• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Optimized health care for subjects with type 1 diabetes in a resource constraint society:A three-year followup study from Pakistan

    2019-04-16 02:21:58MuhammadYakoobAhmedaniAsherFawwadFarihaShaheenBilalTahirNazishWarisAbdulBasit
    World Journal of Diabetes 2019年3期

    Muhammad Yakoob Ahmedani,Asher Fawwad,Fariha Shaheen,Bilal Tahir,Nazish Waris,Abdul Basit

    Muhammad Yakoob Ahmedani,Abdul Basit,Department of Medicine,Baqai Institute of Diabetology and Endocrinology,Baqai Medical University,Karachi 74600,Pakistan

    Asher Fawwad,Department of Biochemistry,Baqai Medical University,Research Department,Baqai Institute of Diabetology and Endocrinology,Baqai Medical University,Karachi 74600,Pakistan

    Fariha Shaheen,Bilal Tahir,Nazish Waris,Research Department,Baqai Institute of Diabetology and Endocrinology,Baqai Medical University,Karachi 74600,Pakistan

    Abstract

    Key words:Insulin My Life;Type 1 diabetes;Insulin;Care;Pakistan

    INTRODUCTION

    Annually,more than 132600 subjects under 19 years of age have been diagnosed with type 1 diabetes (T1D) globally[1].It is also estimated that currently around 1106500 subjects (0-19 years) are living with T1D worldwide[1].Although,there are clear geographic differences in trends but the estimated annual increase in T1D is around 3%[2].In 2015,according to IDF,more than 7 million cases of diabetes are reported in Pakistan out of which 2% are suffering from T1D[3].The incidence of T1D in Pakistan has been reported as 1.02 per 100000 per year[4].

    Uncontrolled T1D can lead to microvascular and macrovascular complications mostly in young age group posing a challenge for health care professionals[2,5].Majority of subjects with T1D living in developing countries have minimum or no access to optimal care[2,6]As a result,these subjects are prone to acute and chronic complications of T1D affecting their quality of life[7].

    Limited studies are available on acute and chronic complications in people with T1D from Pakistan[8].A study conducted in the province of Sindh,showed higher rate of complication in subjects with T1D.Authors have reported that every fourth person with T1D is suffering from any one of the chronic complication while 2% subjects with T1D had diabetic ketoacidosis (DKA) and 21% had history of DKA[9].Similar trend was noted in smaller scale studies from this region[8,10].

    Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with T1D in Pakistan[11-13].In Pakistan,33% people lives with poverty and most of the populations (40%) does not receive basic health services[14].Health expenses are 0.7%-0.8% of gross domestic product of Pakistan,while 3.5% of total governmental budget.Overall health care system in Pakistan also offers the support for diabetes but subjects with T1D needs specific attention and optimal care[7,14].

    The study aims to observe effectiveness of optimal care for subjects with T1D including (free periodic consultations,education,dietary advice,provision of insulin and syringes,glucometers,and assessment of glycemic control through HbA1c 6 monthly) by establishing model clinics throughout the province of Sindh,Pakistan.

    MATERIALS AND METHODS

    A welfare project with name of “Insulin My Life (IML)”,was started in the province of Sindh in between February 2010 to February 2013.This was a collaborative work of Baqai Institute of Diabetology and Endocrinology (BIDE),World Diabetes Foundation and Baqai Medical University.Ethical approval was obtained by the Institutional Review Board (IRB) of BIDE with approval/reference number:BIDE/IRB/Prof.Yakoob-IML/02/11/10/025.Subjects with only T1D were included in this study.Informed consent was obtained from above 19 years of age and below 19 years were enrolled after obtaining informed consent from their parents by diabetes educators and physicians.

    Three days’ workshop for doctors and educators

    A total of 34 physicians with post graduate diploma in diabetes and 30 diabetes educators were identified from each district of Sindh.A three days structured training program as per the standard guidelines[15,16]for the management of T1D and prevention of complications was designed for the physicians and for the educators separately.

    Community based awareness and education sessions through camps and media coverage

    More than 0.3 million teachers were sensitized about T1D specifically for the identification and management of emergencies in subjects with T1D.A total of 654 community based awareness camps and group sessions were held in the vicinity of identified clinics.In these awareness camps knowledge of self-monitoring blood glucose (SMBG),insulin using techniques,dose regime,optimal targets for glycemic control,adequate diet,physical activity,sick day rule,signs and symptoms of hypoglycemia and hyperglycemia were provided to subjects with T1D and their family members.

    Printed educational material in English,Urdu and regional language (Sindhi) was also provided to subjects with T1DM,their parents and community.Eighteen televisions and 30 radio programmes in local and regional languages were also telecasted as a part of awareness campaign.A dedicated website www.insu linmylife.com was also launched to dessiminate relevant information regarding T1D[17].

    Establishment of model Type 1 diabetic clinics and 24-h helpline service

    Thirty-four model type 1 diabetic clinics were established at least one in each district of Sindh during the initial phase of the project (Figure1)[17].A 24 h telephonic helpline service was made available to all project registrants.Through 24 h helpline service trained diabetes educators in consultation with primary consultant gave advises and sort out day to day problems including dose adjustments,hypo and hyperglycemic management.In case of emergency these registered subjects with diabetes were advised to contact emergency services.

    Diagnosis of T1D

    Biochemical parameters include glucose level in fasting,after 2-h of postprandial glucose,HbA1c,proteinuria and urinary ketones.Polyphagia,polyuria,polydipsia,weight loss history,and DKA history which are confirmed if previous records are present were recorded.In suspected cases of DKA,blood pH,HCO3 was done[9].

    Provision of optimal care for T1D

    No single subject had free insulin and blood sugar testing equipment at the start of the study.All registered subjects with T1D were asked to have free of cost consultation with physician,diabetes educators,free coverage for insulin and glucose testing equipment after every six months.

    Subjects with other than T1D were excluded from the study.HbA1c,microalbuminuria test and consultation with a dietitian were offered after every 6 months.Free medical supplies including insulin,glucometers,glucose strips,lancets and insulin syringes,SMBG recording booklets were provided to the participants and they were asked to monitor their glucose readings with a record of these readings to be maintained in diaries.All children (less than and equal to 12 years of age) with T1D were referred to pediatrician as and when needed.The Growth chart with growth velocity was also followed throughout the study period.

    Glycemic control assessment

    Figure1 Type 1 diabetic model clinics in the province of Sindh.

    Glycemic control was assessed by checking FBS and RBS at baseline and end of the study along with fasting HbA1c at baseline and after every 6 mo during 3 years follow up.Glycemic control was also assessed by using SMBG level at different meal timings in all age groups.Those who have HbA1c between 6.5%-8%,9%-10% and ≥10% were considered good,fair and poor control,respectively[15,18].

    Screening of micro vascular complications

    Vista 20 direct ophthalmoscope was used for fundus examine.Retinopathy was confirmed by normal,microdots,hard exudates,pre-proliferative and proliferative or maculopathy.Protein>1+ on dipstick (Combur 10,Roche Diagnostics) show nephropathy.Twenty-four hours quantitative analyses of urine for protein and creatinine were done.Neuropathy was known as absent touch or vibratory sensations of the feet.The 10-g monofilament and vibration sensation by 128 Hz tuning fork was used for touch sensation.

    Data collection

    Electronic and centralized database was designed to records demographic,biochemical,anthropometric and medical examination.

    Statistical analysis

    Statistical Package for Social Sciences (SPSS,version 20) was used for demographic and biochemical data.Continuous data was presented as mean,standard deviation and categorical data as numbers and percentages.Chi-square test was used for comparison of percentages andttest was performed for the mean difference comparison.Statistically significant was considered asP-value < 0.05.

    RESULTS

    T1D model clinics in the province of Sindh-Pakistan are shown in Figure1.Out of 1428 subjects 790 (55.3%) were males and 638 (44.7%) were females.Subjects were categorized into four groups according to age as ≤ 5 years of age (n= 103,7.2%),between 6-12 years (n= 323,22.6%),between 13-18 years (n= 428,29.7%) and ≥ 19 years of age (n= 574,40.2%) groups.Mean age (years) at the time of diagnosis in ≤ 5 years of age was 3.2 (± 1.5) and at the time of recruitment 3.5 (± 1.5),between 6-12 years was 8.3 (± 2.5) and 9.5 (± 1.9),between 13-18 years 13.7 (± 3.6) and 15.6 (± 1.7)and in ≥ 19 years of age groups 22 (± 6.3) and 25.7 (± 5.5),respectively.Duration of diabetes,family history of diabetes,weight,systolic and diastolic blood pressure were noted in all age groups along with serum creatinine at baseline (Table1).

    Mean HbA1c at baselinevsend of study in ≤ 5 years of age subjects was (11.5 ± 2.04vs10.2 ± 2.12,P= 0.026),between 6-12 years was (10.7 ± 2.28vs8.9 ± 2.24,P≤ 0.0001),between 13-18 years was (10.5 ± 2.76vs8.7 ± 2.49,P≤ 0.0001) and (9.6 ± 2.52vs8.5 ±2.17,P <0.0001) in ≥ 19 years of age.A significant decrease in HbA1c was observed in all age categories (P <0.05) (Table2).The comparison of systolic,diastolic blood pressure along with fasting and random blood glucose were also presented in Table2.Glycemic control as retrieved by HbA1c was significantly improved at final visit as compared to the baseline in all age groups.At baseline visit good glycemic control was observed in 3.6% subjects which increased to 25.9% at the end of study for ≤ 5 years of age.Similar trend can be seen in age 6-12 years (baseline 13.5%vsend line 36.3%,P <0.0001),for age 13-18 years (14.7%vs37.7%,P <000001) and (26.8%vs62.1%,P <0.0001) for ≥ 19 years of age group (Table3).

    During three years follow up decreasing trends of mean SMBG were also observed at different meal timings in all age groups (Table3).Comparatively lower mean SMBG values were observed compared to first month during the study period (Table4).Graphical representation of microvascular complications was shown in Figure2.The frequency of retinopathy shows a slight increasing (non-significant) trend,while the frequency of nephropathy and neuropathy almost remained the same during the study period.Significant improvement in HbA1c levels was observed in all age groups at end of study period (at 3 years) (Figure3).

    DISCUSSION

    In this observational study,a three year follow up of people with T1D registered under project of IML in the province of Sindh Pakistan.Significant improvement in the glycemic control was noted with provision of comprehensive care,awareness and treatment free of cost.

    Though it is difficult to achieve optimum glycemic control among adolescents,regardless the type of diabetes[19],what we have observed that with proper care fewer people remained in the poor glycemic category and many people achieved fair to good control (Table2).This has been shown by Diabetes Patient Verlaufsdokumentation (DPV) registry also that healthy outcomes can be achieved in individuals with T1D when provided with optimized and personalized care[20].Good glycemic control not only important for decreasing the morbidity,but it can decrease diabetes related mortality rate as well as shown by Nordwall M related DM registry[21,22].On the other hand,without proper access to standardized care people with T1D suffer from adverse results even at an earlier age[23].In our study,over 3 years,people with T1D in each age category showed downward trend of HbA1c and this decline was statistically significant.

    With provision of free glucostrips and glucometers it was made possible for study registered participants to check blood glucose at least 2 times/d.However,the annual cost per participant which include consultation fee,lab diagnosis,glucometers,insulins,strips,lancets and syringes,etc.was 61000pkr (436USD),per month 5083pkr(36USD) and per day 169pkr (1.2USD).SMBG profile of our cohort also showed downward trend at different mealtimes and this proves that by continuous education and pursuing its effectiveness enhances the motivation of subjects and their families to achieve better glycemic control.Study from Bulgarian suggests that due to families’devotion to diabetes control,children under six years achieved good glycemic control[24].Glycemic control with chronic complications was clearly shown by landmark study that is in Diabetes Control and Complication Trial (DCCT)[25,26].On the contrary association between poor glycemic control and increase risk of chronic complication was shown by several studies[26].

    In study from Southeast Sweden,prolonged uncontrolled HbA1c was closely associated with the development of severe complications in individuals with T1D[22].Another observational,population based study from DPV registry indicates that poor HbA1c was found to be a powerful biomarker for the development of retinopathy,nephropathy and neuropathy in patients with T1D[27].Time to onset of complications was also influenced by HbA1c as in the primary prevention cohort of DCCT[22].However,in our study rate of complication including nephropathy,and neuropathy remained the same throughout the study period through there was non-significant rise in frequency of retinopathy.

    This study with best of our knowledge,concludes that it is first of its kind from Pakistan,giving us long-term longitudinal data of patients with T1D in a resource constraint society.With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency ofmicrovascular complications was observed over 3 years.

    Table1 Baseline demographic and clinical characteristic of study subjects

    Limitations

    In a resource constraint society like Pakistan,there is lack of an infrastructure for current study to provide health care system in a proper way.But,with available resources such kind of data was considered as the best available option.All the study participants during the study duration were coming to their respective medical centers for the required care.However,in remote areas the follow-up HbA1c was not completely available.This study helps us to know more about T1D in Pakistan than ever before,but much is still to be learned.This study need to be replicated at Nationwide level.

    Table2 Comparison of clinical measures from baseline to last follow up

    Table3 Age distributed glycemic status on first and last visit of the study period

    Table4 Trends of mean self-monitoring blood glucose readings during the study period

    0-5 yr 281.6 252.2 204.7 257.5 6-12 yr 269.8 226.8 237.3 207.6 13-18 yr 246.6 230.6 237.4 194.8 19 and above 223.1 211.8 202.8 203.8 Before dinner 0-5 yr 299.2 276 216.2 239.9 6-12 yr 262 261.1 242.6 218.1 13-18 yr 255 228.4 234 205.5 19 and above 223.6 191.8 211.4 182.1 After 2 h of dinner 0-5 yr 297.3 254.3 196.8 239.8 6-12 yr 239.3 247.8 244.7 192.5 13-18 yr 240.1 219.2 213.7 179.8 19 and above 217.4 195.9 212.1 180.7 Before sleeping 0-5 yr 273.3 254.9 212.5 214.7 6-12 yr 230.7 230.6 181.1 211.3 13-18 yr 195 223.3 218.8 165.7 19 and above 167.3 167.9 196.4 195

    Figure2 Complications rate of patients with ≥ 10 years diabetes duration.

    Figure3 Trends of glycosylated hemoglobin (HbA1c levels).

    ARTICLE HIGHLIGHTS

    Research background

    Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes (T1D) in Pakistan.

    Research motivation

    The current study with lack of an infrastructure provides health care system in a proper way with available resources,to evaluate patient centered outcomes in the measurement of progression and treatment.Such kind of data was considered as the best available option.

    Research objectives

    The objective of this study is to observe the effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan.

    Research methods

    In this welfare project “Insulin My Life (IML)”,subjects with only T1D were included.Thirtyfour model T1D clinic were established and total of 654 community based awareness camps and group sessions were held.All registered subjects with T1D were asked to have free of cost consultation with physician,diabetes educators,free coverage for insulin and glucose testing equipment after every six months.Glycemic control was assessed by checking FBS and RBS at baseline and end of the study along with fasting HbA1c at baseline and after every 6 mo during 3 years follow up.Glycemic control was also assessed by using self-monitoring blood glucose level (SMBG) at different meal timings in all age groups.

    Research results

    Out of 1428 subjects 790 (55.3%) were males and 638 (44.7%) were females.Glycemic control as retrieved by HbA1c was significantly improved at final visit as compared to the baseline in all age groups.At baseline visit good glycemic control was observed in 3.6% subjects which increased to 25.9% at the end of study for ≤ 5 years of age.Similar trend can be seen in age 6-12 years,13-18 years,and ≥ 19 years of age group.Comparatively lower mean SMBG values were observed compared to first month during the study period.

    Research conclusions

    With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.

    Research perspectives

    This study helps us to know more about T1D in Pakistan than ever before,but much is still to be learned.This study need to be replicated at Nationwide level.

    ACKNOWLEDGEMENTS

    We acknowledge the support of “Insulin My Life” (IML) project,a collaborative project of World Diabetes Foundation (WDF),Life for a Child program (LFAC) and Baqai Institute of Diabetology and Endocrinology (BIDE).We also grateful to following doctors of type 1 model clinics for their help in recruiting and care in the IML project;Dr.Abdul Rasheed Joyo (Khairpur),Dr.Abdullah Memon (Sukkar),Dr.Aejaz Solangi (Khairpur),Dr.Ahsan Siddiqui (Gharo,Sehwan and Karachi),Dr.Ameer Memon (khairpur),Dr.Asif Brohi (Nawabshah),Dr.Fareed Uddin (Karachi),Dr.Farhan Baloch (Sukkar and Shikarpur),Dr.Fateh Dero (Hyderabad),Dr.Irshad Ahmed (Hyderabad),Dr.Kashif (Nawabshah),Dr.Merajuddin Nizami (Hyderabad),Dr.Najma Samejo (Tandojam),Dr.Nazeer Khokar (Khairpur),Dr.Nazeer Soomro(Jacobabad),Dr.Pawan Kumar (Kashmoor and Larkana),Dr.Riasat Ali Khan(Karachi),Dr.Riaz Ahmed (Tharparkar),Dr.Muhammad Saif Ulhaque (Karachi),Dr.Sanober (Karachi),Dr.Shahid (Nosheroferoz),Dr.Shahjahan Mangi (Shikarpur),Dr.Umeet Kumar (Ghotki),Dr.Veru Mal (Karachi and Mirpurkhas),Dr.Zahoor Shaikh(Dadu),Dr.Muhammad Irfan (Shahdahpur),Dr.Zahid Miyan (Karachi),Dr.Awn Bin Zafar (Karachi),Dr.Farhatullah Khan (Karachi).We would also like to thank Dr.Maqsood Mohiuddin and Mr.Iqbal Hussain (Project Coordinators),Mrs.Afshan Siddiqui and Miss.Raheela Naseem (Clinical Coordinators) and Mrs.Rubina Sabir and Mr.Fawwad Ahmed (Laboratory and Pharmacy Managers) for their support.Prof.Muhammad Yakoob Ahmedani and Dr.Asher Fawwad,is a guarantor and undertakes the full responsibility for all contents of the article submitted for publication.

    久久人妻av系列| 国产午夜精品久久久久久一区二区三区| 久久婷婷人人爽人人干人人爱| 观看美女的网站| 精品人妻熟女av久视频| 国内精品久久久久精免费| 黄色一级大片看看| 久久这里只有精品中国| 国产黄色小视频在线观看| 午夜激情欧美在线| 成人午夜精彩视频在线观看| 久久久久久九九精品二区国产| 久久久久久久久久黄片| 春色校园在线视频观看| 十八禁国产超污无遮挡网站| 国产伦一二天堂av在线观看| 久久久午夜欧美精品| 国产av不卡久久| 能在线免费看毛片的网站| 人妻系列 视频| 精品久久久噜噜| 在线观看免费视频日本深夜| 久久这里只有精品中国| 亚洲欧美清纯卡通| 欧洲精品卡2卡3卡4卡5卡区| 白带黄色成豆腐渣| 日韩欧美一区二区三区在线观看| 久久精品影院6| 国产成人精品婷婷| 男女做爰动态图高潮gif福利片| 国内揄拍国产精品人妻在线| 欧美bdsm另类| 亚洲精品日韩av片在线观看| 亚洲成人精品中文字幕电影| 国产探花极品一区二区| 天堂√8在线中文| 国产精品一及| 国产高清激情床上av| 久久99精品国语久久久| 波多野结衣高清无吗| 久久国产乱子免费精品| 精品一区二区免费观看| 国产精品,欧美在线| 99在线人妻在线中文字幕| 国产成人精品婷婷| 听说在线观看完整版免费高清| 亚洲av熟女| 日韩欧美精品免费久久| 日韩 亚洲 欧美在线| 国产v大片淫在线免费观看| 中文字幕久久专区| av专区在线播放| 成人毛片60女人毛片免费| 亚洲精品色激情综合| 久久久久九九精品影院| 免费人成在线观看视频色| 身体一侧抽搐| 一边亲一边摸免费视频| 国产视频内射| 黄色一级大片看看| 久久久久久久久久黄片| 秋霞在线观看毛片| 亚洲性久久影院| 国产精品福利在线免费观看| 国产黄色小视频在线观看| 久久精品国产99精品国产亚洲性色| 国产精品人妻久久久久久| 亚洲精品日韩在线中文字幕 | 啦啦啦啦在线视频资源| 亚洲无线观看免费| 午夜a级毛片| 99久久无色码亚洲精品果冻| 尤物成人国产欧美一区二区三区| 国产老妇女一区| 日日撸夜夜添| 国产淫片久久久久久久久| 99热精品在线国产| 欧美精品一区二区大全| 亚洲国产欧美人成| 蜜桃亚洲精品一区二区三区| 成人亚洲欧美一区二区av| 日韩制服骚丝袜av| 国产淫片久久久久久久久| 大又大粗又爽又黄少妇毛片口| 两个人的视频大全免费| 嫩草影院精品99| 成年免费大片在线观看| .国产精品久久| 热99在线观看视频| 欧美色视频一区免费| 国产 一区 欧美 日韩| 亚洲av二区三区四区| 2021天堂中文幕一二区在线观| 国产一区二区在线av高清观看| 久久精品夜色国产| 欧美激情久久久久久爽电影| 亚洲自偷自拍三级| 久久久国产成人精品二区| 日韩国内少妇激情av| 午夜a级毛片| 一本久久精品| 日韩成人伦理影院| 国产av在哪里看| 69人妻影院| 免费黄网站久久成人精品| 日韩在线高清观看一区二区三区| 日韩精品有码人妻一区| 好男人在线观看高清免费视频| 联通29元200g的流量卡| 男人舔奶头视频| 一级二级三级毛片免费看| 性欧美人与动物交配| 亚洲国产精品合色在线| 91麻豆精品激情在线观看国产| 亚洲最大成人手机在线| 看黄色毛片网站| 久久欧美精品欧美久久欧美| 两个人视频免费观看高清| 日本三级黄在线观看| 99视频精品全部免费 在线| 国产男人的电影天堂91| 亚洲一区高清亚洲精品| 国产亚洲精品久久久久久毛片| 国产精品人妻久久久影院| 成人av在线播放网站| 久久久欧美国产精品| 人人妻人人澡欧美一区二区| 欧美zozozo另类| 天堂影院成人在线观看| 欧美又色又爽又黄视频| 99国产精品一区二区蜜桃av| 中文精品一卡2卡3卡4更新| 熟女人妻精品中文字幕| 黄色配什么色好看| 变态另类丝袜制服| 中出人妻视频一区二区| 欧美激情久久久久久爽电影| 免费不卡的大黄色大毛片视频在线观看 | 日本与韩国留学比较| 国产黄片视频在线免费观看| 日韩视频在线欧美| av国产免费在线观看| 99久久无色码亚洲精品果冻| 精品久久久噜噜| 亚洲精品乱码久久久久久按摩| 免费观看人在逋| 久久精品国产亚洲av天美| 欧美三级亚洲精品| 观看美女的网站| 亚洲国产精品国产精品| 国产精品综合久久久久久久免费| 少妇裸体淫交视频免费看高清| 成年av动漫网址| 日本-黄色视频高清免费观看| 久久久久久久午夜电影| 99热全是精品| 国产在线精品亚洲第一网站| 特大巨黑吊av在线直播| 激情 狠狠 欧美| 午夜老司机福利剧场| 日本在线视频免费播放| 欧美又色又爽又黄视频| 男插女下体视频免费在线播放| 久久这里有精品视频免费| 国产 一区精品| 欧美成人一区二区免费高清观看| 亚洲精华国产精华液的使用体验 | 99热全是精品| 成人亚洲欧美一区二区av| 亚洲欧美成人综合另类久久久 | 在现免费观看毛片| 如何舔出高潮| 亚洲欧美成人精品一区二区| 国产精品1区2区在线观看.| 身体一侧抽搐| 精品人妻视频免费看| 一边亲一边摸免费视频| 一本一本综合久久| 国产亚洲av片在线观看秒播厂 | 久久久精品94久久精品| 美女cb高潮喷水在线观看| 日韩欧美国产在线观看| 白带黄色成豆腐渣| 久久精品国产自在天天线| 搡老妇女老女人老熟妇| 晚上一个人看的免费电影| 欧美人与善性xxx| 此物有八面人人有两片| 国产私拍福利视频在线观看| 国产精品精品国产色婷婷| 男人和女人高潮做爰伦理| 日日摸夜夜添夜夜添av毛片| 深夜精品福利| 久久精品国产99精品国产亚洲性色| 女同久久另类99精品国产91| 日本免费a在线| 日本一本二区三区精品| 亚洲精品日韩av片在线观看| 欧美xxxx性猛交bbbb| 色综合色国产| 综合色av麻豆| 午夜久久久久精精品| 亚洲激情五月婷婷啪啪| 最近手机中文字幕大全| 亚洲成av人片在线播放无| 男女做爰动态图高潮gif福利片| 国产真实乱freesex| 国产伦一二天堂av在线观看| 国产精品三级大全| 国产综合懂色| 欧美日韩精品成人综合77777| 一本一本综合久久| 国产高清不卡午夜福利| a级毛片a级免费在线| 成人亚洲精品av一区二区| 欧美精品一区二区大全| 高清毛片免费观看视频网站| 国产精品99久久久久久久久| 长腿黑丝高跟| 又爽又黄a免费视频| 1000部很黄的大片| 免费看美女性在线毛片视频| 真实男女啪啪啪动态图| 看非洲黑人一级黄片| 精品一区二区三区视频在线| 日本成人三级电影网站| 日韩av在线大香蕉| 91精品一卡2卡3卡4卡| 美女国产视频在线观看| 国产精品久久久久久久久免| 22中文网久久字幕| 男插女下体视频免费在线播放| 久久久久久久久久成人| 久久人人爽人人爽人人片va| 亚洲av电影不卡..在线观看| 日本五十路高清| 国产成人影院久久av| a级一级毛片免费在线观看| 久久精品久久久久久噜噜老黄 | 成人午夜精彩视频在线观看| 亚洲av.av天堂| 国产69精品久久久久777片| 国产亚洲精品久久久久久毛片| 少妇裸体淫交视频免费看高清| 日韩视频在线欧美| 日韩欧美三级三区| 高清在线视频一区二区三区 | 国产精品免费一区二区三区在线| 一卡2卡三卡四卡精品乱码亚洲| 亚洲精品乱码久久久久久按摩| 最后的刺客免费高清国语| 欧美+日韩+精品| 国产亚洲91精品色在线| 最近最新中文字幕大全电影3| 日本色播在线视频| 久久久久性生活片| 男女啪啪激烈高潮av片| 久久久国产成人免费| 一个人看的www免费观看视频| 成人漫画全彩无遮挡| 又黄又爽又刺激的免费视频.| 深夜a级毛片| 亚洲成人久久爱视频| 国产亚洲精品久久久久久毛片| 69人妻影院| 亚洲人成网站在线观看播放| 精品久久国产蜜桃| 免费观看精品视频网站| 国产一区亚洲一区在线观看| 高清在线视频一区二区三区 | 深夜精品福利| 可以在线观看毛片的网站| 草草在线视频免费看| 久久久久性生活片| 麻豆久久精品国产亚洲av| 精品久久久久久久末码| 大香蕉久久网| av视频在线观看入口| 波多野结衣巨乳人妻| 美女国产视频在线观看| 亚洲欧美精品综合久久99| 日韩一本色道免费dvd| 亚洲婷婷狠狠爱综合网| 久久精品国产亚洲av涩爱 | 亚洲最大成人中文| 国产精品爽爽va在线观看网站| 精品久久久久久久久久免费视频| 亚洲综合色惰| 亚洲国产精品国产精品| 九九久久精品国产亚洲av麻豆| 国产精品一二三区在线看| 悠悠久久av| 午夜免费激情av| 大香蕉久久网| 99国产精品一区二区蜜桃av| 久久久久国产网址| av在线天堂中文字幕| 国产探花在线观看一区二区| 国产男人的电影天堂91| 天堂网av新在线| 国产成人91sexporn| 久久久久性生活片| h日本视频在线播放| 久久99精品国语久久久| 亚洲人成网站在线播放欧美日韩| 深夜精品福利| 一进一出抽搐动态| 国产午夜精品一二区理论片| 一边亲一边摸免费视频| 大又大粗又爽又黄少妇毛片口| 日日撸夜夜添| 中文在线观看免费www的网站| 少妇丰满av| 女人被狂操c到高潮| 在线观看av片永久免费下载| 一本一本综合久久| 麻豆久久精品国产亚洲av| 一本久久中文字幕| av福利片在线观看| 亚洲五月天丁香| 亚洲在久久综合| 欧美性猛交╳xxx乱大交人| 麻豆一二三区av精品| 国产精品人妻久久久影院| 午夜久久久久精精品| 男女做爰动态图高潮gif福利片| 极品教师在线视频| 在线观看一区二区三区| 亚洲精品乱码久久久v下载方式| 国产 一区精品| 国产69精品久久久久777片| 神马国产精品三级电影在线观看| 最近2019中文字幕mv第一页| 国产精品久久久久久亚洲av鲁大| 午夜激情欧美在线| 蜜臀久久99精品久久宅男| 熟女人妻精品中文字幕| 亚洲av中文av极速乱| 国产黄色视频一区二区在线观看 | 色噜噜av男人的天堂激情| 欧美色欧美亚洲另类二区| 成人亚洲欧美一区二区av| 亚洲av中文av极速乱| 人妻制服诱惑在线中文字幕| 国产极品天堂在线| a级毛片免费高清观看在线播放| 久久久久网色| 亚洲,欧美,日韩| 26uuu在线亚洲综合色| 欧美成人a在线观看| 国产av麻豆久久久久久久| 日本色播在线视频| 禁无遮挡网站| 在线播放无遮挡| 婷婷六月久久综合丁香| 午夜爱爱视频在线播放| 人妻制服诱惑在线中文字幕| 波多野结衣高清作品| 成人鲁丝片一二三区免费| 精品熟女少妇av免费看| 一级二级三级毛片免费看| 国产 一区 欧美 日韩| 久久人人精品亚洲av| 日本一二三区视频观看| 日韩成人伦理影院| 国产精品人妻久久久影院| 成人亚洲精品av一区二区| 男女啪啪激烈高潮av片| 好男人视频免费观看在线| 亚洲人成网站在线观看播放| 综合色av麻豆| 国产免费男女视频| 亚洲aⅴ乱码一区二区在线播放| 伊人久久精品亚洲午夜| 天天躁日日操中文字幕| 婷婷精品国产亚洲av| 午夜福利在线观看吧| 夫妻性生交免费视频一级片| 99久久精品国产国产毛片| 国产极品精品免费视频能看的| 午夜精品在线福利| 中文字幕av成人在线电影| 少妇人妻精品综合一区二区 | 免费观看人在逋| 搞女人的毛片| 欧美激情在线99| h日本视频在线播放| 好男人视频免费观看在线| 97超碰精品成人国产| 国产精品一及| 大又大粗又爽又黄少妇毛片口| 久久中文看片网| 亚洲精品456在线播放app| 国产精品久久久久久亚洲av鲁大| 99热这里只有是精品在线观看| 国产精品福利在线免费观看| 午夜精品国产一区二区电影 | 免费看av在线观看网站| 3wmmmm亚洲av在线观看| 级片在线观看| 精品午夜福利在线看| 欧美潮喷喷水| 偷拍熟女少妇极品色| 国产精品乱码一区二三区的特点| 久久韩国三级中文字幕| 精品不卡国产一区二区三区| 久久久久网色| 亚洲真实伦在线观看| 一级av片app| 日韩中字成人| 又爽又黄a免费视频| 亚洲精品色激情综合| 成人一区二区视频在线观看| 国产一区二区三区在线臀色熟女| 久久鲁丝午夜福利片| 国产精品久久久久久av不卡| 午夜福利在线观看免费完整高清在 | 国产成人一区二区在线| 一个人观看的视频www高清免费观看| 网址你懂的国产日韩在线| 日韩高清综合在线| 午夜福利高清视频| 久久99热6这里只有精品| 五月伊人婷婷丁香| 在线播放国产精品三级| 哪里可以看免费的av片| 色5月婷婷丁香| 久久6这里有精品| 看十八女毛片水多多多| 亚洲欧美清纯卡通| 欧美+亚洲+日韩+国产| 亚洲一区高清亚洲精品| 日韩制服骚丝袜av| 成人一区二区视频在线观看| 国产精品女同一区二区软件| 三级经典国产精品| 国产精华一区二区三区| 日韩人妻高清精品专区| 亚洲一区高清亚洲精品| 久久99热这里只有精品18| 最近最新中文字幕大全电影3| 九色成人免费人妻av| 国产亚洲精品av在线| 校园人妻丝袜中文字幕| 欧美最新免费一区二区三区| 99久国产av精品国产电影| 精品人妻偷拍中文字幕| 国产精品伦人一区二区| 国产蜜桃级精品一区二区三区| 精品日产1卡2卡| 久久精品国产亚洲av香蕉五月| 国产日韩欧美在线精品| 激情 狠狠 欧美| 国产精品国产高清国产av| 久久久久九九精品影院| 久久欧美精品欧美久久欧美| 99热这里只有精品一区| 亚洲精品色激情综合| 日韩一本色道免费dvd| 少妇人妻精品综合一区二区 | 国产精华一区二区三区| 一进一出抽搐gif免费好疼| 国产精品一区www在线观看| 久久热精品热| 夜夜夜夜夜久久久久| 欧美日韩精品成人综合77777| 直男gayav资源| av免费在线看不卡| 麻豆一二三区av精品| 超碰av人人做人人爽久久| 日韩,欧美,国产一区二区三区 | 麻豆精品久久久久久蜜桃| 亚洲成人精品中文字幕电影| 国产精品久久电影中文字幕| 免费电影在线观看免费观看| 成人欧美大片| 久久综合国产亚洲精品| 老熟妇乱子伦视频在线观看| 男人的好看免费观看在线视频| 欧美精品一区二区大全| 性欧美人与动物交配| avwww免费| 一本精品99久久精品77| 麻豆国产97在线/欧美| 中国美白少妇内射xxxbb| 狠狠狠狠99中文字幕| 国产精品1区2区在线观看.| 日本欧美国产在线视频| 男人舔奶头视频| 91精品国产九色| 久久久成人免费电影| 久久久久久久亚洲中文字幕| 一级毛片电影观看 | 亚洲欧美成人精品一区二区| 毛片一级片免费看久久久久| 成人特级黄色片久久久久久久| 日韩 亚洲 欧美在线| 国产 一区精品| av黄色大香蕉| 亚洲精品粉嫩美女一区| 91狼人影院| 18禁在线无遮挡免费观看视频| 亚洲中文字幕一区二区三区有码在线看| 午夜激情欧美在线| 久久精品久久久久久噜噜老黄 | 看十八女毛片水多多多| 欧美色视频一区免费| 人人妻人人澡欧美一区二区| 日本在线视频免费播放| 亚洲欧洲日产国产| 亚洲国产精品合色在线| 国产亚洲精品久久久com| av天堂在线播放| 午夜精品国产一区二区电影 | 夜夜爽天天搞| 身体一侧抽搐| 成人二区视频| 国产蜜桃级精品一区二区三区| 欧美潮喷喷水| av视频在线观看入口| 精品熟女少妇av免费看| 夜夜夜夜夜久久久久| 菩萨蛮人人尽说江南好唐韦庄 | 亚洲av成人精品一区久久| 舔av片在线| 亚洲av二区三区四区| 国产精品久久久久久精品电影小说 | 国产精品人妻久久久久久| 丝袜美腿在线中文| 在线观看av片永久免费下载| 日本三级黄在线观看| 丰满乱子伦码专区| 国产高清不卡午夜福利| 麻豆精品久久久久久蜜桃| 高清日韩中文字幕在线| 尾随美女入室| 久久九九热精品免费| 国产av在哪里看| 国产 一区 欧美 日韩| 18禁在线播放成人免费| 国产极品精品免费视频能看的| 久久精品国产99精品国产亚洲性色| 黑人高潮一二区| 国产伦一二天堂av在线观看| 亚洲四区av| 国产真实伦视频高清在线观看| 国产成人a区在线观看| 超碰av人人做人人爽久久| 午夜福利在线观看免费完整高清在 | 91久久精品电影网| 高清毛片免费看| 欧美一区二区国产精品久久精品| 国语自产精品视频在线第100页| 久99久视频精品免费| 男人舔女人下体高潮全视频| 一级毛片aaaaaa免费看小| 夜夜爽天天搞| av天堂在线播放| 国产高清三级在线| 91在线精品国自产拍蜜月| 国产白丝娇喘喷水9色精品| 一本久久精品| 一进一出抽搐gif免费好疼| 亚洲欧美日韩高清专用| 日本免费一区二区三区高清不卡| 日韩一区二区三区影片| 久久精品人妻少妇| 国产单亲对白刺激| 婷婷六月久久综合丁香| 国产精品久久电影中文字幕| 精品国产三级普通话版| 欧美极品一区二区三区四区| 菩萨蛮人人尽说江南好唐韦庄 | 在线免费观看不下载黄p国产| av天堂在线播放| 精品无人区乱码1区二区| 自拍偷自拍亚洲精品老妇| videossex国产| 人人妻人人澡人人爽人人夜夜 | 亚州av有码| 啦啦啦韩国在线观看视频| 舔av片在线| 少妇熟女aⅴ在线视频| 久久午夜福利片| 精品熟女少妇av免费看| 热99re8久久精品国产| 国产一区二区三区av在线 | 亚洲综合色惰| 啦啦啦韩国在线观看视频| 日本爱情动作片www.在线观看| 成人毛片60女人毛片免费| 99久久人妻综合| 我要搜黄色片| ponron亚洲| 天堂影院成人在线观看| 国产黄片视频在线免费观看| 又粗又爽又猛毛片免费看| 乱码一卡2卡4卡精品| 日日干狠狠操夜夜爽| 男人舔奶头视频| 亚洲在线自拍视频| av卡一久久| 欧美日韩在线观看h| 久久这里有精品视频免费| 高清毛片免费观看视频网站| www日本黄色视频网| 麻豆一二三区av精品| 国产精华一区二区三区| 日韩精品有码人妻一区| 国产伦理片在线播放av一区 | 中文亚洲av片在线观看爽| 人妻久久中文字幕网| 成人特级av手机在线观看| 精品熟女少妇av免费看| 欧美高清性xxxxhd video|