Journal of Diabetes Science and Technology最新文献

{"title":"Diabetic Retinopathy Screening Using Smartphone-Based Fundus Photography and Deep-Learning Artificial Intelligence in the Yucatan Peninsula: A Field Study.","authors":"John J Wroblewski, Ermilo Sanchez-Buenfil, Miguel Inciarte, Jay Berdia, Lewis Blake, Simon Wroblewski, Alexandria Patti, Gretchen Suter, George E Sanborn","doi":"10.1177/19322968231194644","DOIUrl":"10.1177/19322968231194644","url":null,"abstract":"<p><strong>Background: </strong>To compare the performance of Medios (offline) and EyeArt (online) artificial intelligence (AI) algorithms for detecting diabetic retinopathy (DR) on images captured using fundus-on-smartphone photography in a remote outreach field setting.</p><p><strong>Methods: </strong>In June, 2019 in the Yucatan Peninsula, 248 patients, many of whom had chronic visual impairment, were screened for DR using two portable Remidio fundus-on-phone cameras, and 2130 images obtained were analyzed, retrospectively, by Medios and EyeArt. Screening performance metrics also were determined retrospectively using masked image analysis combined with clinical examination results as the reference standard.</p><p><strong>Results: </strong>A total of 129 patients were determined to have some level of DR; 119 patients had no DR. Medios was capable of evaluating every patient with a sensitivity (95% confidence intervals [CIs]) of 94% (88%-97%) and specificity of 94% (88%-98%). Owing primarily to photographer error, EyeArt evaluated 156 patients with a sensitivity of 94% (86%-98%) and specificity of 86% (77%-93%). In a head-to-head comparison of 110 patients, the sensitivities of Medios and EyeArt were 99% (93%-100%) and 95% (87%-99%). The specificities for both were 88% (73%-97%).</p><p><strong>Conclusions: </strong>Medios and EyeArt AI algorithms demonstrated high levels of sensitivity and specificity for detecting DR when applied in this real-world field setting. Both programs should be considered in remote, large-scale DR screening campaigns where immediate results are desirable, and in the case of EyeArt, online access is possible.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"370-376"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Do-It-Yourself Real-Time Continuous Glucose Monitoring on Glycemic Variables and Participant-Reported Outcomes in Adults With Type 1 Diabetes: A Randomized Crossover Trial.","authors":"Shekhar Sehgal, Mona Elbalshy, Jonathan Williman, Barbara Galland, Hamish Crocket, Rosemary Hall, Ryan Paul, Robert Leikis, Martin de Bock, Benjamin J Wheeler","doi":"10.1177/19322968231196562","DOIUrl":"10.1177/19322968231196562","url":null,"abstract":"<p><strong>Aim: </strong>Real-time continuous glucose monitoring (rtCGM) has several advantages over intermittently scanned continuous glucose monitoring (isCGM) but generally comes at a higher cost. Do-it-yourself rtCGM (DIY-rtCGM) potentially has benefits similar to those of rtCGM. This study compared outcomes in adults with type 1 diabetes using DIY-rtCGM versus isCGM.</p><p><strong>Methods: </strong>In this crossover trial, adults with type 1 diabetes were randomized to use isCGM or DIY-rtCGM for eight weeks before crossover to use the other device for eight weeks, after a four-week washout period where participants reverted back to isCGM. The primary endpoint was time in range (TIR; 3.9-10 mmol/L). Secondary endpoints included other glycemic control measures, psychosocial outcomes, and sleep quality.</p><p><strong>Results: </strong>Sixty participants were recruited, and 52 (87%) completed follow-up. Glucose outcomes were similar in the DIY-rtCGM and isCGM groups, including TIR (53.1% vs 51.3%; mean difference -1.7% <i>P</i> = .593), glycosylated hemoglobin (57.0 ± 17.8 vs 61.4 ± 12.2 mmol/L; <i>P</i> = .593), and time in hypoglycemia <3.9 mmol/L (3.9 ± 3.8% vs 3.8 ± 4.0%; <i>P</i> = .947). Hypoglycemia Fear Survey total score (1.17 ± 0.52 vs 0.97 ± 0.54; <i>P</i> = .02) and fear of hypoglycemia score (1.18 ± 0.64 vs 0.97 ± 0.45; <i>P</i> = .02) were significantly higher during DIY-rtCGM versus isCGM. Diabetes Treatment Satisfaction Questionnaire status (DTSQS) score was also higher with DIY-rtCGM versus isCGM (28.7 ± 5.8 vs 26.0 ± 5.8; <i>P</i> = .04), whereas diabetes-related quality of life was slightly lower (DAWN2 Impact of Diabetes score: 3.11 ± 0.4 vs 3.32 ± 0.51; <i>P</i> = .045); sleep quality did not differ between the two groups.</p><p><strong>Conclusion: </strong>Although the use of DIY-rtCGM did not improve glycemic outcomes compared with isCGM, it positively impacted several patient-reported psychosocial variables. DIY-rtCGM potentially provides an alternative, cost-effective rtCGM option.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"415-425"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Glycemic Control Between In-Person and Virtual Diabetes Consults in Hospitalized Patients With Diabetes.","authors":"Maria Gracia Luzuriaga, Monica Lieberman, Ruixuan Ma, Sabina Casula, Violet Lagari-Libhaber, Shari Messinger, Hua Li, Bresta Miranda, David A Baidal, Ernesto Bernal Mizrachi, Gianluca Iacobellis, Rajesh Garg, Francesco Vendrame","doi":"10.1177/19322968231199470","DOIUrl":"10.1177/19322968231199470","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence that the diabetes in-person consult in hospitalized patients can be replaced by a virtual consult. During COVID-19 pandemic, the diabetes in-person consult service at the University of Miami and Miami Veterans Affairs Healthcare System transitioned to a virtual model. The aim of this study was to assess the impact of telemedicine on glycemic control after this transition.</p><p><strong>Methods: </strong>We retrospectively analyzed glucose metrics from in-person consults (In-person) during January 16 to March 14, 2020 and virtual consults during March 15 to May 14, 2020. Data from virtual consults were analyzed by separating patients infected with COVID-19, who were seen only virtually (Virtual-COVID-19-Pos), and patients who were not infected (Virtual-COVID-19-Neg), or by combining the two groups (Virtual-All).</p><p><strong>Results: </strong>Patient-day-weighted blood glucose was not significantly different between In-person, Virtual-All, and Virtual-COVID-19-Neg, but Virtual-COVID-19-Pos had significantly higher mean ± SD blood glucose (mg/dL) compared with others (206.7 ± 49.6 In-person, 214.6 ± 56.2 Virtual-All, 206.5 ± 57.2 Virtual-COVID-19-Neg, 229.7 ± 51.6 Virtual-COVID-19-Pos; <i>P</i> = .015). A significantly less percentage of patients in this group also achieved a mean ± SD glucose target of 140 to 180 mg/dL (23.8 ± 22.5 In-person, 21.5 ± 20.5 Virtual-All, 25.3 ± 20.8 Virtual-COVID-19-Neg, and 14.4±18.1 Virtual-COVID-19-Pos, <i>P</i> = .024), but there was no significant difference between In-person, Virtual-All, and Virtual-COVID-19-Neg. The occurrence of hypoglycemia was not significantly different among groups.</p><p><strong>Conclusions: </strong>In-person and virtual consults delivered by a diabetes team at an academic institution were not associated with significant differences in glycemic control. These real-world data suggest that telemedicine could be used for in-patient diabetes management, although additional studies are needed to better assess clinical outcomes and safety.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"400-406"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41124025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Insulin Delivery System and People With Type 2 Diabetes: A Topic With Many Facets.","authors":"Lutz Heinemann","doi":"10.1177/19322968231204625","DOIUrl":"10.1177/19322968231204625","url":null,"abstract":"<p><p>Optimizing glucose control is of interest also for patients with type 2 diabetes (T2D). While systems for automated insulin delivery are widely used for patients with type 1 diabetes, as documented by many publications, this is not the case with T2D. Because of the number of such patients, this will change drastically in the next years. Manufacturers can transfer many learnings from type 1 to type 2; however, specific clinical aspects have to be considered. This commentary will discuss these aspects and some of the current activities. Future automated insulin delivery (AID) systems will take data from multisensor systems into account to individualize the AID algorithm, supported by artificial intelligence. There is a high need to document the benefits of AID systems in this patient group.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"475-480"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41131754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Smartphone-Based Activity Tracking and Nocturnal Hypoglycemia in People With Type 1 Diabetes.","authors":"Daphne Gardner, Hong Chang Tan, Gek Hsiang Lim, May Zin Oo, Xiaohui Xin, Andrew Kingsworth, Pratik Choudhary, Suresh Rama Chandran","doi":"10.1177/19322968231186401","DOIUrl":"10.1177/19322968231186401","url":null,"abstract":"<p><strong>Background: </strong>Nocturnal hypoglycemia (NH) remains a major burden for people with type 1 diabetes (T1D). Daytime physical activity (PA) increases the risk of NH. This pilot study tested whether cumulative daytime PA measured using a smartphone-based step tracker was associated with NH.</p><p><strong>Methods: </strong>Adults with T1D for ≥ 5 years (y) on multiple daily insulin or continuous insulin infusion, not using continuous glucose monitoring and HbA1c 6 to 10% wore blinded Freestyle Libre Pro sensors and recorded total daily carbohydrate (TDC) and total daily dose (TDD) of insulin. During this time, daily step count (DSC) was tracked using the smartphone-based Fitbit MobileTrack application. Mixed effects logistic regression was used to estimate the effect of DSC on NH (sensor glucose <70, <54 mg/dl for ≥15 minutes), while adjusting for TDC and TDD of insulin, and treating participants as a random effect.</p><p><strong>Results: </strong>Twenty-six adults, with 65.4% females, median age 27 years (interquartile range: 26-32) mean body mass index 23.9 kg/m², median HbA1c 7.6% (7.1-8.1) and mean Gold Score 2.1 (standard deviation 1.0) formed the study population. The median DSC for the whole group was 2867 (1820-4807). There was a significant effect of DSC on NH episodes <70 mg/dl. (odds ratio 1.11 [95% CI: 1.01-1.23, <i>P</i> = .04]. There was no significant effect on NH <54 mg/dl.</p><p><strong>Conclusion: </strong>Daily PA measured by a smartphone-based step tracker was associated with the risk of NH in people with type 1 diabetes.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"377-384"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Effects of Pulsed Electromagnetic Therapy on Painful Diabetic Distal Symmetric Peripheral Neuropathy: A Double-Blind Randomized Controlled Trial.","authors":"Erica E Tassone, Jeffrey C Page, Marvin J Slepian","doi":"10.1177/19322968231190413","DOIUrl":"10.1177/19322968231190413","url":null,"abstract":"<p><strong>Background: </strong>Significant complications of diabetes include pain and the loss of sensation in peripheral limbs. Pain management of diabetic symmetric peripheral neuropathy (DSPN) remains challenging. This study reports on utilizing pulsed electromagnetic field therapy (PEMF) to reduce pain and improve skin perfusion pressure (SPP) in subjects with DSPN.</p><p><strong>Methods: </strong>A randomized, sham-controlled, double-blind, clinical trial was conducted on subjects afflicted with foot pain associated with DSPN. Following informed consent, 182 subjects with diabetes and confirmed DSPN were entered into the trial for a period of 18 weeks. Subjects were randomized into active PEMF treatment or nonactive sham and instructed to treat to their feet for 30 minutes, twice daily and report daily pain scores. Some patients in the active arm experienced a transient low field strength notification (LFSN) due to improper pad placement during treatment. Skin perfusion pressure measurements were also collected at two and seven weeks to assess peripheral arterial disease effects via measurement of local microcirculatory flow and blood pressure.</p><p><strong>Results: </strong>Patients in the active arm who did not receive an LFSN experienced a clinically significant 30% reduction in pain from baseline compared to sham (<i>P</i> < .05). Though not statistically significant, SPP in the active group trended toward improvement compared to sham.</p><p><strong>Conclusions: </strong>Pulsed electromagnetic field therapy appears effective as a nonpharmacological means for reduction of pain associated with diabetic peripheral neuropathy and holds promise for improvement of vascular physiology in microcirculatory dysfunction associated with diabetic peripheral arterial disease.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"361-369"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation.","authors":"Grazia Aleppo, Ryan Chmiel, Andrew Zurn, Ryan Bandoske, Patrick Creamer, Nicholas Neubauer, Jo Wong, Sarah B Andrade, Alexis Hauptman","doi":"10.1177/19322968231196168","DOIUrl":"10.1177/19322968231196168","url":null,"abstract":"<p><p>Managing data from continuous glucose monitoring (CGM) systems presents challenges to health care provider teams that rely on the electronic health record (EHR) during patient visits. A method of integrating CGM data with the EHR that relies on the Dexcom API was developed by Northwestern Medicine and Dexcom to address these challenges. Here, we describe the data management steps and user interface of the integrated system. Providers can access patients' historical and latest daily CGM data in the form of modal day plots and stacked columns showing time in various glucose concentration ranges. The integration facilitates the acquisition, storage, analysis, and display of CGM data within an EHR system and may be appropriate for deployment in other health care facilities.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"426-430"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10468263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic and Psychosocial Correlates of Continuous Glucose Monitor Use Among Adolescents With Type 1 Diabetes.","authors":"Emma Straton, Hailey Inverso, Hailey Moore, Kashope Anifowoshe, Kendall Washington, Randi Streisand, Karishma Datye, Sarah S Jaser","doi":"10.1177/19322968231186428","DOIUrl":"10.1177/19322968231186428","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use.</p><p><strong>Methods: </strong>This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (<i>Current Users, Past Users</i>, and <i>Never Users</i>).</p><p><strong>Results: </strong><i>Current Users</i> demonstrated significantly lower HbA1c than <i>Never Users</i> and significantly lower diabetes distress than <i>Past Users</i>. CGM use was not associated with family conflict or quality of life.</p><p><strong>Conclusions: </strong>CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"436-440"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41235751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectations and Outcomes From Glucagon-Like Peptide-1 Receptor Agonists As Adjunct Treatment for Type 1 Diabetes - Case Presentations.","authors":"Sujatha Seetharaman, Eda Cengiz","doi":"10.1177/19322968241305641","DOIUrl":"10.1177/19322968241305641","url":null,"abstract":"<p><strong>Background: </strong>Type 1 diabetes (T1D) is characterized by the autoimmune destruction of pancreatic beta cells, leading to lifelong insulin dependence. Despite advancements in insulin therapies and glucose monitoring, maintaining optimal blood glucose control remains challenging with common issues like weight gain and glucose variability. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs), approved for type 2 diabetes and obesity, are being explored off-label for T1D.</p><p><strong>Case report: </strong>This case series investigates the effectiveness of GLP-1 RAs, mainly semaglutide and tirzepatide, as an adjunct therapy to insulin in adolescents and young adults (AYA) with T1D, in a single center, providing real-world insights and highlighting practical issues.</p><p><strong>Discussion: </strong>Most patients had obesity, consistent with typical indication for use in AYA. Common gastrointestinal side effects improved with dose titration, but careful monitoring is needed for persistent symptoms. One patient developed an eating disorder, underscoring the need for vigilance. Insurance and medication shortage issues impacted treatment continuity, highlighting the need for better support. Glycemic parameters improved in most patients, with weight reduction in several patients with obesity, and no reported diabetic ketoacidosis.</p><p><strong>Conclusions: </strong>GLP-1 RAs can be a beneficial adjunct therapy in T1D, improving glycemic control, reducing insulin needs, and supporting weight management, while potentially preventing long-term cardiovascular and renal complications.</p>","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"304-310"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Printed Copies of \"Instructions of Use\": What Nonsense!","authors":"Lutz Heinemann","doi":"10.1177/19322968241310891","DOIUrl":"10.1177/19322968241310891","url":null,"abstract":"","PeriodicalId":15475,"journal":{"name":"Journal of Diabetes Science and Technology","volume":" ","pages":"598-599"},"PeriodicalIF":4.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}