Diabetes technology & therapeutics最新文献

{"title":"Glycemic Variability and Disordered Eating Among Adolescents and Young Adults with Type 1 Diabetes: The Role of Disinhibited Eating.","authors":"Tamar Propper-Lewinsohn, Shlomit Shalitin, Michal Gillon-Keren, Michal Yackobovitch-Gavan, Alon Liberman, Moshe Phillip, Roni Elran-Barak","doi":"10.1089/dia.2024.0267","DOIUrl":"10.1089/dia.2024.0267","url":null,"abstract":"<p><p><b><i>Background and Aims:</i></b> Disordered eating behaviors (DEB) are common among individuals with type 1 diabetes (T1D). Glycemic variability, potentially harmful in T1D, may reveal distinct characteristics between those with higher versus lower variability, particularly concerning DEB. Our aim was to evaluate the prevalence of DEB and associated risk factors among adolescents and young adults with T1D and to investigate unique factors associated with DEB across different levels of glycemic variability. <b><i>Methods:</i></b> An observational, cross-sectional study was conducted with 147 individuals with T1D, aged 13-21 years. Data were collected from medical charts, personal technological devices for assessing glycemic variability, and self-reported questionnaires, including assessments of DEB. <b><i>Results:</i></b> DEB were found in 62 (42.1%) individuals, and 41.5% achieved the glycemic variability (% coefficient of variation) target ≤36%. Among individuals with low glycemic variability, DEB were positively associated with diabetes distress (odds ratio [OR]: 1.14 [95% confidence interval or CI: 1.05-1.22], <i>P</i> < 0.001), longer diabetes duration (OR: 1.34 [95% CI: 1.05-1.70], <i>P</i> = 0.016) and lower socioeconomic-status (OR: 0.53 [95% CI: 0.31-0.90], <i>P</i> = 0.019). Among those with high glycemic variability, body mass index Z score (OR: 3.82 [95% CI: 1.48-9.85], <i>P</i> = 0.005), HbA1c (OR: 4.12 [95% CI: 1.33-12.80], <i>P</i> = 0.014), disinhibited eating (OR: 1.57 [95% CI: 1.14-2.15], <i>P</i> = 0.005), and tendency to lower socioeconomic status (OR: 0.75 [95% CI: 0.56-1.01], <i>P</i> = 0.065). <b><i>Discussion:</i></b> DEB are prevalent among adolescents and young adults with T1D and are associated with various risk factors. Factors associated with DEB vary across different levels of glycemic variability. Both low and high glycemic variability are associated with specific risk factors for DEB. One notable risk factor is diabetes-specific disinhibited eating among individuals with high glycemic variability, in contrast to those with low glycemic variability. Given these different risk factors, it may be prudent to adjust intervention programs to reduce DEB among T1D adolescents according to their glycemic variability levels.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"113-120"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281838","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":"Effect of Interrupting Prolonged Sitting with Frequent Activity Breaks on Postprandial Glycemia and Insulin Sensitivity in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy: A Randomized Crossover Pilot Trial.","authors":"Robyn Larsen, Frances Taylor, Paddy C Dempsey, Melitta McNarry, Kym Rickards, Parneet Sethi, Ashleigh Homer, Neale Cohen, Neville Owen, Kavita Kumareswaran, Richard MacIsaac, Sybil A McAuley, David O'Neal, David W Dunstan","doi":"10.1089/dia.2024.0146","DOIUrl":"10.1089/dia.2024.0146","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study examined acute effects of interrupting prolonged sitting with short activity breaks on postprandial glucose/insulin responses and estimations of insulin sensitivity in adults with type 1 diabetes (T1D). <b><i>Method:</i></b> In a randomized crossover trial, eight adults (age = 46 ± 14 years [mean ± SD], body mass index [BMI] = 27.2 ± 3.8 kg/m²) receiving continuous subcutaneous insulin infusion (CSII) therapy completed two 6-h conditions as follows: uninterrupted sitting (SIT) and sitting interrupted with 3-min bouts of simple resistance activities (SRAs) every 30 min. Basal and bolus insulin were standardized across conditions except in cases of hypoglycemia. Postprandial responses were assessed using incremental area-under-the-curve (iAUC) and total AUC (tAUC) from half-hourly venous sampling. Meal-based insulin sensitivity determined from glucose sensor and insulin pump (S<i>_i</i>^SP) was assessed from flash continuous glucose monitor and insulin pump data. Outcomes were analyzed using mixed models adjusted for sex, BMI, treatment order, and preprandial values. <b><i>Results:</i></b> Glucose iAUC did not differ by condition (SIT: 19.8 ± 3.0 [estimated marginal means ± standard error] vs. SRA: 14.4 ± 3.0 mmol.6 h.L^-1; <i>P</i> = 0.086). Despite CSII being standardized between conditions, insulin iAUC was higher in SRA compared to SIT (137.1 ± 22.7 vs. 170.9 ± 22.7 mU.6 h.L^-1; <i>P</i> < 0.001). This resulted in a lower glucose response relative to the change in plasma insulin in SRA (tAUCglu/tAUCins: 0.32 ± 0.02 vs. 0.40 ± 0.02 mmol.mU^-1; <i>P</i> = 0.03). Si^SP was also higher at dinner following the SRA condition, with no between-condition differences at breakfast or lunch. <b><i>Conclusion:</i></b> Regularly interrupting prolonged sitting in T1D may increase plasma insulin and improve insulin sensitivity when meals and CSII are standardized. Future studies should explore underlying mechanistic determinants and the applicability of findings to those on multiple daily injections. <b><i>Trial Registration:</i></b> Australian and New Zealand Clinical Trial Registry Identifier-ACTRN12618000126213 (www.anzctr.org.au).</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"101-112"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589730","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":"Clinical Utility of Serum C-Peptide Concentration for Hospitalized Patients with Hyperglycemia.","authors":"Damla N Costa, Yogish C Kudva, Michael D Jensen, Pankaj Shah","doi":"10.1089/dia.2024.0246","DOIUrl":"10.1089/dia.2024.0246","url":null,"abstract":"<p><p><b><i>Background:</i></b> Serum C-peptide concentration is often utilized for diagnostic, prognostic, or therapeutic assessment in diabetes mellitus. However, there are limited clinical data regarding diagnostic and predictive value of C-peptide measured during hospitalizations for hyperglycemia. <b><i>Materials and Methods:</i></b> Adults admitted to Mayo Clinic inpatient facilities due to an acute hyperglycemic emergency between January 2017 and November 2022 were included in our study. Predictive capacity of C-peptide for discontinuation of therapeutic insulin was examined in the entire cohort and the subgroup of non-autoimmune non-pancreatitis diabetes (NANP-DM). <b><i>Results:</i></b> We included 187 patients (63 women) in our study. During hospitalization, patients with type 1 diabetes antibodies displayed diminished serum C-peptide concentration (<i>P</i> = 0.014), correlating inversely with subsequent hemoglobin A1c% [<i>r</i> = (-0.22), <i>P</i> = 0.005]. Initial C-peptide concentrations did not differ between patients requiring insulin therapy during follow-up and those who did not (<i>P</i> = 0.16). C-peptide concentrations showed limited predictive capacity for achieving glycemic control. Subgroup analyses in NANP-DM exhibited similar limited capacity for anticipating therapeutic insulin needs and achieving glycemic controls. <b><i>Discussion:</i></b> C-peptide concentration did not exhibit a robust predictive capability for future need of insulin therapy and achieving glycemic control, limiting its utility in clinical practice within inpatient settings.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"121-127"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125123","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":"The Feasibility of an Experimental Hypobaric Simulation to Evaluate the Safety of Closed-Loop Insulin Delivery Systems in Flight-Related Atmospheric Pressure Changes.","authors":"Ka Siu Fan, Fariba Shojaee-Moradie, Antonios Manoli, Petra M Baumann, Gerd Koehler, Victoria Edwards, Vivienne Lee, Chantal Mathieu, Julia K Mader, David Russell-Jones","doi":"10.1089/dia.2024.0380","DOIUrl":"10.1089/dia.2024.0380","url":null,"abstract":"<p><p>Hybrid closed-loop (HCL) systems remain underexplored within aviation, and as atmospheric pressure changes can independently affect insulin pumps and continuous glucose monitoring readings, this preliminary study assessed the feasibility of HCL safety evaluation, in both fasting and post-prandial states, by using hypobaric chamber to simulate flights. Participants with type 1 diabetes and on HCL were studied: Medtronic Guardian 4-Medtronic 780G-SmartGuard (<i>n</i> = 4), Dexcom G6-Omnipod DASH-Android APS (<i>n</i> = 1), and Dexcom G6-Ypsomed Pump-CamAPS (<i>n</i> = 1). Flight cabin pressures of 550 mmHg and 750 mmHg were simulated in a hypobaric chamber. Seven-hundred-50 glucose measurements were taken, with glucose levels demonstrating a stable decline to 4 mmol/L during fasting. To maintain a tight fasting and post-prandial glucose range across the different pressure settings, the HCL administered insulin as expected. While not demonstrating any apparent issues, repeating flight simulation protocol with other systems, examining longer flights, and undertaking larger, powered randomised controlled trials can confirm their safety in aviation.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"128-133"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496843","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":"Safe Options for the Treatment of Mothers and Babies with Pregestational Diabetes.","authors":"Katrien Benhalima, Chantal Mathieu, Angela Napoli, Yogish C Kudva, Katarzyna Cypryk, Peter Hammond, Tali Cukierman-Yaffe, Katarzyna Cyganek, Hema Divakar, Moshe Hod","doi":"10.1089/dia.2024.0499","DOIUrl":"10.1089/dia.2024.0499","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"91-92"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581376","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":"GLP-1 Receptor Agonist Therapy in Cystic Fibrosis-Related Diabetes: A Case Report.","authors":"Gida Ayada, Sagit Zolotov, Raya Cohen, Tal Lavi, Muhammad Abdul-Ghani, Naim Shehadeh, Afif Nakhleh","doi":"10.1089/dia.2024.0367","DOIUrl":"10.1089/dia.2024.0367","url":null,"abstract":"","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"144-146"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364771","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":"Automated Insulin Delivery Effects During Driving Among Older Adults with Type 1 Diabetes in a Randomized Trial.","authors":"Steven Trawley, Hye Jin Kwon, Sara Vogrin, Peter G Colman, Spiros Fourlanos, Melissa H Lee, Richard J MacIsaac, David N O'Neal, Niamh A O'Regan, Vijaya Sundararajan, Glenn M Ward, Sybil A McAuley","doi":"10.1089/dia.2024.0303","DOIUrl":"10.1089/dia.2024.0303","url":null,"abstract":"<p><p>Dysglycemia among drivers with type 1 diabetes (T1D) is associated with impaired driving performance, and glucose levels \"above 5 to drive\" are often recommended for insulin-treated drivers. Evidence for diabetes treatments that support euglycemia while driving is minimal, particularly for older drivers. In this randomized, crossover trial involving adults aged ≥60 years with T1D, we used continuous glucose monitoring (CGM) during driving to compare the first-generation closed-loop automated insulin delivery (AID) versus a sensor-augmented pump therapy. There were 1894 trips undertaken by 8 drivers (median age 68 years [IQR: 64-70]). During AID versus sensor-augmented pump, time in range >5.0-10.0 mmol/L was greater (100% [0-100] vs. 81% [0-100]; <i>P</i> = 0.033) and fewer trips had any CGM >16.7 mmol/L (3.5% vs. 6.4%; <i>P</i> = 0.006). Three percent of all trips included CGM <3.9 mmol/L, with no between-stage difference (3.0% vs. 3.5%; <i>P</i> = 0.52). System alerts occurred in 10% of all trips, with no between-stage difference (9% vs. 11%; <i>P</i> = 0.078). First-generation AID reduces hyperglycemic driving among older drivers with T1D, without increasing hypoglycemia. Developing dedicated \"driving-mode\" settings could prioritize safety while minimizing distraction. Trial Registration: ACTRN12619000515190.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"134-138"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766892","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":"Insulin Pump Use and Diabetic Ketoacidosis Risk in Type 1 Diabetes: Secular Trends over Four Decades.","authors":"Dalton R Budhram, Priya Bapat, Abdulmohsen Bakhsh, Mohammad I Abuabat, Natasha J Verhoeff, Doug Mumford, Wajeeha Cheema, Andrej Orszag, Akshay Jain, David Z I Cherney, Michael Fralick, Bader N Alamri, Alanna Weisman, Leif Erik Lovblom, Bruce A Perkins","doi":"10.1089/dia.2024.0272","DOIUrl":"10.1089/dia.2024.0272","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Continuous subcutaneous insulin infusion (CSII) in type 1 diabetes has been regarded as a major diabetic ketoacidosis (DKA) risk factor. We aimed to determine secular trends in risk since CSII implementation in the 1980s. <b><i>Research Design and Methods:</i></b> We assessed the relationship between time-varying CSII use and DKA events from 1983 to 2017 and by each decade in the 1441 Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study participants using crude and adjusted Cox proportional hazards models. <b><i>Results:</i></b> Time-varying CSII exposure was associated with significantly higher DKA risk in the 1980s (adjusted hazard ratio [HR] 5.81; 95% confidence interval [CI] 3.28-10.29; <i>P</i> < 0.001), but in the 2010s, this risk was not significantly elevated (adjusted HR 1.24; 95% CI 0.73-2.12; <i>P</i> = 0.43). <b><i>Conclusions:</i></b> DKA risk associated with CSII in type 1 diabetes has declined substantially since the 1980s such that the remaining risk in the past decade appears to be of low magnitude.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"139-143"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460184","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":"Evaluation of an Automated Priming Bolus for Improving Prandial Glucose Control in Full Closed Loop Delivery.","authors":"Marcela Moscoso-Vasquez, Patricio Colmegna, Charlotte Barnett, Morgan Fuller, Chaitanya L K Koravi, Sue A Brown, Mark D DeBoer, Marc D Breton","doi":"10.1089/dia.2024.0315","DOIUrl":"10.1089/dia.2024.0315","url":null,"abstract":"<p><p><b><i>Background:</i></b> Automated insulin delivery (AID) is widely available to people with type 1 diabetes (T1D), providing superior glycemic control versus traditional methods. The next generation of AID devices focus on minimizing user/device interactions, especially around meals (\"full closed loop,\" [FCL]). Our goal was to assess the postprandial glycemic impact of the bolus priming system (BPS), an algorithm delivering fixed insulin doses based on the likelihood of a meal having occurred, in conjunction with UVA's latest AID. <b><i>Method:</i></b> Eleven adults with T1D participated in a supervised randomized-crossover trial assessing glycemic control during two 24-h sessions with identical meals and activity-with and without BPS. On the day in-between study sessions, participants underwent food and activity challenges to test BPS safety and robustness. Continuous glucose monitor (CGM) outcomes and total insulin doses were assessed overall and following meals with potential for BPS to dose additional insulin (CGM >90 mg/dL for 1 h prior). <b><i>Results:</i></b> Daytime CGM outcomes were similar with and without BPS: time-in-range (TIR) 70-180 mg/dL 70.6% [62.2-76.5] versus 65.7% [58.6%-80.6%]; time-below-range <70 mg/dL 0% [0-2.1] versus 0% [0-1.3]; respectively. Insulin delivery during 3 h postprandial was indistinguishable 33.5 U [26.4-47.0] versus 35.7 U [28.7-44.9]. Among 43 out of 66 meals with potential to trigger BPS (24/19 BPS/no-BPS), postprandial incremental area-under-the-curve (iAUC) was lower for BPS versus no-BPS (2530 ± 1934 versus 3228 ± 2029, <i>P</i> = 0.047), but CGM outcomes were inconclusive: 4-h-TIR 51.2% [19.8-83.3] versus 40.2% [20.8-56.3] (<i>P</i> = 0.24). There were no severe adverse events. <b><i>Conclusion:</i></b> While there was no difference in TIR, when BPS was active an improved postprandial AUC in FCL was obtained via earlier insulin injection.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":"93-100"},"PeriodicalIF":5.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581194","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":"EValuating Glucose ContrOL Using a Next-GeneraTION Automated Insulin Delivery Algorithm in Patients with Type 1 and Type 2 Diabetes: The EVOLUTION Study.","authors":"Tom Wilkinson, Renee Meier, Niranjala Hewapathirana, Claire Lever, Solita Donnelly, Rachael Sampson, Jonathan Williman, Mert Sevil, Saeed Salavati, Sam Carl, Bonnie Dumais, Trang T Ly, Martin de Bock","doi":"10.1089/dia.2024.0463","DOIUrl":"https://doi.org/10.1089/dia.2024.0463","url":null,"abstract":"<p><p>This study evaluated a next-generation automated insulin delivery (AID) algorithm for Omnipod in type 1 and type 2 diabetes across multiple phases: 14-day run-in with usual therapy, 48-h AID use in a hotel setting (type 1 only), and up to 6 weeks of outpatient AID use. Participants did, or did not, deliver manual boluses at alternating periods. Twelve adults with type 1 diabetes completed the hotel phase; 9 of those 12 plus 8 adults with type 2 diabetes completed the subsequent outpatient phase. Outpatient % continuous glucose monitor readings >250 mg/dL decreased from 33.5% at baseline to 9.4% with, and 14.3% without, manual boluses in type 1 diabetes and from 20.8% to 7.7% with, and 10.5% without, manual boluses in type 2 diabetes. Time below 70 mg/dL remained <4% during all phases. No adverse events occurred. In conclusion, a next-generation AID algorithm demonstrated feasibility in people with diabetes.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045869","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}