Leigh Perreault, MD
Visiting Associate Clinical Professor, Medicine-Endocrinology/Metabolism/Diabetes

Professional Titles

• Associate Professor of Medicine, Division of Endocrinology, Metabolism and Diabetes
• Associate Professor of Epidemiology and Biostatistics
• Affiliate, Center for Global Health

Recognition & Awards

• Fellow, American College of Physicians (2019)
  Elected as a fellow to the American College of Physicians (FACP)
• Ruth Gray Memorial Lectureship, Northshore University Health System (2016)
  Awarded to a clinic-scientist for excellence in metabolic and/or cardiovascular disease research
• Lancet symposium lecture, American Diabetes Association (2012)
  As the lead author of a paper published in the Lancet, our work was selected for an award lecture as one of the most important papers the journal published on diabetes in 2012

Research Interests

Publications

• Suresh K, Holtrop JS, Dickinson LM, Willems E, Smith PC, Gritz RM, Perreault L. PATHWEIGH, pragmatic weight management in adult patients in primary care in Colorado, USA: study protocol for a stepped wedge cluster randomized trial. Trials. 2022 Jan 10;23(1):26. PubMed PMID: 35012628
• Suresh K, Willems E, Williams J, Gritz RM, Dickinson LM, Perreault L, Holtrop JS. An Assessment of Weight Loss Management in Health System Primary Care Practices. J Am Board Fam Med. 2022 Dec 2. [Epub ahead of print] PubMed PMID: 36460354
• Zarini S, Brozinick JT, Zemski Berry KA, Garfield A, Perreault L, Kerege A, Bui HH, Sanders P, Siddall P, Kuo MS, Bergman BC. Serum dihydroceramides correlate with insulin sensitivity in humans and decrease insulin sensitivity in vitro. J Lipid Res. 2022 Oct;63(10):100270. PubMed PMID: 36030929
• Wild J, Kaizer A, Willems E, Kramer ES, Perreault L. Prelude to PATHWEIGH: pragmatic weight management in primary care. Fam Pract. 2022 Aug 23. [Epub ahead of print] PubMed PMID: 35997768
• Perreault L, Davies M, Frias JP, Laursen PN, Lingvay I, Machineni S, Varbo A, Wilding JPH, Wallenstein SOR, le Roux CW. Changes in Glucose Metabolism and Glycemic Status With Once-Weekly Subcutaneous Semaglutide 2.4 mg Among Participants With Prediabetes in the STEP Program. Diabetes Care. 2022 Oct 1;45(10):2396-2405. PubMed PMID: 35724304
• Mottl AK, Alicic R, Argyropoulos C, Brosius FC, Mauer M, Molitch M, Nelson RG, Perreault L, Nicholas SB. KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD. Am J Kidney Dis. 2022 Apr;79(4):457-479. PubMed PMID: 35144840
• Suresh K, Holtrop JS, Dickinson LM, Willems E, Smith PC, Gritz RM, Perreault L. PATHWEIGH, pragmatic weight management in adult patients in primary care in Colorado, USA: study protocol for a stepped wedge cluster randomized trial. Trials. 2022 Jan 10;23(1):26. PubMed PMID: 35012628
• Kahn D, Perreault L, Macias E, Zarini S, Newsom SA, Strauss A, Kerege A, Harrison K, Snell-Bergeon J, Bergman BC. Subcellular localisation and composition of intramuscular triacylglycerol influence insulin sensitivity in humans. Diabetologia. 2021 Jan;64(1):168-180. PubMed PMID: 33128577
• Ritchie ND, Sauder KA, Kaufmann PG, Perreault L. Patient-Centered Goal-Setting in the National Diabetes Prevention Program: A Pilot Study. Diabetes Care. 2021 Nov;44(11):2464-2469. PubMed PMID: 34404739
• Depner CM, Melanson EL, Eckel RH, Higgins JA, Bergman BC, Perreault L, Knauer OA, Birks BR, Wright KP. Effects of ad libitum food intake, insufficient sleep and weekend recovery sleep on energy balance. Sleep. 2021 Nov 12;44(11). PubMed PMID: 34059916
• Goldberg RB, Tripputi MT, Boyko EJ, Budoff M, Chen ZZ, Clark JM, Dabelea DM, Edelstein SL, Gerszten RE, Horton E, Mather KJ, Perreault L, Temprosa M, Wallia A, Watson K, Irfan Z. Hepatic Fat in Participants With and Without Incident Diabetes in the Diabetes Prevention Program Outcome Study. J Clin Endocrinol Metab. 2021 Oct 21;106(11):e4746-e4765. PubMed PMID: 33705543
• Davies M, Færch L, Jeppesen OK, Pakseresht A, Pedersen SD, Perreault L, Rosenstock J, Shimomura I, Viljoen A, Wadden TA, Lingvay I. Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021 Mar 13;397(10278):971-984. PubMed PMID: 33667417
• Broussard JL, Perreault L, Macias E, Newsom SA, Harrison K, Bui HH, Milligan P, Roth KD, Nemkov T, D'Alessandro A, Brozinick JT, Bergman BC. Sex Differences in Insulin Sensitivity are Related to Muscle Tissue Acylcarnitine But Not Subcellular Lipid Distribution. Obesity (Silver Spring). 2021 Mar;29(3):550-561. PubMed PMID: 33624435
• Kahn D, Perreault L, Macias E, Zarini S, Newsom SA, Strauss A, Kerege A, Harrison K, Snell-Bergeon J, Bergman BC. Subcellular localisation and composition of intramuscular triacylglycerol influence insulin sensitivity in humans. Diabetologia. 2021 Jan;64(1):168-180. PubMed PMID: 33128577
• Tuttle KR, Brosius FC 3rd, Cavender MA, Fioretto P, Fowler KJ, Heerspink HJL, Manley T, McGuire DK, Molitch ME, Mottl AK, Perreault L, Rosas SE, Rossing P, Sola L, Vallon V, Wanner C, Perkovic V. SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis. 2021 Jan;77(1):94-109. PubMed PMID: 33121838
• Tuttle KR, Brosius FC 3rd, Cavender MA, Fioretto P, Fowler KJ, Heerspink HJL, Manley T, McGuire DK, Molitch ME, Mottl AK, Perreault L, Rosas SE, Rossing P, Sola L, Vallon V, Wanner C, Perkovic V. SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Diabetes. 2021 Jan;70(1):1-16. PubMed PMID: 33106255
• Harding JL, Benoit SR, Gregg EW, Pavkov ME, Perreault L. Trends in Rates of Infections Requiring Hospitalization Among Adults With Versus Without Diabetes in the U.S., 2000-2015. Diabetes Care. 2020 Jan;43(1):106-116. PubMed PMID: 31615853
• Aroda VR, Christophi CA, Edelstein SL, Perreault L, Kim C, Golden SH, Horton E, Mather KJ. Circulating sex hormone binding globulin levels are modified with intensive lifestyle intervention, but their changes did not independently predict diabetes risk in the Diabetes Prevention Program. BMJ Open Diabetes Res Care. 2020 Dec;8(2). PubMed PMID: 33328161
• Tuttle KR, Brosius FC 3rd, Cavender MA, Fioretto P, Fowler KJ, Heerspink HJL, Manley T, McGuire DK, Molitch ME, Mottl AK, Perreault L, Rosas SE, Rossing P, Sola L, Vallon V, Wanner C, Perkovic V. SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis. 2020 Oct 22. [Epub ahead of print] PubMed PMID: 33121838
• Tuttle KR, Brosius FC 3rd, Cavender MA, Fioretto P, Fowler KJ, Heerspink HJL, Manley T, McGuire DK, Molitch ME, Mottl AK, Perreault L, Rosas SE, Rossing P, Sola L, Vallon V, Wanner C, Perkovic V. SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Diabetes. 2020 Oct 26. [Epub ahead of print] PubMed PMID: 33106255
• Bruhn L, Vistisen D, Vainø CTR, Perreault L, Færch K. Physiological factors contributing to HbA(1c) in the normal and pre-diabetic range: a cross-sectional analysis. Endocrine. 2020 May;68(2):306-311. PubMed PMID: 32112239
• Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abrahamson MJ, Barzilay JI, Blonde L, Bush MA, DeFronzo RA, Garber JR, Garvey WT, Hirsch IB, Jellinger PS, McGill JB, Mechanick JI, Perreault L, Rosenblit PD, Samson S, Umpierrez GE. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2020 EXECUTIVE SUMMARY . Endocr Pract. 2020 Jan;26(1):107-139. PubMed PMID: 32022600
• Harman NL, Wilding JPH, Curry D, Harris J, Logue J, Pemberton RJ, Perreault L, Thompson G, Tunis S, Williamson PR. Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 diabetes (SCORE-IT): a patient and healthcare professional consensus on a core outcome set for type 2 diabetes. BMJ Open Diabetes Res Care. 2019;7(1):e000700. PubMed PMID: 31908789
• Sachs S, Zarini S, Kahn DE, Harrison KA, Perreault L, Phang T, Newsom SA, Strauss A, Kerege A, Schoen JA, Bessesen DH, Schwarzmayr T, Graf E, Lutter D, Krumsiek J, Hofmann S, Bergman BC. Intermuscular adipose tissue (IMAT) directly modulates skeletal muscle insulin sensitivity in humans. Am J Physiol Endocrinol Metab. 2019 Jan 8. [Epub ahead of print] PubMed PMID: 30620635
• Coppell K, Freer T, Abel S, Whitehead L, Tipene-Leach D, Gray AR, Merriman T, Sullivan T, Krebs J, Perreault L. What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study. BMJ Open. 2019 Dec 9;9(12):e033358. PubMed PMID: 31822546
• Perreault L, Rodbard H, Valentine V, Johnson E. Optimizing Fixed-Ratio Combination Therapy in Type 2 Diabetes. Adv Ther. 2019 Feb;36(2):265-277. PubMed PMID: 30610613
• Goldberg RB, Bray GA, Marcovina SM, Mather KJ, Orchard TJ, Perreault L, Temprosa M. Non-traditional biomarkers and incident diabetes in the Diabetes Prevention Program: comparative effects of lifestyle and metformin interventions. Diabetologia. 2019 Jan;62(1):58-69. PubMed PMID: 30334082
• Chen ZZ, Liu J, Morningstar J, Heckman-Stoddard BM, Lee CG, Dagogo-Jack S, Ferguson JF, Hamman RF, Knowler WC, Mather KJ, Perreault L, Florez JC, Wang TJ, Clish C, Temprosa M, Gerszten RE. Metabolite Profiles of Incident Diabetes and Heterogeneity of Treatment Effect in the Diabetes Prevention Program. Diabetes. 2019 Dec;68(12):2337-2349. PubMed PMID: 31582408
• Perreault L, Pan Q, Schroeder EB, Kalyani RR, Bray GA, Dagogo-Jack S, White NH, Goldberg RB, Kahn SE, Knowler WC, Mathioudakis N, Dabelea D. Regression From Prediabetes to Normal Glucose Regulation and Prevalence of Microvascular Disease in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabetes Care. 2019 Sep;42(9):1809-1815. PubMed PMID: 31320445
• Vistisen D, Kivimäki M, Perreault L, Hulman A, Witte DR, Brunner EJ, Tabák A, Jørgensen ME, Færch K. Reversion from prediabetes to normoglycaemia and risk of cardiovascular disease and mortality: the Whitehall II cohort study. Diabetologia. 2019 Aug;62(8):1385-1390. PubMed PMID: 31123789
• Perreault L, Vincent L, Neumiller JJ, Santos-Cavaiola T. Initiation and Titration of Basal Insulin in Primary Care: Barriers and Practical Solutions. J Am Board Fam Med. 2019 May-Jun;32(3):431-447. PubMed PMID: 31068410
• Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Erratum. Impact of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation. Diabetes Care 2017;40:1668-1677. Diabetes Care. 2019 Apr;42(4):701. PubMed PMID: 30894384
• Depner CM, Melanson EL, Eckel RH, Snell-Bergeon JK, Perreault L, Bergman BC, Higgins JA, Guerin MK, Stothard ER, Morton SJ, Wright KP Jr. Ad libitum Weekend Recovery Sleep Fails to Prevent Metabolic Dysregulation during a Repeating Pattern of Insufficient Sleep and Weekend Recovery Sleep. Curr Biol. 2019 Mar 18;29(6):957-967.e4. PubMed PMID: 30827911
• Perreault L, Boardman MK, Pak J. The Association Between Type 2 Diabetes and Cardiovascular Disease: The "For Your SweetHeart™" Survey. Adv Ther. 2019 Mar;36(3):746-755. PubMed PMID: 30758740
• Sachs S, Zarini S, Kahn DE, Harrison KA, Perreault L, Phang T, Newsom SA, Strauss A, Kerege A, Schoen JA, Bessesen DH, Schwarzmayr T, Graf E, Lutter D, Krumsiek J, Hofmann SM, Bergman BC. Intermuscular adipose tissue directly modulates skeletal muscle insulin sensitivity in humans. Am J Physiol Endocrinol Metab. 2019 May 1;316(5):E866-E879. PubMed PMID: 30620635
• Perreault L, Rodbard H, Valentine V, Johnson E. Optimizing Fixed-Ratio Combination Therapy in Type 2 Diabetes. Adv Ther. 2019 Feb;36(2):265-277. PubMed PMID: 30610613
• Goldberg RB, Bray GA, Marcovina SM, Mather KJ, Orchard TJ, Perreault L, Temprosa M. Non-traditional biomarkers and incident diabetes in the Diabetes Prevention Program: comparative effects of lifestyle and metformin interventions. Diabetologia. 2019 Jan;62(1):58-69. PubMed PMID: 30334082
• Perreault L. GOALS FOR MEDICAL TREATMENT IN OBESITY AND PREDIABETES: IMPROVING OUTCOMES FOR BOTH. Endocr Pract. 2018 Oct 5. [Epub ahead of print] PubMed PMID: 30289308
• Harman NL, Wilding J, Curry D, Harris J, Logue J, Pemberton RJ, Perreault L, Thompson G, Tunis S, Williamson PR. Selecting Core Outcomes for Randomised Effectiveness trials In Type 2 Diabetes (SCORE-IT): study protocol for the development of a core outcome set. Trials. 2018 Aug 7;19(1):427. PubMed PMID: 30086771
• Su W, Chen F, Dall TM, Zvenyach T, Kyle TK, Perreault L. Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach. J Med Econ. 2018 Sep;21(9):936-943. PubMed PMID: 29973101
• Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Erratum. Impact of Lifestyle and Metformin Interventions on the Risk of Progression to Diabetes and Regression to Normal Glucose Regulation in Overweight or Obese People With Impaired Glucose Regulation. Diabetes Care 2017;40:1668-1677. Diabetes Care. 2018 Apr;41(4):913. PubMed PMID: 29475844
• Perreault L, Newsom SA, Strauss A, Kerege A, Kahn DE, Harrison KA, Snell-Bergeon JK, Nemkov T, D'Alessandro A, Jackman MR, MacLean PS, Bergman BC. Intracellular localization of diacylglycerols and sphingolipids influences insulin sensitivity and mitochondrial function in human skeletal muscle. JCI Insight. 2018 Feb 8;3(3). [Epub ahead of print] PubMed PMID: 29415895
• Bergman BC, Perreault L, Strauss A, Bacon S, Kerege A, Harrison K, Brozinick JT, Hunerdosse DM, Playdon MC, Holmes W, Bui HH, Sanders P, Siddall P, Wei T, Thomas MK, Kuo MS, Eckel RH. Intramuscular triglyceride synthesis: importance in muscle lipid partitioning in humans. Am J Physiol Endocrinol Metab. 2018 Feb 1;314(2):E152-E164. PubMed PMID: 28978544
• Herman WH, Pan Q, Edelstein SL, Mather KJ, Perreault L, Barrett-Connor E, Dabelea DM, Horton E, Kahn SE, Knowler WC, Lorenzo C, Pi-Sunyer X, Venditti E, Ye W. Impact of Lifestyle and Metformin Interventions on the Risk of Progression to Diabetes and Regression to Normal Glucose Regulation in Overweight or Obese People With Impaired Glucose Regulation. Diabetes Care. 2017 Dec;40(12):1668-1677. PubMed PMID: 29021207
• Bergman BC, Perreault L, Strauss A, Bacon SD, Kerege AA, Harrison K, Brozinick JT, Hunerdosse DM, Playdon MC, Holmes W, Bui HH, Sanders P, Siddall P, Wei T, Thomas MK, Kuo MS, Eckel RH. Intramuscular triglyceride synthesis - importance in partitioning muscle lipids in humans. Am J Physiol Endocrinol Metab. 2017 Oct 3;:ajpendo.00142.2017. [Epub ahead of print] PubMed PMID: 28978544
• Perreault L, Pan Q, Aroda VR, Barrett-Connor E, Dabelea D, Dagogo-Jack S, Hamman RF, Kahn SE, Mather KJ, Knowler WC. Exploring residual risk for diabetes and microvascular disease in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabet Med. 2017 Dec;34(12):1747-1755. PubMed PMID: 28833481
• Aroda VR, Knowler WC, Crandall JP, Perreault L, Edelstein SL, Jeffries SL, Molitch ME, Pi-Sunyer X, Darwin C, Heckman-Stoddard BM, Temprosa M, Kahn SE, Nathan DM. Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. Diabetologia. 2017 Sep;60(9):1601-1611. PubMed PMID: 28770322
• Perreault L, Færch K, Gregg EW. Can Cardiovascular Epidemiology and Clinical Trials Close the Risk Management Gap Between Diabetes and Prediabetes?. Curr Diab Rep. 2017 Sep;17(9):77. PubMed PMID: 28766246
• Perreault L. EMPA-REG OUTCOME: The Endocrinologist's Point of View. Am J Cardiol. 2017 Jul 1;120(1S):S48-S52. PubMed PMID: 28606344
• Perreault L. EMPA-REG OUTCOME: The Endocrinologist's Point of View. Am J Med. 2017 Jun;130(6S):S51-S56. PubMed PMID: 28526185
• Goldberg RB, Temprosa M, Mele L, Orchard T, Mather K, Bray G, Horton E, Kitabchi A, Krakoff J, Marcovina S, Perreault L, White N. Erratum to: "Change in adiponectin explains most of the change in HDL particles induced by lifestyle intervention but not metformin treatment in the diabetes prevention program" [Metabolism (2016) 65; 764-775]. Metabolism. 2017 Mar;68:184-186. PubMed PMID: 28065437
• Goldberg RB, Temprosa M, Mele L, Orchard T, Mather K, Bray G, Horton E, Kitabchi A, Krakoff J, Marcovina S, Perreault L, White N. Change in adiponectin explains most of the change in HDL particles induced by lifestyle intervention but not metformin treatment in the Diabetes Prevention Program. Metabolism. 2016 May;65(5):764-75. PubMed PMID: 27085783
• Newsom SA, Brozinick JT, Kiseljak-Vassiliades K, Strauss AN, Bacon SD, Kerege AA, Bui HH, Sanders P, Siddall P, Wei T, Thomas M, Kuo MS, Nemkov T, D'Alessandro A, Hansen KC, Perreault L, Bergman BC. Skeletal muscle phosphatidylcholine and phosphatidylethanolamine are related to insulin sensitivity and respond to acute exercise in humans. J Appl Physiol (1985). 2016 Jun 1;120(11):1355-63. PubMed PMID: 27032901
• Guess N, Perreault L, Kerege A, Strauss A, Bergman BC. Dietary Fatty Acids Differentially Associate with Fasting Versus 2-Hour Glucose Homeostasis: Implications for The Management of Subtypes of Prediabetes. PLoS One. 2016 Mar 21;11(3):e0150148. PubMed PMID: 26999667
• Su W, Chen F, Dall TM, Iacobucci W, Perreault L. Return on Investment for Digital Behavioral Counseling in Patients With Prediabetes and Cardiovascular Disease. Prev Chronic Dis. 2016 Jan 28;13:E13. PubMed PMID: 26820045
• Bergman BC, Brozinick JT, Strauss A, Bacon S, Kerege A, Bui HH, Sanders P, Siddall P, Wei T, Thomas MK, Kuo MS, Perreault L. Muscle sphingolipids during rest and exercise: a C18:0 signature for insulin resistance in humans. Diabetologia. 2016 Apr;59(4):785-98. PubMed PMID: 26739815
• Perreault L, Starling AP, Glueck D, Brozinick JT, Sanders P, Siddall P, Kuo MS, Dabelea D, Bergman BC. Biomarkers of Ectopic Fat Deposition: The Next Frontier in Serum Lipidomics. J Clin Endocrinol Metab. 2016 Jan;101(1):176-82. PubMed PMID: 26574956
• Hivert MF, Christophi CA, Franks PW, Jablonski KA, Ehrmann DA, Kahn SE, Horton ES, Pollin TI, Mather KJ, Perreault L, Barrett-Connor E, Knowler WC, Florez JC. Lifestyle and Metformin Ameliorate Insulin Sensitivity Independently of the Genetic Burden of Established Insulin Resistance Variants in Diabetes Prevention Program Participants. Diabetes. 2016 Feb;65(2):520-6. PubMed PMID: 26525880
• Kim C, Christophi CA, Goldberg RB, Perreault L, Dabelea D, Marcovina SM, Pi-Sunyer X, Barrett-Connor E. Adiponectin, C-reactive protein, fibrinogen and tissue plasminogen activator antigen levels among glucose-intolerant women with and without histories of gestational diabetes. Diabet Med. 2016 Jan;33(1):32-8. PubMed PMID: 25970741
• Delahanty LM, Pan Q, Jablonski KA, Aroda VR, Watson KE, Bray GA, Kahn SE, Florez JC, Perreault L, Franks PW, Diabetes Prevention Program Research Group. Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program. Diabetes Care. 2014 Oct;37(10):2738-45. PubMed PMID: 25024396
• Perreault L, Temprosa M, Mather KJ, Horton E, Kitabchi A, Larkin M, Montez MG, Thayer D, Orchard TJ, Hamman RF, Goldberg RB, Diabetes Prevention Program Research Group. Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: results from the Diabetes Prevention Program outcomes study. Diabetes Care. 2014 Sep;37(9):2622-31. PubMed PMID: 24969574
• Perreault L. Prediabetes. . 2000. PubMed PMID: 30860692