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The local surge appears to be concentrated in southeastern Michigan, affecting areas like Monroe, Lenawee, Washtenaw, and Livingston counties

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It has been associated with complications from diabetic retinopathy

Examples of patient-specific factors that potentially affect treatment discontinuation and adherence are the inability or reluctance to cover drug costs, polypharmacy, changes in medical needs, language barriers leading to miscommunication with health professionals, and patient priorities

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