{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:44:09Z","timestamp":1785451449284,"version":"3.56.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Care cascade indicators are widely used to monitor national diabetes control efforts. However, diabetes definitions used to derive care cascades vary across studies, which may markedly affect results and subsequent policy decisions. Here, we examine the magnitude of resultant differences between approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We analyzed nationally representative, cross-sectional data of 800,348 individuals aged \u226525 years from 88 countries in 2008\u20132021. We used two different diabetes definitions: elevated biomarkers (glycated hemoglobin [HbA1c] \u22656.5%; fasting plasma glucose \u22657.0 mmol\/L; or random plasma glucose \u226511.1 mmol\/L) or self-reported diagnosis (\u201cdiagnosis-based definition\u201d) versus elevated biomarkers or self-reported treatment (\u201ctreatment-based definition\u201d). Care cascade estimates included 1) proportions of individuals with diabetes who were diagnosed, and proportions of individuals with diagnosed diabetes who 2) received treatment and 3) attained glycemic control. We benchmarked results against World Health Organization (WHO) diabetes targets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Diabetes prevalence was 12.9% (95% CI 12.1\u201313.8) applying the diagnosis-based definition and 11.3% (95% CI 10.5\u201312.1) with the treatment-based definition. Using the diagnosis-based rather than treatment-based diabetes definition to derive care cascades consistently increased the percentages of those who attain diagnosis and control stages but decreased percentages of those receiving treatment. Across countries, median differences between approaches were 11.3% (interquartile range [IQR] 5.1\u201324.7) for diabetes diagnosis, 21.6% (IQR 14.5\u201337.8) for treatment, and 16.4% (IQR 7.8\u201326.8) for control. The WHO 80% glycemic control target was met by 22% versus 6% of countries when using the diagnosis-based versus treatment-based definition, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Care cascade estimates diverged substantially and consistently across diabetes definitions, skewing policy implications in predictable ways. Harmonizing diabetes performance metrics may improve decision-making and facilitate cross-country comparisons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0267","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T19:02:46Z","timestamp":1779303766000},"page":"1106-1114","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":1,"title":["Comparing Approaches for Deriving Diabetes Care Cascades to Inform Policy: A Cross-sectional Analysis Using National Data From 88 Countries"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-4783","authenticated-orcid":false,"given":"Felix","family":"Teufel","sequence":"first","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University 1 , Atlanta, GA"},{"name":"Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University 2 , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Theilmann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women's Hospital 3 , Boston, MA"},{"name":"Harvard Medical School 4 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja E.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women's Hospital 3 , Boston, MA"},{"name":"Harvard Medical School 4 , Boston, MA"},{"name":"Institute of Public Health, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin 5 , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mubarak A.","family":"Sulola","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University 6 , Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Guwatudde","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Makerere University 7 , Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedley K.","family":"Quintana","sequence":"additional","affiliation":[{"name":"Instituto Conmemorativo Gorgas de Estudios de la Salud 8 , Panama City, Panama"},{"name":"Departamento de Medicina Preventiva y Social, Facultad de Medicina, Universidad de Panam\u00e1 9 , Panama City, Panama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 R.","family":"Banegas","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Aut\u00f3noma de Madrid and CIBERESP 10 , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamna","family":"Soniwala","sequence":"additional","affiliation":[{"name":"Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University 2 , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Kim","sequence":"additional","affiliation":[{"name":"Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University 2 , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Aryal","sequence":"additional","affiliation":[{"name":"Bergen Centre for Ethics and Priority Setting and Health, University of Bergen 11 , Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silver","family":"Bahendeka","sequence":"additional","affiliation":[{"name":"Uganda Martyrs University 12 , Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brice","family":"Bicaba","sequence":"additional","affiliation":[{"name":"African Institute of Public Health 13 , Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertino","family":"Damasceno","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Eduardo Mondlane University 14 , Maputo, Mozambique"},{"name":"Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto 15 , Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farshad","family":"Farzadfar","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences 16 , Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine","family":"Houehanou","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi 17 , Cotonou, Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Howitt","sequence":"additional","affiliation":[{"name":"George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies 18 , Bridgetown, Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khem","family":"Karki","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University 19 , Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Lunet","sequence":"additional","affiliation":[{"name":"Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto 15 , Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Martins","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e (UNTL) 20 , Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary T.","family":"Mayige","sequence":"additional","affiliation":[{"name":"National Institute for Medical Research 21 , Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kibachio J.","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Division of Non-Communicable Diseases, Ministry of Health 22 , Nairobi, Kenya"},{"name":"The Institute of Global Health, Faculty of Medicine, University of Geneva 23 , Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Quesnel-Crooks","sequence":"additional","affiliation":[{"name":"Caribbean Public Health Agency, Port of Spain 24 , Trinidad and Tobago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reina G.","family":"Roa Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Panama Ministry of Health 25 , Panama City, Panama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Rodr\u00edguez-Artalejo","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Aut\u00f3noma de Madrid and CIBERESP 10 , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar Saeedi","family":"Moghaddam","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences 26 , Tehran, Iran"},{"name":"Kiel Institute for the World Economy 27 , Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abla M.","family":"Sibai","sequence":"additional","affiliation":[{"name":"Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut 28 , Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lela","family":"Sturua","sequence":"additional","affiliation":[{"name":"Non-Communicable Disease Department, National Center for Disease Control and Public Health 29 , Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindiwe","family":"Tsabedze","sequence":"additional","affiliation":[{"name":"Eswatini Ministry of Health 30 , Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaxybay","family":"Zhumadilov","sequence":"additional","affiliation":[{"name":"Nazarbayev University School of Medicine 31 , Astana, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University 6 , Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Geldsetzer","sequence":"additional","affiliation":[{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University 32 , Stanford, CA"},{"name":"Biohub, San Francisco 33 , CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rifat","family":"Atun","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health 34 , Boston, MA"},{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Harvard University 35 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Vollmer","sequence":"additional","affiliation":[{"name":"Department of Economics and Centre for Modern Indian Studies, University of Goettingen 36 , G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Manne-Goehler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Brigham and Women's Hospital 3 , Boston, MA"},{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School 37 , Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Flood","sequence":"additional","affiliation":[{"name":"University of Michigan 38 , Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward W.","family":"Gregg","sequence":"additional","affiliation":[{"name":"School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences 39 , Dublin, Ireland"},{"name":"School of Public Health, Imperial College London 40 , London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine I.","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Applied Health Research, University of Birmingham 41 , Birmingham, U.K."},{"name":"Centre for Global Surgery, Department of Public Health, Stellenbosch University 42 , Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed K.","family":"Ali","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University 1 , Atlanta, GA"},{"name":"Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University 2 , Atlanta, GA"},{"name":"Department of Family and Preventive Medicine, School of Medicine, Emory University 43 , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jithin Sam","family":"Varghese","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University 1 , Atlanta, GA"},{"name":"Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University 2 , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026061812574466000_B1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"Ong","year":"2023","journal-title":"Lancet"},{"key":"2026061812574466000_B2","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/S2213-8587(25)00217-7","article-title":"Global, regional, and national cascades of diabetes care, 2000-23: a systematic review and modelling analysis using findings from the Global Burden of Disease Study","volume":"13","author":"Stafford","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026061812574466000_B3","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/0002-9343(72)90055-1","article-title":"Hypertension-a community problem","volume":"52","author":"Wilber","year":"1972","journal-title":"Am J Med"},{"key":"2026061812574466000_B4","volume-title":"90-90-90: An ambitious treatment target to help end the AIDS epidemic.","author":"UNAIDS)","year":"2014"},{"key":"2026061812574466000_B5","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1161\/01.HYP.26.1.60","article-title":"Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the Health Examination Surveys, 1960 to 1991","volume":"26","author":"Burt","year":"1995","journal-title":"Hypertension"},{"key":"2026061812574466000_B6","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S0140-6736(23)00001-6","article-title":"Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact","volume":"401","author":"Gregg","year":"2023","journal-title":"Lancet"},{"key":"2026061812574466000_B7","doi-asserted-by":"crossref","first-page":"e1002751","DOI":"10.1371\/journal.pmed.1002751","article-title":"Health system performance for people with diabetes in 28 low- and middle-income countries: a cross-sectional study of nationally representative surveys","volume":"16","author":"Manne-Goehler","year":"2019","journal-title":"PLoS Med"},{"key":"2026061812574466000_B8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S2213-8587(25)00299-2","article-title":"11th edition of the IDF Diabetes Atlas: global, regional, and national diabetes prevalence estimates for 2024 and projections for 2050","volume":"14","author":"Genitsaridi","year":"2026","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026061812574466000_B9","doi-asserted-by":"crossref","first-page":"681","DOI":"10.7326\/M14-0019","article-title":"A cascade of care for diabetes in the United States: visualizing the gaps","volume":"161","author":"Ali","year":"2014","journal-title":"Ann Intern Med"},{"key":"2026061812574466000_B10","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1001\/jamainternmed.2019.2396","article-title":"Evaluation of the cascade of diabetes care in the United States, 2005\u20132016","volume":"179","author":"Kazemian","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2026061812574466000_B11","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S2213-8587(17)30432-1","article-title":"Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi","volume":"6","author":"Price","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026061812574466000_B12","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1001\/jamainternmed.2023.3070","article-title":"National estimates of the adult diabetes care continuum in India, 2019\u20132021","volume":"183","author":"Varghese","year":"2023","journal-title":"JAMA Intern Med"},{"key":"2026061812574466000_B13","doi-asserted-by":"crossref","first-page":"e069193","DOI":"10.1136\/bmjopen-2022-069193","article-title":"Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study","volume":"13","author":"Wade","year":"2023","journal-title":"BMJ Open"},{"key":"2026061812574466000_B14","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5334\/gh.1056","article-title":"Health system performance for multimorbid cardiometabolic disease in India: a population-based cross-sectional study","volume":"17","author":"Geldsetzer","year":"2022","journal-title":"Glob Heart"},{"key":"2026061812574466000_B15","doi-asserted-by":"crossref","first-page":"e340","DOI":"10.1016\/S2666-7568(21)00089-1","article-title":"The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults","volume":"2","author":"Flood","year":"2021","journal-title":"Lancet Healthy Longev"},{"key":"2026061812574466000_B16","doi-asserted-by":"crossref","first-page":"e1004140","DOI":"10.1371\/journal.pmed.1004140","article-title":"Care cascades for hypertension and diabetes: cross-sectional evaluation of rural districts in Tanzania","volume":"19","author":"Osetinsky","year":"2022","journal-title":"PLoS Med"},{"key":"2026061812574466000_B17","first-page":"100313","article-title":"Cascades of diabetes and hypertension care in Samoa: identifying gaps in the diagnosis, treatment, and control continuum - a cross-sectional study","volume":"18","author":"LaMonica","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"key":"2026061812574466000_B18","doi-asserted-by":"crossref","first-page":"923249","DOI":"10.3389\/fcvm.2022.923249","article-title":"Provincial heterogeneity in the management of care cascade for hypertension, diabetes, and dyslipidaemia in China: analysis of nationally representative population-based survey","volume":"9","author":"Zhao","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026061812574466000_B19","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1016\/S0140-6736(24)02317-1","article-title":"Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants","volume":"404","author":"Zhou","year":"2024","journal-title":"Lancet"},{"key":"2026061812574466000_B20","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1038\/s41591-023-02769-8","article-title":"Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries","volume":"30","author":"Stein","year":"2024","journal-title":"Nat Med"},{"key":"2026061812574466000_B21","doi-asserted-by":"crossref","first-page":"e337","DOI":"10.1093\/ije\/dyac125","article-title":"Data resource profile: the Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC)","volume":"51","author":"Manne-Goehler","year":"2022","journal-title":"Int J Epidemiol"},{"key":"2026061812574466000_B22","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1373\/clinchem.2005.051979","article-title":"Approved IFCC recommendation on reporting results for blood glucose (abbreviated)","volume":"51","author":"D\u2019Orazio","year":"2005","journal-title":"Clin Chem"},{"key":"2026061812574466000_B23","unstructured":"World Health Organization\n          . Classification of diabetes mellitus.Report No. 9241515708.Geneva, Switzerland, 2019"},{"key":"2026061812574466000_B24","doi-asserted-by":"crossref","first-page":"562","DOI":"10.2337\/dc09-1524","article-title":"Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988\u20132006","volume":"33","author":"Cowie","year":"2010","journal-title":"Diabetes Care"},{"key":"2026061812574466000_B25","doi-asserted-by":"crossref","first-page":"S128","DOI":"10.2337\/dc25-S006","article-title":"6. Glycemic goals and hypoglycemia: Standards of Care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2024","journal-title":"Diabetes Care"},{"key":"2026061812574466000_B26","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.2337\/dc13-2173","article-title":"Empirically establishing blood glucose targets to achieve HbA1c goals","volume":"37","author":"Wei","year":"2014","journal-title":"Diabetes Care"},{"key":"2026061812574466000_B27","first-page":"e2023054","article-title":"Access to medicines in the Indian Public Health System\u2014what works and what does not? 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