***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Salsalate , a nonacetylated prodrug of salicylate , has been shown to decrease blood glucose concentration in small studies . OBJECTIVE To compare the efficacy and safety of salsalate at different doses in patients with type 2 diabetes . DESIGN Parallel r and omized trial with computer-generated r and omization and central ized allocation . Patients and investigators , including those assessing outcomes and performing analyses , were masked to group assignment . ( Clinical Trials.gov registration number : NCT00392678 ) SETTING 3 private practice s and 14 universities in the United States . PATIENTS Persons aged 18 to 75 years with fasting plasma glucose concentrations of 12.5 mmol/L or less ( < or = 225 mg/dL ) and hemoglobin A1c ( HbA1c ) levels of 7.0 % to 9.5 % treated by diet , exercise , and oral medication at stable doses for at least 8 weeks . INTERVENTION After a 4-week , single-masked run-in period , patients were r and omly assigned to receive placebo or salsalate in dosages of 3.0 , 3.5 , or 4.0 g/d for 14 weeks ( 27 patients each ) in addition to their current therapy . MEASUREMENTS Change in HbA1c was the primary outcome . Adverse effects and changes in measures of coronary risk and renal function were secondary outcomes . RESULTS Higher proportions of patients in the 3 salsalate treatment groups experienced decreases in HbA1c levels of 0.5 % or more from baseline ( P = 0.009 ) . Mean HbA1c changes were -0.36 % ( P = 0.02 ) at 3.0 g/d , -0.34 % ( P = 0.02 ) at 3.5 g/d , and -0.49 % ( P = 0.001 ) at 4.0 g/d compared with placebo . Other markers of glycemic control also improved in the 3 salsalate groups , as did circulating triglyceride and adiponectin concentrations . Mild hypoglycemia was more common with salsalate ; documented events occurred only in patients taking sulfonylureas . Urine albumin concentrations increased in all salsalate groups compared with placebo . The drug was otherwise well tolerated . LIMITATION The number of patients studied and the trial duration were insufficient to warrant recommending the use of salsalate for type 2 diabetes at this time . CONCLUSION Salsalate lowers HbA1c levels and improves other markers of glycemic control in patients with type 2 diabetes and may therefore provide a new avenue for treatment . Renal and cardiac safety of the drug require further evaluation . PRIMARY FUNDING SOURCE National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health AIM Periodontal disease encompasses gingivitis and periodontitis , which exerts systemic effects . We conducted a population -based study to evaluate the association between periodontal disease and the  risk of cancer . METHODS We used insurance cl aims data from 1997 to 2010 , accessing a data base of 1 million r and omly selected insurants in Taiwan . All patients were older than 20 and newly diagnosed with periodontitis between 1 January 1997 and 31 December 2010 . The comparison cohort comprised patients older than 20 , who were newly diagnosed with gingivitis in the same period . Both cohorts were followed until a cancer diagnosis , lost to follow-up , death , termination of insurance , or the end of 2010 . RESULTS The incidence rate of cancer was 1.14 times higher in the study cohort than in the comparison cohort [ confidence interval ( CI ) = 1.11 - 1.17 ] . The adjusted hazard ratio ( HR ) was 1.05 ( 95 % CI = 1.00 - 1.11 ) . A multivariable analysis showed that the periodontitis patients exhibited an elevated risk of developing oral cancer ( adjusted HR = 1.79 , 95 % CI = 1.42 - 2.25 ) . CONCLUSION The findings indicated that patients in the periodontitis cohort exhibited a higher risk of developing oral cancer than those in the gingivitis cohort Purpose Diabetes and periodontal disease are two common diseases with high prevalence rates . Recent evidence has shown a bidirectional relationship between diabetes and periodontitis . The aim of this study was to investigate the effects of nonsurgical periodontal therapy on glycemic control in type 2 diabetes mellitus patients . Methods Sixty subjects aged 35 - 45 years with blood sugar controlled by oral hypoglycaemic agents  were r and omly divided equally among 3 groups : group A ( scaling , mouthwash , and brushing ) , group B ( mouthwash and brushing ) , and group C ( brushing only ) . Glycated haemoglobin ( HbA1c ) , fasting blood sugar ( FBS ) , probing pocket depth ( PPD ) , gingival index ( GI ) , plaque index ( PI ) , and the relevant drug history were recorded at baseline and after 3 months of intervention . Comparison of the mean difference among the variables was performed by parametric and nonparametric tests , which were further evaluated using multiple regression analysis . Results The mean differences between the PPD , FBS , HbA1c , GI , and PI in groups A and B were found to be statistically significant ( P<0.001 ) . Multiple regression analysis in group A showed that out of all the independent variables , GI and frequency of drug administration independently ( b=0.3761 and b=0.598 ) showed a significantly greater impact on HbA1c ( R2=0.832 , P<0.05 ) . Conclusions Nonsurgical periodontal therapy can effectively decrease HbA1c levels in type 2 diabetes mellitus patients on medication IMPORTANCE Chronic periodontitis , a destructive inflammatory disorder of the supporting structures of the teeth , is prevalent in patients with diabetes . Limited evidence suggests that periodontal therapy may improve glycemic control . OBJECTIVE To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin ( HbA1c ) in persons with type 2 diabetes and moderate to advanced chronic periodontitis . DESIGN , SETTING , AND PARTICIPANTS The Diabetes and Periodontal Therapy Trial ( DPTT ) , a 6-month , single-masked , multicenter , r and omized clinical trial . Participants had type 2 diabetes , were taking stable doses of medications , had HbA1c levels between 7 % and less than 9 % , and untreated chronic periodontitis . Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers . INTERVENTIONS The treatment group ( n = 257 ) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months . The control group ( n = 257 ) received no treatment for 6 months . MAIN OUTCOMES AND MEASURES Difference in change in HbA1c level from baseline between groups at 6 months . Secondary outcomes included changes in probing pocket depths , clinical attachment loss , bleeding on probing , gingival index , fasting glucose level , and Homeostasis Model Assessment ( HOMA2 ) score . RESULTS Enrollment was stopped early because of futility . At 6 months , mean HbA1c levels in the periodontal therapy group increased 0.17 % ( SD , 1.0 ) , compared with 0.11 % ( SD , 1.0 ) in the control group , with no significant difference between groups based on a linear regression model adjusting for clinical site ( mean difference , -0.05 % [ 95 % CI , -0.23 % to 0.12 % ] ; P = .55 ) . Periodontal measures improved in the treatment group compared with the control group at 6 months , with adjusted between-group differences of 0.28 mm ( 95 % CI , 0.18 to 0.37 ) for probing depth , 0.25 mm ( 95 % CI , 0.14 to 0.36 ) for clinical attachment loss , 13.1 % ( 95 % CI , 8.1 % to 18.1 % ) for bleeding on probing , and 0.27 ( 95 % CI , 0.17 to 0.37 ) for gingival index ( P < .001 for all ) . CONCLUSIONS AND RELEVANCE Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis . These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00997178 A large body of evidence underlines an association between periodontal disease and cardiovascular disease . In contrast , data on its relation with endothelial dysfunction as a marker of early sub clinical atherosclerosis is inconclusive and limited to patient-cohort studies . We therefore investigated the association between periodontal disease and flow-mediated dilation of the brachial artery ( FMD ) as a measure of endothelial dysfunction in a general population , and also addressed a possible mediation via inflammation . The study population comprised 1,234 subjects ( 50.5 % men ) aged 25–85 years from the 5-year follow-up of the Study of Health in Pomerania , a population -based cohort study .  Clinical attachment loss ( CAL ) and pocket probing depth ( PPD ) as measures of periodontal disease were assessed half-mouth at four sites per tooth . Subjects were classified according to the periodontitis case definition proposed by Tonetti and Claffey ( 2005 ) . Measurements of FMD and nitroglycerin-mediated dilation ( NMD ) were performed using st and ardized ultrasound techniques . High-sensitive C-reactive protein , fibrinogen and leukocyte count were measured . Fully adjusted multivariate linear regression analyses revealed significant associations of the percentage of sites with PPD ≥6 mm with FMD ( ptrend=0.048 ) , with subjects within the highest category having a 0.74 % higher FMD compared to subjects within the lowest category ( p<0.05 ) . Consistently , FMD values increased significantly across categories of the percentage of sites with CAL ≥6 mm ( ptrend=0.01 ) and the periodontitis case definition ( ptrend=0.006 ) . Restrictions to subjects without antihypertensive or statin medication or current non-smokers confirmed previous results . Systemic inflammation did not seem to mediate the relation . Both PPD and CAL were not consistently associated with NMD . In contrast to previous studies , high levels of periodontal disease were significantly associated with high FMD values . This association was not mediated via systemic inflammation . This study revives the discussion on whether and how periodontitis contributes to endothelial dysfunction BACKGROUND Intensive diabetes therapy aim ed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes . We studied whether the use of intensive therapy as compared with conventional therapy during the Diabetes Control and Complications Trial ( DCCT ) affected the long-term incidence of cardiovascular disease . METHODS The DCCT r and omly assigned 1441 patients with type 1 diabetes to intensive or conventional therapy , treating them for a mean of 6.5 years between 1983 and 1993 . Ninety-three percent were subsequently followed until February 1 , 2005 , during the observational Epidemiology of Diabetes Interventions and Complications study . Cardiovascular disease ( defined as nonfatal myocardial infa rct ion , stroke , death from cardiovascular disease , confirmed angina , or the need for coronary-artery revascularization ) was assessed with st and ardized measures and classified by an independent committee . RESULTS During the mean 17 years of follow-up , 46 cardiovascular disease events occurred in 31 patients who had received intensive treatment in the DCCT , as compared with 98 events in 52 patients who had received conventional treatment . Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent ( 95 percent confidence interval , 9 to 63 percent ; P=0.02 ) and the risk of nonfatal myocardial infa rct ion , stroke , or death from cardiovascular disease by 57 percent ( 95 percent confidence interval , 12 to 79 percent ; P=0.02 ) . The decrease in glycosylated hemoglobin values during the DCCT was significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease . Microalbuminuria and albuminuria were associated with a significant increase in the risk of cardiovascular disease , but differences between treatment groups remained significant ( P < or = 0.05 ) after adjusting for these factors . CONCLUSIONS Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes Purpose The purpose of study was to compare glycemic control using glycated hemoglobin levels ( HbA1c ) in diabetic patients with chronic generalized periodontitis ( CGP ) undergoing scaling and root planing ( SRP ) with and without systemic doxycycline . Methods Fifty subjects with type 2 diabetes mellitus ( T2DM ) and CGP receiving antidiabetic 
    Output:
    
CONCLUSIONS Periodontal treatment leads to the modest reduction in HbA1c along with the improvement of periodontal status in diabetic patients for 3 months , and this result is consistent with previous systematic review s. And the effect of periodontal treatment on HbA1c can not be observed at 6-month after treatment