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Gourlay A, Sutherland C, Radley A. Point-of-Care testing of HbA 1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:7-16. [PMID: 37925311 DOI: 10.1016/j.pcd.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Glycated haemoglobin (HbA1c) measurement using Point of Care (POC) testing may be of huge utility, providing convenient testing for early diagnosis and regular monitoring of hard-to-reach patient groups. This systematic review aimed to identify evidence for the successful deployment of these devices to improve patient outcomes in diabetes. METHODS A systematic review and meta-analysis was undertaken in February 2023, to identify all relevant articles: (CINAHL, Cochrane, PubMed, Scopus, and Web of Science). Studies were included if they reported outcomes of community POC testing for HbA1c for people with diabetes or at risk of diabetes. The Prospero database and trial registers were searched. Only English language articles were included. Title, abstract screening and full text review was carried out by two reviewers (AG/AR). The Cochrane risk of bias tool for randomised studies and the NIH Quality Assessment tool for observational cohort and cross-sectional studies were used. Publication bias was assessed visually using funnel plot and statistical assessment. We performed a meta-analysis on appropriate studies, applying a fixed effect model. We investigated heterogeneity using visual inspection of forest plots along with evaluative approaches (χ2, I2). Strength of evidence was assessed using GRADE. FINDINGS 24 studies fulfilled the criteria to be included in the narrative synthesis and 5 could be included in quantitative analysis. 13 studies evaluated HbA1c POC testing in non-diabetic patients, 9 reported results for diabetic patients and 2 included both groups. The narrative synthesis was constructed around 6 key themes: increased test access, diagnosis of people who would otherwise go undiagnosed, intervention/lifestyle change, POC testing effect on HbA1c and glycaemic control, follow-up time and patient satisfaction. INTERPRETATION The available published data supports the proposed use of POC devices in a community setting, with positive effects on diabetic care with limited evidence that patients can achieve better glycaemic control.
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Affiliation(s)
- Anna Gourlay
- School of Life Sciences, University of Dundee, Scotland
| | | | - Andrew Radley
- School of Medicine, University of Dundee, Scotland; Directorate of Public Health, NHS Tayside, UK.
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Pi L, Zheng Y, Shi X, Wang Z, Zhou Z. Using point-of-care HbA1c to facilitate the identification of diabetes and abnormal glucose regulation in primary healthcare settings. Front Public Health 2023; 11:1078361. [PMID: 37228727 PMCID: PMC10203162 DOI: 10.3389/fpubh.2023.1078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Glycated hemoglobin A1c (HbA1c) is a critical index for the diagnosis and glycemic control evaluation of diabetes. However, a standardized method for HbA1c measurement is unaffordable and unavailable among the Chinese population in low-resource rural settings. Point-of-care (POC) HbA1c testing is convenient and inexpensive, but its performance remains to be elucidated. Objective To investigate the value of POC HbA1c for identifying diabetes and abnormal glucose regulation (AGR) in the resource-limited Chinese population. Methods Participants were recruited from 6 Township Health Centers in Hunan Province. Samples for POC HbA1c, venous HbA1c, fasting plasma glucose, and 2 h-plasma glucose were obtained after physical examination. The oral glucose tolerance test was performed as the gold standard for diagnosis. The diagnostic capacities of the POC HbA1c measurement in predicting undiagnosed diabetes and AGR were evaluated. Results Among 388 participants, 274 (70.6%) normoglycemic controls, 63 (16.2%) prediabetes patients, and 51 (13.1%) diabetes patients were identified with oral glucose tolerance test (OGTT). Meanwhile, among 97 participants who underwent two HbA1c detection methods simultaneously, a positive correlation was found between POC HbA1c and standardized HbA1c (r = 0.75, P < 0.001). No notable systematic difference was observed from the Bland-Altman Plots. The POC HbA1c cutoff values were 5.95 and 5.25%, which efficiently identified diabetes (AUC 0.92) and AGR (AUC 0.89), respectively. Conclusions The alternative POC HbA1c test efficiently discriminated AGR and diabetes from normoglycemia, especially among the Chinese population in primary healthcare settings.
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Affiliation(s)
- Linhua Pi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zheng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Center for Medical Research, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiajie Shi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen Wang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Khadanga S, Singh G, Pakhare AP, Joshi R. Diagnostic Accuracy of Point-of-Care Tests Measuring Glycosylated Haemoglobin (HbA1c) for Glycemic Control: A Field Study in India. Cureus 2021; 13:e17920. [PMID: 34660113 PMCID: PMC8513731 DOI: 10.7759/cureus.17920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with high-performance liquid chromatography (HPLC) as a reference. Settings The study was carried at two locations, general medical outpatient department of a teaching medical college in Bhopal (urban), and a primary health care centre in a rural area in the state of Madhya Pradesh, India. Participants All individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We compared HbA1c estimated from two index tests (Hemocue Hb 501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard. Primary and secondary outcome measures Diagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure. Results Out of 114 patients, all received reference standard - 103 patients received Hemocue A1C test and 110 patients received SD Biosensor test. Overall both the index tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95% CI 0.886-0.983), and for Hemocue device was 0.938 (95% CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue, respectively. Ambient air temperatures were no different for the device test failures. Conclusions Commercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC-based measurements for the assessment of glycemic control. Tests and device failure rates of both the index tests are similar.
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Affiliation(s)
- Sagar Khadanga
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Gyanendra Singh
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhijit P Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rajnish Joshi
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Handrinos L, Januszewski AS, Trimble E, Donelan N, Williams P, Jenkins AJ. Point-of-care testing of HbA1c, renal function and lipids in remote or disadvantaged regions. Intern Med J 2021; 50:1567-1571. [PMID: 33354871 DOI: 10.1111/imj.15114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/21/2020] [Accepted: 02/15/2020] [Indexed: 11/30/2022]
Abstract
For optimal diabetes management HbA1c, lipid and renal function measurements are key. Suitable point-of-care systems can provide such data in remote areas, diabetes camps, disaster relief, small community hospitals and in community screening days in disadvantaged regions. Some systems are currently used in Australian rural, remote and indigenous health services.
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Affiliation(s)
- Lena Handrinos
- Insulin for Life, Sydney, New South Wales, Australia.,St Vincent's Health, Melbourne, Victoria, Australia
| | - Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Neil Donelan
- Insulin for Life, Sydney, New South Wales, Australia
| | - Paul Williams
- Insulin for Life, Sydney, New South Wales, Australia.,Greg Brown Research Laboratories, Charles Perkins Centre, Department of Endocrinology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alicia J Jenkins
- Insulin for Life, Sydney, New South Wales, Australia.,St Vincent's Health, Melbourne, Victoria, Australia
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Manifold A, Atkinson D, Marley JV, Scott L, Cleland G, Edgill P, Singleton S. Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care. Aust J Prim Health 2020; 25:501-508. [PMID: 31634436 DOI: 10.1071/py19030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to ascertain whether a simplified screening algorithm incorporating glycated haemoglobin (HbA1c) tests increases type 2 diabetes (T2D) screening in 10- to 14-year-old Aboriginal Australians presenting to primary healthcare (PHC) services. The study involved a 6-month pilot of a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town. A retrospective audit of electronic health records for the pilot period (27 June-26 December 2016) and a 6-month period before the screening algorithm was introduced (1 October 2015-31 March 2016) was conducted. Interviews were held with 30 PHC staff at participating PHC services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service. During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (28/130 (22%) v. 50/139 (36%), P = 0.011), but there was no change at the hospital (0.02% v. 0.02%, P = 0.615). Staff feedback suggested measures to improve screening; these include simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
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Affiliation(s)
- Andreana Manifold
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia; and Corresponding author.
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia; and Kimberley Aboriginal Medical Services Ltd, PO Box 1377, Broome, WA 6725, Australia
| | - Lydia Scott
- Western Australia Country Health Service Kimberley, PO Box 62, Broome, WA 6725, Australia
| | - Gavin Cleland
- Western Australia Country Health Service Kimberley, PO Box 62, Broome, WA 6725, Australia
| | - Paula Edgill
- Derbarl Yerrigan Health Service, 156-172 Wittenoom Street, East Perth, WA 6004, Australia; and Centre for Aboriginal Medical and Dental Health, The University of Western Australia (M303), 35 Stirling Highway, Perth, WA 6009, Australia
| | - Sally Singleton
- The Rural Clinical School of Western Australia, The University of Western Australia, PO Box 1377, Broome, WA 6725, Australia
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Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Performance of Point-of-Care Testing Compared with the Standard Laboratory Diagnostic Test in the Measurement of HbA1c in Indonesian Diabetic and Nondiabetic Subjects. J Diabetes Res 2020; 2020:2037565. [PMID: 32733964 PMCID: PMC7369652 DOI: 10.1155/2020/2037565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 06/19/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study is aimed at investigating if point-of-care testing for HbA1c (POCT-HbA1c) using the HemoCue® HbA1c 501 system could be an alternative method for diabetes screening and monitoring to replace the HbA1c measurement in a standard diagnostic laboratory. DESIGN This was a cross-sectional study to assess the agreement between POCT and a standard laboratory measurement method for determining the level of HbA1c. Setting and Participants. In total, 108 participants were recruited to participate in this study, consisting of 61 diabetics and 47 nondiabetics. The diabetic group comprised 37 females and 24 males, diagnosed with type 2 diabetes mellitus (DM) and undergoing diabetes treatment at several community health care centres in Bandung, West Java. The nondiabetic group consisted of 15 female and 32 male patients of several community health care centres and healthy volunteers. Sample Collection and Analysis. A venous blood sample was taken for routine HbA1c analysis by the diagnostic laboratory method. For the POCT-HbA1c, a blood sample was taken from the fingertip at the same time and analysed with the HemoCue® HbA1c 501 system. Outcome Measures. The HbA1c results of both methods were compared and analysed with a Bland-Altman agreement plot. The sensitivity and specificity of the POCT-HbA1c data were also compared with those of the standard diagnostic results. RESULTS Based on the Bland-Altman plot, the HbA1c level for 100 out of 108 (92.59%) subjects analysed by the POCT-HbA1c was within the range of the 95% limit of agreement. Compared with the standard diagnostic assay, the sensitivity of the POCT-HbA1c was 97.83% and its specificity was 77.42%. CONCLUSIONS The high sensitivity and accuracy of POCT-HbA1c indicate that it is a potential method for diabetes screening and monitoring to replace the routine diagnostic laboratory HbA1c measurement, especially when a rapid result is required.
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Affiliation(s)
- Afiat Berbudi
- Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nofri Rahmadika
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Adi Imam Tjahjadi
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Microbiology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Pharmacology and Therapy Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Beks H, Binder M, Kourbelis C, May N, Clark R, Hudson K, Versace V. Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the primary healthcare setting: a scoping review protocol. ACTA ACUST UNITED AC 2019; 16:2268-2278. [PMID: 30531481 DOI: 10.11124/jbisrir-2017-003833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The question of this review is: Which locations in Australia have chronic disease programs for Aboriginal and Torres Strait Islander adult populations in the primary healthcare context been evaluated?Specific objectives are to.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
| | - Marley Binder
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
| | - Constance Kourbelis
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Nikki May
- South Australia Health Library, South Australia Health, Adelaide, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Kerry Hudson
- Dhauwurd-Wurrung Elderly and Community Health Service, Portland, Australia
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
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Diabetes Spatial Care Paths, Leading Edge HbA1c Testing, Facilitation Thresholds, Proactive-Preemptive Strategic Intelligence, and Unmanned Aerial Vehicles in Limited-Resource Countries. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/poc.0000000000000122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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What’s New in Point-of-Care Testing? POINT OF CARE 2016. [DOI: 10.1097/poc.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nguyen HD, Chitturi S, Maple-Brown LJ. Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population. Intern Med J 2016; 46:1252-1259. [DOI: 10.1111/imj.13123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/08/2016] [Accepted: 04/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. D. Nguyen
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - S. Chitturi
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - L. J. Maple-Brown
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
- Menzies School of Health Research; Charles Darwin University; Casuarina Northern Territory Australia
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Arnold LW, Hoy WE, Sharma SK, Wang Z. The Association between HbA1c and Cardiovascular Disease Markers in a Remote Indigenous Australian Community with and without Diagnosed Diabetes. J Diabetes Res 2016; 2016:5342304. [PMID: 26989697 PMCID: PMC4773550 DOI: 10.1155/2016/5342304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/19/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study investigates the burden of cardiovascular risk markers in people with and without diabetes in a remote Indigenous Australian community, based on their HbA1c concentration. METHODS This study included health screening exams of 1187 remote Indigenous residents over 15 years old who represented 70% of the age-eligible community. The participants were stratified by HbA1c into 5 groups using cut-off points recommended by international organisations. The associations of traditional cardiovascular risk markers with HbA1c groups were assessed using logistic and linear regressions and ANOVA models. RESULTS Of the 1187 participants, 158 (13%) had a previous diabetes diagnosis, up to 568 (48%) were at high risk (5.7-6.4% (39-46 mmol/mol) HbA1c), and 67 (6%) potential new cases of diabetes (≥6.5% (48 mmol/mol)) were identified. Individuals with higher HbA1c levels were more likely to have albuminuria (OR 3.14, 95% CI 1.26-7.82) and dyslipidaemia (OR 2.37, 95% CI 1.29-4.34) and visited the clinic more often (OR 2.52, 95% CI 1.26-4.99). Almost all traditional CVD risk factors showed a positive association with HbA1c. CONCLUSIONS Screening in this remote Indigenous Australian community highlights the high proportion of individuals who are at high risk of diabetes as indicated by HbA1c and who also had an accentuated cardiovascular risk profile.
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Affiliation(s)
- Luke W. Arnold
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
- *Luke W. Arnold:
| | - Wendy E. Hoy
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
| | - Suresh K. Sharma
- Division of Medicine, Royal Darwin Hospital, Top End Health Network, Northern Territory Government, Tiwi, NT 0810, Australia
| | - Zhiqiang Wang
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
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