metformin lower blood sugar and decrease resistance of insulin at the cellular level, it improves cell functioning, lipids, and how fat is distributed in our bodies. Increasing evidence in research points to Metformin’s effects on decreasing the replication of cancer cells, and providing a protective action for the neurological system. Let’s find out why Lori didn’t want to take Metformin. After learning about the benefits of going on Metformin, she changed her mind. Lori’s Story Lori came in worrying. Her doctor had placed her on Metformin, but she didn’t want to get the prescription filled. “I don’t want to go on diabetes medicine,” said Lori. “If I go on pills, next it will be shots. I don’t want to end up like my dad who took four shots a day.” “The doctor wants you on Metformin now to protect cells in your pancreas, so they can make more insulin. With diet and exercise, at your age, you can reverse the diagnosis. Would you like to talk about how we can work together to accomplish that?” “Reverse?” she asked. “What do you mean reverse? Will I not have Type 2 Diabetes anymore?” “You will always have it, but if you want to put it in remission, you are certainly young enough to do so. Your doctor wants to protect your beta cells in the pancreas. If you take the new medication, Continue reading >>

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Metformin in the diabetic elderly patient: an old, safe and effective treatment Over-65 diabetics represent about half of the patients visiting general practitioners. Although diabetes pathogenesis in geriatric and young age are similar, treatment gold standards and clinical conditions are extremely variable, requiring a more individualised approach.1 In this context, a recent review points out that there is no clear evidence for the optimal glycaemic target in the elderly patient and that patient’s preferences and pharmacologic burden must be taken into consideration, within the therapeutic choices, together with the possible risks and benefits associated to single treatments.2 This study also suggests a HbA1c value between 7.5% and 9.0% as optimal glycaemic target in the elderly patient. Steps for the individualised treatment of diabetes in the elderly patient:2 Estimate desired benefits upon the life expectancy Estimate the risks potentially associated with intensive glycaemic control (age, polypharmacy, disease duration, social support) Particularly in the elderly patient, the onset of hypoglycaemia is often associated with severe consequences and is facilitated by several factors, such as polypharmacy and the risk of subsequent interactions, the mistakes caused by the reduced ability of handling medicines, the inability of evaluating the relation between ingested carbohydrates and the therapy, the scarce symptomatology of neuropathies and the reduced adrenergic reaction.3 Hypoglycaemia absolute risk increases with age, therefore in elderly diabetics it is often preferable to avoid intensive hypoglycaemic treatments that increase the risk of hypoglycaemia4 whilst low hypoglycaemia risk treatments should be privileged, even at the expense of a less than optimal gl Continue reading >>

Metformin Dosage 250mg Is Too Low?

Metformin Dosage 250mg Is Too Low?

Friend Thin super-active but rising FBG; Mom T2 I felt nothing after one week on 250mg glucostage. Maybe the dosage is too low and too soon to share experience. I read someone saying met needs at least 1000mg to start working, is it true? I am considering raising it to 850mg XR after 90days, when I will do a blood testing At first metformin 500 mg worked but eventually needed more and that is when i couldnt handle the side effects. Also you have to eat low carb with it to work good D.D. Family Getting much harder to control A lot depends on what your eating. Met can not counter act what carbs do. Also it could take 6 weeks to fully work most likely they started you low dose to prevent stomach issues. I started 500mg for first week and then upped to 1000mg. As furball says the initial lower dose is so your body adjusts. 250 does sound a bit low though. I am also taking 2.5mg of glipizide once a day. Friend Thin super-active but rising FBG; Mom T2 I work hard to persuade dr. for even 250mg dosage because in their book the patient is normal unless FBG is 7+ or HBA1c is 6.5%+ After 3 months, I will have the battle to get 850mg XR ... I truely believe Met needs more dosage to work.. 250mg, which is too low, is wasting my kidney and my time.... D.D. Family Getting much harder to control Friend Thin super-active but rising FBG; Mom T2 it's like eating much salt while I am not a salty dinner fan... Met is dumped by my kidney, right? My lovely organ should not "in vain" function, my opinion... D.D. Family Getting much harder to control Met works in the liver and reduces insulin resistance and you been on it only one week it's not like a pancreas stimulating med. D.D. Family diabetic since 1997, on insulin 2000 When I first started metformin, I had to raise it to 2550 mg before Continue reading >>

"low Dose" Metformin Improves Hyperglycemia Better Than Acarbose In Type 2 Diabetics

Rev Diabet Stud. 2004 Summer; 1(2): 8994. Published online 2004 Aug 10. doi: 10.1900/RDS.2004.1.89 "Low Dose" Metformin Improves Hyperglycemia Better Than Acarbose in Type 2 Diabetics 1Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan 2Department of Internal Medicine, Hamamatsu Red Cross Hospital, Hamamatsu, 430-0907, Japan 3Department of Internal Medicine, Tokyo Denryoku Hospital, Tokyo, 160-0016, Japan Address correspondence to: Akira Shimada, e-mail: [email protected] Copyright 2004, SBDR - Society for Biomedical Diabetes Research This article has been cited by other articles in PMC. OBJECTIVES: "High dose" metformin therapy (2,550 mg/day) is reported to improve glycemic control in type 2 diabetic patients with obesity (body mass index (BMI) 30). Some have reported that metformin therapy, even in low doses (500-750 mg/day), improves glycemic control in non-obese type 2 diabetic patients (BMI approximately 25). However, it is unclear whether "low dose" metformin improves glycemic control better than acarbose in non-obese type 2 diabetic patients, which has been shown to improve glycemic control in type 2 diabetes with obesity. METHODS: We randomly divided 22 non-obese type 2 diabetic patients (mean BMI approximately 25) into two groups (A = 11, B = 11). Group A was treated with "low dose" metformin (500-750 mg/day) for 3 months, and switched to acarbose (150-300 mg/day) for another 3 months. Group B was treated with acarbose first, and then switched to "low dose" metformin. RESULTS: "Low dose" metformin significantly decreased the fasting plasma glucose (FPG) and HbA1c level in both groups A and B, whereas acarbose decreased HbA1c levels in group B but not in group A. Overall, "low dose" met Continue reading >>

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Abstract The management of T2DM requires aggressive treatment to achieve glycemic and cardiovascular risk factor goals. In this setting, metformin, an old and widely accepted first line agent, stands out not only for its antihyperglycemic properties but also for its effects beyond glycemic control such as improvements in endothelial dysfunction, hemostasis and oxidative stress, insulin resistance, lipid profiles, and fat redistribution. These properties may have contributed to the decrease of adverse cardiovascular outcomes otherwise not attributable to metformin’s mere antihyperglycemic effects. Several other classes of oral antidiabetic agents have been recently launched, introducing the need to evaluate the role of metformin as initial therapy and in combination with these newer drugs. There is increasing evidence from in vivo and in vitro studies supporting its anti-proliferative role in cancer and possibly a neuroprotective effect. Metformin’s negligible risk of hypoglycemia in monotherapy and few drug interactions of clinical relevance give this drug a high safety profile. The tolerability of metformin may be improved by using an appropiate dose titration, starting with low doses, so that side-effects can be minimized or by switching to an extended release form. We reviewed the role of metformin in the treatment of patients with type 2 diabetes and describe the additional benefits beyond its glycemic effect. We also discuss its potential role for a variety of insulin resistant and pre-diabetic states, obesity, metabolic abnormalities associated with HIV disease, gestational diabetes, cancer, and neuroprotection. Introduction The discovery of metformin began with the synthesis of galegine-like compounds derived from Gallega officinalis, a plant traditionally em Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex This medicine usually comes with a patient information insert. Read the information carefully and make sure you understand it before taking this medicine. If you have any questions, ask your doctor. Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed. Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it. While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way. You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the Continue reading >>

Effective Dosage For Metformin

Effective Dosage For Metformin

Diabetes Forum The Global Diabetes Community This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Get the Diabetes Forum App for your phone - available on iOS and Android . Find support, ask questions and share your experiences. Join the community Discussion in ' Metformin/Biguanides ' started by LittleGreyCat , Dec 2, 2014 . I'm going back on Metformin for the winter because my weight loss has stalled and my exercise has gone down due to dodgy weather and dodgy knees. Looking through this forum, there are suggestions that the dosage I was on (500mg twice a day) is too low to have much effect. Any guidance on how much is considered to be effective, or do you just ramp up slowly until you see a distinct change in your fasting BG? i,ve just been upped on metformin too 3000mg from 1500mg. so the old rate wasn,t doing anything for me so it was doubled and only started the new dosage today so will see if they will help with losing weight I kept records when I was on Metformin and I kept records when I wasn't on Metformin and I couldn't tell the difference. With the agreement of my DN I have stopped taking it. I started on glucophage and increased it to 2000mg a day...one morning and lunch and two with evening meal.It has only been on the high dose that it has brought my sugars down from 12/13 to 6/8.I do low carb and have been on the exercise bike for 20mins every day since starting the glucophage.I am pleased the sugars are falling but my weight has not changed at all I was told metformin probably wouldn't affect my weight but with low carbing and more exercise I am disappointed. Next review on Monday with DN .She did mention starting gliptins last time but I personally feel the longer term safety is unproven so am not Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

High-dose Metformin Safe, Effective In Japanese Adults With Type 2 Diabetes

High-dose Metformin Safe, Effective In Japanese Adults With Type 2 Diabetes

In Japanese adults with poorly controlled type 2 diabetes, high doses of metformin administered twice or three times daily improved fasting plasma glucose and 24-hour glycemic profile in a dose-dependent fashion, according to findings reported in the Journal of Diabetes Investigation. “While the usual dosage of metformin is over 2,000 mg per day in Europe and the USA, the maximum dose allowed for clinical use in Japan has long been limited to 750 mg per day, which is less than half that of Western countries,” Hiroshi Ikegami, MD, PhD, of the department of endocrinology, metabolism and diabetes at Kindai University in Osaka, Japan, and colleagues wrote. “In addition, the recommended prescription of the maximum dose of metformin in Japan (750 mg per day) has been via 250-mg tablets administered three times per day. ... These differences in dosage and dosing frequency of metformin between Japan and Western countries have made it difficult to translate the results of clinical trials in Western countries to Japanese patients.” In two prospective studies, Ikegami and colleagues analyzed data from 71 Japanese patients with type 2 diabetes recruited between August 2011 and October 2016 from Kindai University Hospital (39 men; mean age, 61 years; mean BMI, 27 kg/m²; mean diabetes duration, 8.4 years; mean FPG, 7.5 mmol/L). All patients were provided standard meals recommended by the Japan Diabetes Society, and treatment with metformin was not initiated until patient FPG reached 11 mmol/L or less, to minimize the confounding effect of an initial improvement in glycemic control due to hospitalization. In the total cohort, 14 patients were treated with metformin monotherapy, whereas 54 patients were prescribed metformin as an add-on therapy to other antidiabetes medication Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying the Effect of Metformin Treatment and Dose on Glycemic Control Jennifer A. Hirst , MSC,1 Andrew J. Farmer , MD,1 Raghib Ali , MSC,2,3 Nia W. Roberts , MSC,4 and Richard J. Stevens , PHD1 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 2Cancer Epidemiology Unit, University of Oxford, Oxford, U.K. 3Department of Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 2Cancer Epidemiology Unit, University of Oxford, Oxford, U.K. 3Department of Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates 4Bodleian Health Care Libraries, University of Oxford, Oxford, U.K. Corresponding author: Jennifer A. Hirst, [email protected] . Received 2011 Aug 3; Accepted 2011 Oct 31. Copyright 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literatur Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Abstract OBJECTIVE Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literature to quantify the effect of metformin treatment on glycated hemoglobin (HbA1c) levels in all types of diabetes and examine the impact of differing doses on glycemic control. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, and the Cochrane Library were searched from 1950 to June 2010 for trials of at least 12 weeks’ duration in which diabetic patients were treated with either metformin monotherapy or as an add-on therapy. Data on change in HbA1c were pooled in a meta-analysis. Data from dose-comparison trials were separately pooled. RESULTS A total of 35 trials were identified for the main analysis and 7 for the dose-comparison analysis. Metformin monotherapy lowered HbA1c by 1.12% (95% CI 0.92–1.32; I2 = 80%) versus placebo, metformin added to oral therapy lowered HbA1c by 0.95% (0.77–1.13; I2 = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA1c by 0.60% (0.30–0.91; I2 = 79.8%) versus insulin only. There was a significantly greater reduction in HbA1c using higher doses of metformin compared with lower doses of metformin with no significant increase in side effects. CONCLUSIONS Evidence supports the effectiveness of metformin therapy in a clinically important lowering of HbA1c used as monotherapy and in combination with other therapeutic agents. There is potential for using higher doses of metformin to maximize glycemic control in diabetic patients without increasing gastrointestinal effects. Metformin is the most commonly prescribed antihyperglycemic medication for diabetes in the U.S. (1) and the U.K. (2) and is the recommended first choice for oral therapy (2–4). T Continue reading >>

Metformin Dosage

Metformin Dosage

Metformin Dosage There have been no human studies to identify the optimal dose of metformin that is needed to duplicate the beneficial gene expression effects that are described in the June 2003 issue of Life Extension magazine. For people who want to derive the many proven health benefits of metformin, it might be prudent to follow the dosage schedule used by Type II diabetics. According to the Physician's Desk Reference, the starting dose should be 500 mg of metformin twice a day. (An alternative option is 850 mg of metformin once a day). After one week, increase the dose of metformin to 1000 mg as the first dose of the day and 500 mg as the second dose. After another week, increase to 1000 mg of metformin two times a day. The maximum safe dose described in the Physician's Desk Reference is 2550 mg a day (which should be taken as 850 mg three times a day). According to the Physician's Desk Reference, clinically significant responses in Type II diabetics are not seen at doses below 1500 mg a day of metformin. Anti-aging doctors, on the other hand, have recommended doses as low as 500 mg twice a day to healthy non-diabetics who are seeking to obtain metformin's other proven benefits such as enhancing insulin sensitivity and reducing excess levels of insulin, glucose, cholesterol and triglycerides in the blood. It could be the dosage range is highly individualistic in healthy people, meaning some may benefit from 500 mg twice a day, while others may need 1000 mg twice a day for optimal effects. Blood tests to ascertain if the dose of metformin you are taking is improving glucose/insulin metabolism would be: Hemoglobin A1c Fasting insulin CBC/Chemistry panel that includes glucose, cholesterol triglycerides and indicators of liver and kidney function A hemoglobin A1c test Continue reading >>

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