***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: Current Criteria for the Diagnosis of Diabetes ● Fasting plasma glucose ( FPG ) Ն126 mg/dl ( 7.0 mmol/l ) . Fasting is defined as no caloric intake for at least 8 h ● Symptoms of hyperglycemia and a casual ( r and om ) plasma glucose Ն200 mg/dl ( 11.1 mmol/l ) . Casual ( r and om ) is defined as any time of day without regard to time since last meal . The classic symptoms of hyperglycemia include polyuria , polydipsia , and unexplained weight loss . ● 2-h plasma glucose Ն200 mg/dl ( 11.1 mmol/l ) during an oral glucose tolerance test ( OGTT ) . The test should be performed as described by the World Health Organization , using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water . Testing for Pre-Diabetes and Diabetes in Asymptomatic Patients ● Testing to detect pre-diabetes and type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese ( BMI Ն25 kg/m 2 ) and who have one or more additional risk factors for diabetes ) . In those without these risk factors , testing should begin at age 45 years . ( B ) ● If tests are normal , repeat testing should be carried out at least at 3-year intervals . ( E ) ● To test for pre-diabetes or diabetes , an FPG test or 2-h OGTT ( 75-g glucose load ) or both are appropriate . ( B ) ● An OGTT may be considered in patients with impaired fasting glucose ( IFG ) to better define the risk of diabetes . ( E ) ● In those identified with pre-diabetes , identify and , if appropriate , treat other cardiovascular disease ( CVD ) risk factors . ( B ) Testing for Type 2 Diabetes in Children ● Test children who are overweight ( BMI Ͼ85th percentile for age and sex , weight for height Ͼ85th percentile , or weight Ͼ120 % of ideal for height ) and have any two of the following risk factors : ● Family history of type 2 diabetes in first-or second-degree relative ● Signs of insulin resistance or conditions associated with insulin resist a n c e ( a c a n t h o s i s n i g r i c a n s , hypertension , dyslipidemia , polycys-tic ovary syndrome , or small-for-gestational-age birth weight ) ● Maternal history of diabetes or gesta-tional diabetes mellitus ( GDM ) during the child 's gestation ( E ) ● Testing should begin at age 10 years or at onset of puberty , if puberty occurs at a younger age , and be repeated every 3 years . ( E ) ● FPG is the preferred test . ( E ) Detection and Diagnosis of OBJECTIVE Few studies have assessed the efficacy of carbohydrate counting in type 1 diabetes , and none have vali date d its efficacy in patients who are treated with continuous subcutaneous insulin infusion ( CSII ) . The aim of our study was to test the effect of carbohydrate counting on glycemic control and quality of life in adult patients with type 1 diabetes who are receiving CSII . RESEARCH DESIGN AND METHODS Sixty-one adult patients with type 1 diabetes treated with CSII were r and omly assigned to either learning carbohydrate counting ( intervention ) or estimating pre-meal insulin dose in the usual empirical way ( control ) . At baseline and 12 and 24 weeks , we measured HbA1c , fasting plasma glucose , BMI , waist circumference , recorded daily insulin dose , and capillary glucose data , and administered the  Diabetes-Specific Quality -of-Life Scale ( DSQOLS )  question naire . RESULTS Intention-to-treat analysis showed improvement of the DSQOLS score related to diet restrictions ( week 24 – baseline difference , P = 0.008 ) and reduction of BMI ( P = 0.003 ) and waist circumference ( P = 0.002 ) in the intervention group compared with control subjects . No changes in HbA1c , fasting plasma glucose , daily insulin dose , and hypoglycemic episodes ( < 2.8 mmol/L ) were observed . Per- protocol analysis , including only patients who continuously used carbohydrate counting and CSII during the study , confirmed improvement of the DSQOLS score and reduction of BMI and waist circumference , and showed a significant reduction of HbA1c ( −0.35 % vs. control subjects , P = 0.05 ) . CONCLUSIONS Among adult patients with type 1 diabetes treated with CSII  , carbohydrate counting is safe and improves quality of life , reduces BMI and waist circumference , and , in per- protocol analysis , reduces HbA1c BACKGROUND The practicality of diets with a low glycemic index ( GI ) is controversial . Theoretically , low-GI diets may limit food choice and increase dietary fat intake , but there is little objective evidence to support such a theory . OBJECTIVE The objective was to determine the effect of low-GI dietary advice on dietary quality and food choice in children with diabetes . DESIGN Children aged 8 - 13 y with type 1 diabetes ( n = 104 ) were recruited to a prospect i ve , r and omized study comparing the effects of traditional carbohydrate-exchange dietary advice ( CHOx ) with those of more flexible low-GI dietary advice ( LowGI ) . We determined the effect on long-term macronutrient intake and food choice with the use of 3-d food diaries . RESULTS There were no differences in reported macronutrient intakes during any of the recording periods . After 12 mo , intakes of dietary fat ( 33.5 + /- 5.6 % and 34.2 + /- 6.7 % of energy , P = 0.65 ) , carbohydrate ( 48.8 + /- 5.4 % and 48.6 + /- 6.5 % of energy , P = 0.86 ) , protein ( 17.6 + /- 2.5 % and 17.3 + /- 3.7 % of energy , P = 0.61 ) , total sugars , and fiber did not differ significantly between the CHOx and LowGI groups , respectively . The average number of different carbohydrate food choices per day also did not differ significantly . Subjects in the lowest-GI quartile consumed less carbohydrate as potato and white bread , but more carbohydrate as dairy-based foods and whole-grain breads than did subjects in the highest-GI quartile . CONCLUSION Children with diabetes who receive low-GI dietary advice do not report more limited food choices or a diet with worse macronutrient composition than do children who consume a traditional carbohydrate-exchange diet OBJECTIVE To investigate the effect of flexible intensive insulin therapy ( FIIT ) and an automated bolus calculator ( ABC ) in a Danish type 1 diabetes population treated with multiple daily injections . Furthermore , to test the feasibility of teaching FIIT in a 3-h structured course . RESEARCH DESIGN AND METHODS The BolusCal Study was a 16-week r and omized , controlled , open-label , three-arm parallel , clinical study of 51 adults with type 1 diabetes . Patients aged 18–65 years in poor metabolic control ( HbA1c 8.0–10.5 % ) were r and omized to the Control ( n = 8) , CarbCount ( n = 21 ) , or CarbCountABC ( n = 22 ) arm . During a 3-h group teaching , the Control arm received FIIT education excluding carbohydrate counting . CarbCount patients were taught FIIT and how to count carbohydrates . CarbCountABC group teaching included FIIT and carbohydrate counting and patients were provided with an ABC . RESULTS At 16 weeks , the within-group change in HbA1c was −0.1 % ( 95 % CI −1.0 to 0.7 % ; P = 0.730 ) in the Control arm , −0.8 % ( −1.3 to −0.3 % ; P = 0.002 ) in the CarbCount arm , and −0.7 % ( −1.0 to −0.4 % ; P < 0.0001 ) in the CarbCountABC arm . The difference in change in HbA1c between CarbCount and CarbCountABC was insignificant . Adjusting for baseline HbA1c in a regression model , the relative change in HbA1c was −0.6 % ( −1.2 to 0.1 % ; P = 0.082 ) in CarbCount and −0.8 % ( −1.4 to −0.1 % ; P = 0.017 ) in CarbCountABC . Treatment satisfaction measured by the Diabetes Treatment Satisfaction Question naire ( status version ) improved in all study arms , but the improvement was significantly greater in CarbCountABC . CONCLUSIONS FIIT and carbohydrate counting were successfully taught in 3 h and improved metabolic control and treatment satisfaction . Concurrent use of an ABC  improved treatment satisfaction further OBJECTIVE Widespread use of carbohydrate counting is limited by its complex education . In this study we compared a Diabetes Interactive Diary ( DID ) with st and ard carbohydrate counting in terms of metabolic and weight control , time required for education , quality of life , and treatment satisfaction . RESEARCH DESIGN AND METHODS Adults with type 1 diabetes were r and omly assigned to DID ( group A , n = 67 ) or st and ard education ( group B , n = 63 ) and followed for 6 months . A subgroup also completed the  SF-36 Health Survey ( SF-36 ) and World Health Organization-Diabetes Treatment Satisfaction Question naire ( WHO-DTSQ ) at each visit . RESULTS Of 130 patients ( aged 35.7 ± 9.4 years ; diabetes duration 16.5 ± 10.5 years ) , 11 dropped out .  Time for education was 6 h ( range 2–15 h ) in group A and 12 h ( 2.5–25 h ) in group B ( P = 0.07 ) . A1C reduction was similar in both groups ( group A from 8.2 ± 0.8 to 7.8 ± 0.8 % and group B from 8.4 ± 0.7 to 7.9 ± 1.1 % ; P = 0.68 ) . Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight . No severe hypoglycemic episode occurred . WHO-DTSQ scores increased significantly more in group A ( from 26.7 ± 4.4 to 30.3 ± 4.5 ) than in group B ( from 27.5 ± 4.8 to 28.6 ± 5.1 ) ( P = 0.04 ) . Role Physical , General Health , Vitality , and Role Emotional SF-36 scores improved significantly more in group A than in group B. CONCLUSIONS DID is at least as effective as traditional carbohydrate counting education , allowing dietary freedom for a larger proportion of type 1 diabetic patients . DID is safe , requires less time for education , and is associated with lower weight gain . DID significantly improved treatment satisfaction and several quality -of-life dimensions OBJECTIVE To determine the long-term effect of low glycemic index dietary advice on metabolic control and quality of life in children with type 1 diabetes . RESEARCH DESIGN AND METHODS Children with type 1 diabetes ( n = 104 ) were recruited to a prospect i ve , stratified , r and omized , parallel study to examine the effects of a measured carbohydrate exchange ( CHOx ) diet versus a more flexible low-glycemic index ( GI ) dietary regimen on HbA(1c ) levels , incidence of hypo- and hyperglycemia , insulin dose , dietary intake , and measures of quality of life over 12 months . RESULTS At 12 months , children in the low-GI group had significantly better HbA(1c ) levels than those in the CHOx group ( 8.05 + /- 0.95 vs. 8.61 + /- 1.37 % , P = 0.05 ) . Rates of excessive hyperglycemia ( > 15 episodes per month ) were significantly lower in the low-GI group ( 35 vs. 66 % , P = 0.006 ) . There were no differences in insulin dose , hypoglycemic episodes , or dietary composition . The low-GI dietary regimen was associated with better quality of life for both children and parents . CONCLUSIONS Flexible dietary instruction based on the food pyramid with an emphasis of low-GI foods improves HbA(1c ) levels without increasing the risk of hypoglycemia and enhances the quality of life in children with diabetes OBJECTIVE Although carbohydrate counting is routine practice in type 1 diabetes , hyperglycemic episodes are common . A food insulin index ( FII ) has been developed and vali date d for predicting the normal insulin dem and generated by mixed meals in healthy adults . We sought to compare a novel algorithm on the basis of the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes . 
    Output:
    
The meta- analysis showed evidence favoring the use of CHOC in the management of DM1 .
However , this benefit was limited to final HbA1c , which was significantly lower in the CHOC than in the control group