Portia Mensah, Kelly Valdez, Ankita Gyawali, Janet Snell-Bergeon
{"title":"Social and Structural Determinants of Cardiovascular Complications of Diabetes","authors":"Portia Mensah, Kelly Valdez, Ankita Gyawali, Janet Snell-Bergeon","doi":"10.1007/s11892-024-01541-7","DOIUrl":"https://doi.org/10.1007/s11892-024-01541-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Cardiovascular disease (CVD) is the leading cause of mortality in people who have diabetes. Racial and ethnic minorities with diabetes have suboptimal management of cardiovascular risk factors, leading to higher mortality. Social and structural determinants of health are external factors that influence an individual’s ability to choose positive health behaviors. In this review, we will discuss cardiovascular complications in people who have diabetes and their relationship to social determinants of health (SDOH).</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Recent innovations in diabetes treatment, including new devices and medications, have improved care and survival. However, disparities in the availability of these treatments to racial and ethnic minorities may contribute to continued inequities in CVD outcomes.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Racial/ethnic disparities in CVD relate to inequities in economic opportunity, education and health literacy, neighborhoods and social cohesion, and health care access and quality driven by structural racism.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":"88 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140831725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-05-01Epub Date: 2024-02-29DOI: 10.1007/s11892-024-01536-4
Shubham Agarwal, Rodolfo J Galindo, Amy V Shah, Marconi Abreu
{"title":"Diabetes Technology in People with Type 2 Diabetes: Novel Indications.","authors":"Shubham Agarwal, Rodolfo J Galindo, Amy V Shah, Marconi Abreu","doi":"10.1007/s11892-024-01536-4","DOIUrl":"10.1007/s11892-024-01536-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Diabetes technology has been continuously evolving. Current versions of continuous glucose monitors (CGM) use minimally invasive designs, monitor glucose values with high accuracy, and can be used to guide insulin dosing. Extensive evidence supports the use of diabetes technology for monitoring and insulin administration in people with type 1 diabetes. However, there is emerging evidence for people with type 2 diabetes. In this review, we present the different technological devices used to monitor glucose and deliver insulin and the evidence supporting their use in people with type 2 diabetes.</p><p><strong>Recent findings: </strong>The use of CGMs in people with type 2 diabetes treated with insulin or non-insulin therapies has been associated with improvements in glycemic control and time spent in hypoglycemia. Smart insulin pens and smart connected devices are options to track compliance and guide insulin delivery in people who do not require insulin pump therapy. Mechanical patch pumps can be used to reduce the burden of multiple daily insulin injections. Automated insulin delivery algorithms improve glycemic control without an increase in hypoglycemia. The use of technology in the management of type 2 diabetes generates glycemic data previously inaccessible, reduces barriers for insulin initiation, improves glycemic control, tracks adherence to therapy, and improves user satisfaction.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"85-95"},"PeriodicalIF":4.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-05-01Epub Date: 2024-03-08DOI: 10.1007/s11892-024-01538-2
Arantxa Bujanda-Sainz de Murieta, Nelia Soto-Ruiz, Cristina García-Vivar, Leticia San Martín-Rodríguez, Paula Escalada-Hernández
{"title":"Use of Online Communities among People with Type 2 Diabetes: A Scoping Review.","authors":"Arantxa Bujanda-Sainz de Murieta, Nelia Soto-Ruiz, Cristina García-Vivar, Leticia San Martín-Rodríguez, Paula Escalada-Hernández","doi":"10.1007/s11892-024-01538-2","DOIUrl":"10.1007/s11892-024-01538-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>People with diabetes require continuous self-monitoring and face numerous decisions in their day-to-day lives. Therefore, on many occasions, they need more support than that provided by health professionals. In this context, peer support in online diabetes communities could be a useful tool. The purpose of the review is to describe, analyze and synthesize the available evidence on the use and health out-comes of online communities for people with type 2 diabetes mellitus. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed PubMed, Web of Science, CINHAL, Scopus and Cochrane databases.</p><p><strong>Recent findings: </strong>From 1821 identified documents, 6 articles were included. These studies explored the characteristics of diabetes online communities and the population features. Besides, the results were classified according to whether they were clinical, psychosocial, or addressed people's experiences with the online community. The analysis underscores their value in facilitating communication, improving diabetes management, and enhancing psychosocial well-being. Future investigations should prioritize longitudinal assessments to elucidate the sustained impact of community engagement and optimize user participation for enhanced patient outcomes. The growing relevance of new technologies has led to a significant number of individuals with chronic illnesses seeking peer support. Online health communities have emerged as virtual spaces where individuals with shared health interests interact and form relationships. Within these digital spaces, individuals can engage in peer interaction, observe behaviors, and mutually benefit, potentially leading to improved attitudes toward the disease.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"96-107"},"PeriodicalIF":4.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11043193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-05-01Epub Date: 2024-03-01DOI: 10.1007/s11892-024-01537-3
Reza Pishdad, Paul G Auwaerter, Rita R Kalyani
{"title":"Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review.","authors":"Reza Pishdad, Paul G Auwaerter, Rita R Kalyani","doi":"10.1007/s11892-024-01537-3","DOIUrl":"10.1007/s11892-024-01537-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections.</p><p><strong>Recent findings: </strong>Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"108-117"},"PeriodicalIF":4.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Metformin: Past, Present, and Future","authors":"Sandeep Chaudhary, Amitabh Kulkarni","doi":"10.1007/s11892-024-01539-1","DOIUrl":"https://doi.org/10.1007/s11892-024-01539-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>This review provides the most recent update of metformin, a biguanide oral antihyperglycemic drug used as a first-line treatment in type 2 diabetes mellitus.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Metformin continues to dominate in the world of antidiabetics, and its use will continue to rise because of its high efficiency and easy availability. Apart from type 2 diabetes, research is exploring its potential in other conditions such as cancer, memory loss, bone disorders, immunological diseases, and aging.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>Metformin is the most prescribed oral antidiabetic worldwide. It has been in practical use for the last six decades and continues to be the preferred drug for newly diagnosed type 2 diabetes mellitus. It reduces glucose levels by decreasing hepatic glucose production, reducing intestinal glucose absorption, and increasing insulin sensitivity. It can be used as monotherapy or combined with other antidiabetics like sulfonylureas, DPP-4 inhibitors, SGLT-2 inhibitors, or insulin, improving its efficacy. Metformin can be used once or twice daily, depending on requirements. Prolonged usage of metformin may lead to abdominal discomfort, deficiency of Vitamin B12, or lactic acidosis. It should be used carefully in patients with renal impairment. Recent studies have explored additional benefits of metformin in polycystic ovarian disease, gestational diabetes mellitus, cognitive disorders, and immunological diseases. However, more extensive studies are needed to confirm these additional benefits.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":"52 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prandial Insulins: A Person-Centered Choice","authors":"Bhawna Attri, Lakshmi Nagendra, Deep Dutta, Sahana Shetty, Shehla Shaikh, Sanjay Kalra, Saptarshi Bhattacharya","doi":"10.1007/s11892-024-01540-8","DOIUrl":"https://doi.org/10.1007/s11892-024-01540-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":"290 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-04-01Epub Date: 2024-01-31DOI: 10.1007/s11892-024-01534-6
Reid D McClure, Meryem K Talbo, Anne Bonhoure, Joséphine Molveau, Courtney A South, Maha Lebbar, Zekai Wu
{"title":"Exploring Technology's Influence on Health Behaviours and Well-being in Type 1 Diabetes: a Review.","authors":"Reid D McClure, Meryem K Talbo, Anne Bonhoure, Joséphine Molveau, Courtney A South, Maha Lebbar, Zekai Wu","doi":"10.1007/s11892-024-01534-6","DOIUrl":"10.1007/s11892-024-01534-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions.</p><p><strong>Recent findings: </strong>Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"61-73"},"PeriodicalIF":4.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-03-01Epub Date: 2024-01-18DOI: 10.1007/s11892-023-01527-x
Sara E Wetter-Wren, Alexandra C Himelhoch, Kimberly A Driscoll
{"title":"A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes.","authors":"Sara E Wetter-Wren, Alexandra C Himelhoch, Kimberly A Driscoll","doi":"10.1007/s11892-023-01527-x","DOIUrl":"10.1007/s11892-023-01527-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health.</p><p><strong>Recent findings: </strong>Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications. Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"45-60"},"PeriodicalIF":5.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139484391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current Diabetes ReportsPub Date : 2024-03-01Epub Date: 2024-01-31DOI: 10.1007/s11892-024-01533-7
Gechang Yu, Henry C H Tam, Chuiguo Huang, Mai Shi, Cadmon K P Lim, Juliana C N Chan, Ronald C W Ma
{"title":"Lessons and Applications of Omics Research in Diabetes Epidemiology.","authors":"Gechang Yu, Henry C H Tam, Chuiguo Huang, Mai Shi, Cadmon K P Lim, Juliana C N Chan, Ronald C W Ma","doi":"10.1007/s11892-024-01533-7","DOIUrl":"10.1007/s11892-024-01533-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent advances in genomic technology and molecular techniques have greatly facilitated the identification of disease biomarkers, advanced understanding of pathogenesis of different common diseases, and heralded the dawn of precision medicine. Much of these advances in the area of diabetes have been made possible through deep phenotyping of epidemiological cohorts, and analysis of the different omics data in relation to detailed clinical information. In this review, we aim to provide an overview on how omics research could be incorporated into the design of current and future epidemiological studies.</p><p><strong>Recent findings: </strong>We provide an up-to-date review of the current understanding in the area of genetic, epigenetic, proteomic and metabolomic markers for diabetes and related outcomes, including polygenic risk scores. We have drawn on key examples from the literature, as well as our own experience of conducting omics research using the Hong Kong Diabetes Register and Hong Kong Diabetes Biobank, as well as other cohorts, to illustrate the potential of omics research in diabetes. Recent studies highlight the opportunity, as well as potential benefit, to incorporate molecular profiling in the design and set-up of diabetes epidemiology studies, which can also advance understanding on the heterogeneity of diabetes. Learnings from these examples should facilitate other researchers to consider incorporating research on omics technologies into their work to advance the field and our understanding of diabetes and its related co-morbidities. Insights from these studies would be important for future development of precision medicine in diabetes.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":" ","pages":"27-44"},"PeriodicalIF":4.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Armando Peña, Alison M. Miller, Angela G. Campbell, Richard J. Holden, Christina M. Scifres
{"title":"Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review","authors":"Armando Peña, Alison M. Miller, Angela G. Campbell, Richard J. Holden, Christina M. Scifres","doi":"10.1007/s11892-024-01535-5","DOIUrl":"https://doi.org/10.1007/s11892-024-01535-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose of Review</h3><p>The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention.</p><h3 data-test=\"abstract-sub-heading\">Recent Findings</h3><p>A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150 min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31 yr, BMI 31 kg/m<sup>2</sup>). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices.</p><h3 data-test=\"abstract-sub-heading\">Summary</h3><p>There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.</p>","PeriodicalId":10898,"journal":{"name":"Current Diabetes Reports","volume":"70 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}