***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 
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    ***EXAMPLES*** 
    Input: High prevalence of type 2 diabetes ( T2D ) is seen in some immigrant groups in Western countries , particularly in those from the Indian subcontinent . Our aims were to increase the physical activity ( PA ) level  in a group of Pakistani immigrant men , and to see whether any increase was associated with reduced serum glucose and insulin concentrations . The intervention was developed in collaboration with the Pakistani community . It used a social cognitive theory framework and consisted of structured supervised group exercises , group lectures , individual counselling and telephone follow-up .  One- hundred and fifty physically inactive Pakistani immigrant men living in Oslo , Norway , were r and omised to either a control group or an intervention group . The 5-month intervention focused on increasing levels of PA  , which were assessed by use of accelerometer ( Actigraph MTI 7164 ) recordings . Risk of diabetes was assessed by serum glucose and insulin concentrations determined in a fasted state , and after an oral glucose tolerance test ( OGTT ) . ANCOVA was used to assess differences between groups . There was a mean difference in PA between the two groups of 49 counts per minute per day , representing a 15 % ( 95 % CI = 8.7–21.2 ; P = 0.01 ) higher increase in total PA level in the intervention group than in the control group . Insulin values taken 2 h after an OGTT were reduced in the intervention group by 27 % ( 95 % CI = 18.9–35.0 ; P = 0.02 ) more than those in the control group . There were no differences in fasting or postpr and ial glucose values between the groups at the follow-up test . This type of intervention can increase PA and reduce serum insulin in Pakistani immigrant men , thereby presumably reducing their risk of T2D Background There is consistent evidence on the impact of health behaviours on risk of cardiovascular disease ( CVD ) in European population s. As South Asians in the UK have an excess risk of CVD and coronary heart disease ( CHD ) compared to Europeans , we investigated whether a similar association between combined health behaviours and risk of CVD and CHD among this high-risk group exists , and estimated the population impact . Methods and Findings In a prospect i ve cohort of 1090 Europeans and 1006 South Asians ( 40–69 y ) without prevalent CVD at baseline ( 1988–1990 ) , followed up for 21 years to 2011 , there were 601 incident CVD events [ Europeans n = 255 ; South Asians n = 346 ] of which 520 were CHD events [ n = 207 and 313 respectively ] . Participants scored between 0 to 4 points for a composite score including four baseline healthy behaviours ( non-smoker , moderate alcohol intake , physically active , frequent fruit/vegetable intake ) . Adjusted hazard ratios ( 95 % confidence intervals ) for incident CHD in Europeans who had three , two , one , and zero compared to four health behaviours were 1.33 ( 0.78–2.29 ) , 1.96 ( 1.15–3.33 ) , 1.36 ( 0.74–2.48 ) and 2.45 ( 1.18–5.10 ) , respectively , p-trend = 0.025 . In South Asians , corresponding HRs were 2.88 ( 1.33–6.24 ) , 2.28 ( 1.06–4.91 ) , 3.36 ( 1.53–7.39 ) and 3.48 ( 1.38–8.81 ) , p-trend = 0.022 . The results were similar for incident CVD ; Europeans HR 2.12 ( 1.14–3.94 ) , p – trend = 0.014 ; South Asians HR 2.73 ( 1.20–6.21 ) , p-trend = 0.018 . The population attributable fraction in Europeans was 43 % for CHD and 28 % for CVD . In South Asians it was 63 % and 51 % respectively . Conclusions Lack of adherence to four combined health behaviours was associated with 2 to 3-fold increased risk of incident CVD in Europeans and South Asians . A substantial population impact in the South Asian group indicates important potential for disease prevention in this high-risk group by adherence to healthy behaviours BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) Background Despite the growing emphasis on the inclusion of ethnic minority patients in research , there is little published on the recruitment of these population s especially to r and omised , community based , lifestyle intervention trials in the UK . Methods We share our experience of  recruitment to screening  in the PODOSA ( Prevention of Diabetes and Obesity in South Asians ) trial , which screened 1319 recruits ( target 1800 ) for trial eligibility . A multi-pronged recruitment approach was used . Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practice s. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations . Participants were encouraged to refer friends and family throughout the recruitment period . Results Health care professionals referred only 55 potential participants . The response to written invitations via general practitioners was 5.2 % , lower than reported in other general population s. Community orientated , personal approaches for recruitment were comparatively effective yielding 1728 referrals ( 82 % ) to the screening stage . Conclusions The PODOSA experience shows that a community orientated , personal approach for recruiting South Asian ethnic minority population s can be successful in a trial setting . We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches . Research ers should consider prioritising approaches that minimise interference with professionals ' work and , particularly in the current economic climate , keep costs to a minimum . The lessons learned in PODOSA should contribute to future community based trials in South Asians . Trial Registration Current Controlled Trials IS RCT Background The ' Hawthorne Effect ' may be an important factor affecting the generalisability of clinical research to routine practice , but has been little studied . Hawthorne Effects have been reported in previous clinical trials in dementia but to our knowledge , no attempt has been made to quantify them . Our aim was to compare minimal follow-up to intensive follow-up in participants in a placebo controlled trial of Ginkgo biloba for treating mild-moderate dementia . Methods Participants in a dementia trial were r and omised to intensive follow-up ( with comprehensive assessment visits at baseline and two , four and six months post r and omisation ) or minimal follow-up ( with an abbreviated assessment at baseline and a full assessment at six months ) . Our primary outcomes were cognitive functioning ( ADAS-Cog ) and participant and carer-rated quality of life ( QOL-AD ) . Results We recruited 176 participants , mainly through general practice s. The main analysis was based on Intention to treat ( ITT ) , with available data . In the ANCOVA model with baseline score as a co-variate , follow-up group had a significant effect on outcome at six months on the ADAS-Cog score ( n = 140 ; mean difference = -2.018 ; 95%CI -3.914 , -0.121 ; p = 0.037 favouring the intensive follow-up group ) , and on participant-rated quality of life score ( n = 142 ; mean difference = -1.382 ; 95%CI -2.642 , -0.122 ; p = 0.032 favouring minimal follow-up group ) . There was no significant difference on carer quality of life . Conclusion We found that more intensive follow-up of individuals in a placebo-controlled clinical trial of Ginkgo biloba for treating mild-moderate dementia result ed in a better outcome than minimal follow-up , as measured by their cognitive functioning . Trial registration Current controlled trials : IS RCT Aims /hypothesisLifestyle modification helps in the primary prevention of diabetes in multiethnic American , Finnish and Chinese population s. In a prospect i ve community-based study , we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger , leaner and more insulin resistant than the above population s. Methods We r and omised 531 ( 421 men 110 women ) subjects with IGT ( mean age 45.9±5.7 years , BMI 25.8±3.5 kg/m2 ) into four groups . Group 1 was the control , Group 2 was given advice on lifestyle modification ( LSM ) , Group 3 was treated with metformin ( MET ) and Group 4 was given LSM plus MET . The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria . Results The median follow-up period was 30 months , and the 3-year cumulative incidences of diabetes were 55.0 % , 39.3 % , 40.5 % and 39.5 % in Groups 1–4 , respectively . The relative risk reduction was 28.5 % with LSM ( 95 % CI 20.5–37.3 , p=0.018 ) , 26.4 % with MET ( 95 % CI 19.1–35.1 , p=0.029 ) and 28.2 % with LSM + MET ( 95 % CI 20.3–37.0 , p=0.022 ) , as compared with the control group . The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM , 6.9 for MET and 6.5 for LSM + MET . Conclusions /interpretationProgression of IGT to diabetes is high in native Asian Indians .  Both LSM and MET significantly reduced the incidence of diabetes  in Asian Indians with IGT ; there was no added benefit from combining them The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes ( T2D ) and the metabolic syndrome ( MetS ) among Pakistani immigrant women in Oslo , Norway . The r and omised controlled trial ( the InnvaDiab study ) , lasting 7 ± 1 months , comprised six educational sessions about blood glucose , physical activity and diet .  Participants ( age 25 - 62 years ) were r and omised into either a  control ( n 97 ) or an  intervention ( n 101 ) group . Primary outcome variables were fasting and 2 h blood glucose , and secondary outcome variables were fasting levels of insulin , C 
    Output:
    
The evidence whether lifestyle intervention studies in South Asians can improve components of the metabolic system is not clear .