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Oh KM, Cieslowski B, Beran K, Elnahas NH, Steves SL, Sutter RE. Nurse-led telehealth and mobile health care models for type 2 diabetes and hypertension in low-income US populations: A scoping review. J Am Assoc Nurse Pract 2024; 36:565-575. [PMID: 39042268 DOI: 10.1097/jxx.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic. PURPOSE To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations. METHODOLOGY Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases). RESULTS Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement. CONCLUSIONS Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care. IMPLICATIONS Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, Virginia
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Langford AT, Orellana K, Buderer N, Andreadis K, Williams SK. Role of digital health communication, sociodemographic factors, and medical conditions on perceived quality of patient-centered communication. PATIENT EDUCATION AND COUNSELING 2024; 119:108054. [PMID: 37992528 DOI: 10.1016/j.pec.2023.108054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To simultaneously explore associations between digital health, sociodemographic factors, and medical conditions on patient-centered communication (PCC). These are under-explored, yet important knowledge gaps to fill because perceived quality PCC may influence health information seeking behaviors and health outcomes. METHODS Data from the 2019 Health Information National Trends Survey were analyzed. The primary outcome was PCC, which was the summed score of 7 PCC-related questions. Factors of interest included whether participants used electronic methods to communicate with health professionals, age, gender, race/ethnicity, education, feelings about household income, and history of medical conditions. Descriptive statistics and linear regressions were conducted. RESULTS In the multivariate linear regression model, people aged 65-74 years compared with 18-34 year-olds, those with some college compared with college graduates, and those who felt they were living comfortably on their household income compared with all others reported higher PCC scores. People with a history of hypertension compared with those without reported higher PCC scores. CONCLUSION Similar to past studies, sociodemographic factors were associated with PCC. A novel finding was that a history hypertension was associated with perceived quality of PCC. PRACTICE IMPLICATIONS This research may inform methods to enhance communication between patients and clinicians.
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Affiliation(s)
- Aisha T Langford
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Kerli Orellana
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, USA
| | | | - Katerina Andreadis
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, USA
| | - Stephen K Williams
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, USA; Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, USA
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Ortiz-Zúñiga Á, Simó-Servat O, Amigó J, Sánchez M, Morer C, Franch-Nadal J, Mayor R, Snel T, Simó R, Hernández C. Efficacy of Insulin Titration Driven by SMS in Improving Glycemic Control in People with Type 2 Diabetes. J Clin Med 2023; 12:6364. [PMID: 37835008 PMCID: PMC10573537 DOI: 10.3390/jcm12196364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
AIM To evaluate the efficacy of the self-management of insulin titration based on information received by the Short Message Service (SMS). METHODS A case-control study including 59 subjects in each arm with 16 weeks of follow-up was performed. The inclusion criteria were: (1) Subjects with type 2 diabetes (T2D) under basal insulin treatment; (2) Suboptimal glycemic control: HbA1c ≥ 7.5% and fasting capillary blood glucose (FCBG) > 140 mg/dL (>3 times per week). Subjects were invited to use an insulin titration service based on SMS feedback aimed at optimizing glycemic control depending on fasting blood glucose levels. Psychological aspects were evaluated in the interventional group by means of validated questionnaires (DDS, HADS and SF-12). RESULTS The intervention group achieved a lower mean FCBG (126 mg/dL ± 34 vs. 149 mg/dL ± 46, p = 0.001) and lower HbA1c (7.5% ± 1.3 vs. 7.9% ± 0.9, p = 0.021) than the control group. In addition, the intervention group showed a significant improvement in psychological aspects related to Emotional Burden (p = 0.031), Regimen Distress (p < 0.001), Depression (p = 0.049) and Mental Health (p < 0.01). CONCLUSIONS The SMS-guided titration was effective in terms of improving glucometric parameters in comparison with the standard of care and improved significant psychological aspects-mainly, the stress associated with insulin treatment.
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Affiliation(s)
- Ángel Ortiz-Zúñiga
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Olga Simó-Servat
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Judit Amigó
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Mónica Sánchez
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
| | - Carla Morer
- Primary Health Care Center EAP 8K Rio de Janeiro, Institut Català de la Salut, UTAC Muntanya, 08016 Barcelona, Spain;
| | - Josep Franch-Nadal
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, 08001 Barcelona, Spain
| | - Regina Mayor
- Roche Diabetes Care Spain SL, 08174 Barcelona, Spain;
| | - Tim Snel
- Roche Diabetes Care Nederland B.V., NL-1322 Almere, The Netherlands;
| | - Rafael Simó
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Cristina Hernández
- Endocrinology and Nutrition Department, Vall d’Hebron Hospital Campus, 08035 Barcelona, Spain; (O.S.-S.); (J.A.); (M.S.); (R.S.)
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain;
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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Chu MP, Many G, Isquith DA, McKeeth S, Williamson J, Neradilek MB, Colletti P, Zhao XQ. Metabolic and inflammatory risk reduction in response to lipid-lowering and lifestyle modification in the medically underserved individuals. Am J Prev Cardiol 2021; 7:100227. [PMID: 34401861 PMCID: PMC8358155 DOI: 10.1016/j.ajpc.2021.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 10/26/2022] Open
Abstract
Introduction Medically underserved (US) populations have an increased level of atherosclerotic cardiovascular disease (ASCVD) risk, however, few studies investigated ASCVD risk reduction in US. Methods Of 217 subjects with ApoB ≥120 mg/dL and carotid atherosclerosis (≥15% stenosis by ultrasound) enrolled in the Carotid Plaque Composition by MRI (CPC) study between 2005 and 2011, US (n=33) was defined as those without adequate healthcare insurance, while AS (n=184) included those with adequate healthcare coverage. All subjects received atorvastatin-based lipid therapies and lifestyle intervention for 2 years. Metabolic and inflammatory risk factors were compared between AS and US. Results At baseline, compared to AS, US displayed higher levels of metabolic and inflammatory risk including systolic blood pressure (140±27 vs. 131±18 mmHg, p=0.04), fasting glucose (125±59 vs. 102±22 mg/dL, p=0.03) and fasting insulin (39±33 vs. 28±20 µU/dL, p=0.03) which resulted in higher insulin resistance (HOMA-IR 2.2±0.4 vs. 1.3±0.1, p=0.03), and hsCRP (5.6±1.5 vs. 2.8±0.2 mg/L, p=0.03). Over 2 years of intervention, US and AS showed similar reductions in LDL-C (-10.7% vs. -16% per year, p=0.2), triglycerides (-16.7% vs. -15.9% per year, p=0.4), and hsCRP (-0.11% vs. -0.04% per year, p=0.1). However, US continued to show significantly higher levels of fasting blood glucose (115±6.0 vs. 101±2.0 mg/dL, p=0.03) and HOMA-IR (1.9±0.2 vs. 1.5±0.1, p=0.047), and hsCRP (3.9±0.7 vs. 1.9±0.2 mg/L, p<0.001) than AS following 2 years of interventions. Conclusions US displayed higher ASCVD risk than AS at baseline and over 2 years despite similar reductions following the intervention. These findings highlight the unmet needs for improved intervention strategies and implementation methods for ASCVD risk reduction in US. Clinical Trial Registration NCT00715273 at ClinicalTrials.gov.
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Affiliation(s)
- Michael P Chu
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Gina Many
- (GM) Community Health of Central Washington; Yakima, WA, United States
| | - Daniel A Isquith
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Susan McKeeth
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Jayne Williamson
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Moni B Neradilek
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States
| | - Patrick Colletti
- University of Southern California, Keck Hospital of USC; Los Angeles, CA, United States
| | - Xue-Qiao Zhao
- Clinical Atherosclerosis Research Lab, University of Washington Division of Cardiology; Seattle, WA, United States.,(GM) Community Health of Central Washington; Yakima, WA, United States.,University of Southern California, Keck Hospital of USC; Los Angeles, CA, United States
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Challenges of conducting a remote behavioral weight loss study: Lessons learned and a practical guide. Contemp Clin Trials 2021; 108:106522. [PMID: 34352387 DOI: 10.1016/j.cct.2021.106522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe challenges and lessons learned in conducting a remote behavioral weight loss trial. METHODS The Personal Diet Study is an ongoing randomized clinical trial which aims to compare two mobile health (mHealth) weight loss approaches, standardized diet vs. personalized feedback, on glycemic response. Over a six-month period, participants attended dietitian-led group meetings via remote videoconferencing and were encouraged to self-monitor dietary intake using a smartphone app. Descriptive statistics were used to report adherence to counseling sessions and self-monitoring. Challenges were tracked during weekly project meetings. RESULTS Challenges in connecting to and engaging in the videoconferencing sessions were noted. To address these issues, we provided a step-by-step user manual and video tutorials regarding use of WebEx, encouraged alternative means to join sessions, and sent reminder emails/texts about the WebEx sessions and asking participants to join sessions early. Self-monitoring app-related issue included inability to find specific foods in the app database. To overcome this, the study team incorporated commonly consumed foods as "favorites" in the app database, provided a manual and video tutorials regarding use of the app and checked the self-monitoring app dashboard weekly to identify nonadherent participants and intervened as appropriate. Among 135 participants included in the analysis, the median attendance rate for the 14 remote sessions was 85.7% (IQR: 64.3%-92.9%). CONCLUSIONS Experience and lessons shared in this report may provide critical and timely guidance to other behavioral researchers and interventionists seeking to adapt behavioral counseling programs for remote delivery in the age of COVID-19.
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Zhang Y, Liu C, Luo S, Huang J, Yang Y, Ma X, Li X, Zhou Z. Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching. JMIR Mhealth Uhealth 2021; 9:e25122. [PMID: 33544081 PMCID: PMC7895638 DOI: 10.2196/25122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes. Objective We aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform. Methods This retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated. Results A total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function. Conclusions Family support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.
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Affiliation(s)
- Yiyu Zhang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Endocrinology, Changsha Central Hospital, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuoming Luo
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuxin Yang
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xiao Ma
- Lilly Suzhou Pharmaceutical Company, Suzhou, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology of Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
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