***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: 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 This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer 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 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation BACKGROUND Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus ( IDDM ) . We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications . METHODS A total of 1441 patients with IDDM--726 with no retinopathy at base line ( the primary -prevention cohort ) and 715 with mild retinopathy ( the secondary -intervention cohort ) were r and omly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections . The patients were followed for a mean of 6.5 years , and the appearance and progression of retinopathy and other complications were assessed regularly . RESULTS In the primary -prevention cohort , intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent ( 95 percent confidence interval , 62 to 85 percent ) , as compared with conventional therapy . In the secondary -intervention cohort , intensive therapy slowed the progression of retinopathy by 54 percent ( 95 percent confidence interval , 39 to 66 percent ) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent ( 95 percent confidence interval , 14 to 67 percent ) . In the two cohorts combined , intensive therapy reduced the occurrence of microalbuminuria ( urinary albumin excretion of > or = 40 mg per 24 hours ) by 39 percent ( 95 percent confidence interval , 21 to 52 percent ) , that of albuminuria ( urinary albumin excretion of > or = 300 mg per 24 hours ) by 54 percent ( 95 percent confidence interval 19 to 74 percent ) , and that of clinical neuropathy by 60 percent ( 95 percent confidence interval , 38 to 74 percent ) . The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia . CONCLUSIONS Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy , nephropathy , and neuropathy in patients with IDDM OBJECTIVE To compare three intensive management strategies with respect to metabolic control ( glycated haemoglobin , prepr and ial blood glucose , lipid profile , body weight , hypoglycaemic episodes ) and psycho-social adaptation ( quality of life , self-efficacy , stress and perceived complexity ) . RESEARCH DESIGN AND METHODS Fifteen adults with type 1 diabetes completed this 1-year , r and omized , prospect i ve , cross-over study . The three treatment strategies were categorized according to flexibility with insulin self-adjustments as follows : Simplified ( SIMP ) = meal plan based on food exchanges with no self-adjustments of insulin for food , exercise and stress ; Qualitative ( QUAL ) = meal plan based on food exchanges with qualitative adjustment of insulin for food , exercise and stress ; Quantitative ( QUANT ) = meal plan using carbohydrate counting with quantitative adjustment of insulin for food and qualitative adjustment for exercise and stress . All three strategies allowed for adjustments of insulin for prepr and ial blood glucose and the option of adjusting diet for exercise . All subjects followed each strategy for 3.5 months . Subjects kept detailed log sheets where they recorded prepr and ial blood glucose , insulin dosages , food intake , activity and stress level at least four times/day . The psycho-social aspects were determined with vali date d question naires that were completed before and after each strategy . RESULTS There were no statistically significant differences in metabolic control , quality of life and self-efficacy between the three strategies . The mean ( + /- s.e . ) for HbA1 levels ( normal < 8.5 % ) were : Baseline : 10.9+/-0.06 and End of SIMP = 9.7+/-0.03 ; QUAL = 9.5+/-0.04 ; QUANT = 10.2+/-0.04 . Body weight and serum lipid levels did not change significantly . The frequency of severe hypoglycaemic episodes for the entire study was 20 episodes/100 patient-years . Perceived complexity of treatment strategy increased ( p < 0.0001 ) from SIMP to QUANT ( least to most flexible ) . Although the majority of subjects ( n = 11 ) were following a strategy similar to SIMP prior to entering the study , 12 subjects chose to continue with QUAL , three with QUANT and none with SIMP at the end of the study . CONCLUSIONS These results indicate that a strategy that allows for flexibility of self-adjustments of 
    Output:
    
Carbohydrate counting may confer positive impact on glucose control .