***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 Endothelial dysfunction is frequently present in individuals with insulin resistance or type 2 diabetes and can be induced by high-fat or high-carbohydrate meals . Because exenatide reduces postpr and ial glucose and lipid excursions , we hypothesized that it may also improve postpr and ial endothelial function . RESEARCH DESIGN AND METHODS In a double-blinded r and omized crossover design , postpr and ial endothelial function was examined in 28 individuals with impaired glucose tolerance or recent-onset type 2 diabetes after a single injection of exenatide or placebo given just before a high-fat meal . Endothelial function was determined with peripheral arterial tonometry pre- and postpr and ially . RESULTS Postpr and ial endothelial function was higher after exenatide compared with placebo ( P = 0.0002 ) . In the placebo phase , postpr and ial change in endothelial function was inversely associated with mean postpr and ial concentrations of triglycerides ( r = −0.62 , P = 0.0004 ) . Changes in postpr and ial triglyceride concentrations explained 64 % of exenatide 's effect on postpr and ial endothelial function . CONCLUSIONS Exenatide  ameliorates postpr and ial endothelial dysfunction after a high-fat meal Introduction Pregnancy is associated with decreased insulin sensitivity , which is usually overcome by a compensatory increase in insulin secretion . Some pregnant women are not able to increase their insulin secretion sufficiently , and consequently develop gestational diabetes mellitus ( GDM ) . The disease normally disappears after delivery . Nevertheless , women with previous GDM have a high risk of developing type 2 diabetes ( T2D ) later in life . We aim to investigate the early development of T2D in women with previous GDM and to evaluate whether treatment with the glucagon-like peptide-1 receptor ( GLP-1R ) agonist , liraglutide , may modify their risk of developing T2D . Methods and analyses 100 women with previous GDM will be r and omised to either liraglutide or placebo treatment for 1 year ( blinded ) with an open-label extension for another 4 years . Additionally , 15 women without previous GDM will constitute a baseline control group . Women will be tested with an oral glucose tolerance test ( primary endpoint : area under the curve for plasma glucose ) and an isoglycaemic intravenous glucose infusion at baseline , after 1 year and after 5 years . Additional evaluations include a glucagon test , dual-energy X-ray absorptiometry , imaging of the liver ( ultrasound elastography and fibroscanning ) , an ad libitum meal for food intake evaluation and question naires related to appetite , quality of life and alcohol consumption habits . Ethics and dissemination The protocol has been approved by the Danish Medicines Agency , the Scientific-Ethical Committee of the Capital Region of Denmark , and the Danish Data Protection Agency and will be carried out under the surveillance and guidance of the GCP unit at Copenhagen University Hospital Bispebjerg in compliance with the ICH-GCP guidelines and in accordance with the Helsinki Declaration . Positive , negative and inconclusive results will be published at scientific conferences and as one or more scientific manuscripts in peer- review ed journals . Registration s The trial is registered at https://eudract.ema.europa.eu ( 2012 - 001371 - 37 ) and http://www . clinical trials.gov ( NCT01795248 ) Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged PURPOSE We aim ed to assess the impact of spin ( ie , reporting to convince readers that the beneficial effect of the experimental treatment is greater than shown by the results ) on the interpretation of results of abstract s of r and omized controlled trials ( RCTs ) in the field of cancer . METHODS We performed a two-arm , parallel-group RCT . We selected a sample of published RCTs with statistically nonsignificant primary outcome and with spin in the abstract conclusion . Two versions of these abstract s were used-the original with spin and a rewritten version without spin . Participants were clinician corresponding authors of articles reporting RCTs , investigators of trials , and review ers of French national grants . The primary outcome was clinicians ' interpretation of the beneficial effect of the experimental treatment ( 0 to 10 scale ) . Participants were blinded to study hypothesis . RESULTS Three hundred clinicians were r and omly assigned using a Web-based system ; 150 clinicians assessed an abstract with spin and 150 assessed an abstract without spin . For abstract s with spin , the experimental treatment was rated as being more beneficial ( mean difference , 0.71 ; 95 % CI , 0.07 to 1.35 ; P = .030 ) , the trial was rated as being less rigorous ( mean difference , -0.59 ; 95 % CI , -1.13 to 0.05 ; P = .034 ) , and clinicians were more interested in reading the full-text article ( mean difference , 0.77 ; 95 % CI , 0.08 to 1.47 ; P = .029 ) . There was no statistically significant difference in the clinicians ' rating of the importance of the study or the need to run another trial . CONCLUSION Spin in abstract s can have an impact on clinicians ' interpretation of the trial results BACKGROUND & AIMS Uncontrolled studies show sitagliptin , an oral DPP-4 inhibitor , may improve alanine aminotransferase and liver histology in non-alcoholic fatty liver disease ( NAFLD ) patients . We aim ed to compare sitagliptin vs. the efficacy of a placebo in reducing liver fat measured by MRI-derived proton density-fat fraction ( MRI-PDFF ) . METHODS This r and omized , double-blind , allocation-concealed , placebo-controlled trial included 50 NAFLD patients with prediabetes or early diabetes r and omized to sitagliptin orally 100mg/day or placebo for 24weeks . Primary outcome was liver fat change measured by MRI-PDFF in colocalized regions of interest within each of nine liver segments . Additional advanced assessment s included MR spectroscopy ( MRS ) for internal validation of MRI-PDFF 's accuracy , and magnetic resonance elastography ( MRE ) and FIBROSpect ® II to assess liver fibrosis . RESULTS Sitagliptin was not significantly better than placebo in reducing liver fat measured by MRI-PDFF ( mean difference between sitagliptin and placebo arms : -1.3 % , p=0.4 ) . Compared to baseline , there were no significant differences in end-of-treatment MRI-PDFF  for sitagliptin ( 18.1 % to 16.9 % , p=0.27 ) or placebo ( 16.6 % to 14.0 % , p=0.07 ) . The groups had no significant differences for changes in alanine aminotransferase , aspartate aminotransferase , low-density lipoprotein , homeostatic model assessment insulin resistance , and MRE-derived liver stiffness . In both groups at baseline and post-treatment , MRI-PDFF and MRS showed robust correlation coefficients ranging from r(2)=0.96 to r(2)=0.99 ( p<0.0001 ) , demonstrating the strong internal validity of the findings . FIBROSpect ® II showed no changes in the sitagliptin group but was significantly increased in the placebo group ( p=0.03 ) . CONCLUSIONS Sitagliptin was safe but not better than placebo in reducing liver fat in prediabetic or diabetic patients with NAFLD . LAY SUMMARY In a r and omized , double-blind , placebo-controlled study , the anti-diabetic drug sitagliptin was no more effective than placebo for improving liver fat and liver fibrosis in patients with non-alcoholic fatty liver disease . This study demonstrates that non-invasive magnetic resonance imaging techniques , including magnetic resonance imaging-proton density-fat fraction and magnetic resonance elastography , can be used to assess treatment response in non-alcoholic fatty liver disease clinical trials BACKGROUND The cardiovascular safety and efficacy of many current antihyperglycemic agents , including saxagliptin , a dipeptidyl peptidase 4 ( DPP-4 ) inhibitor , are unclear . METHODS We r and omly assigned 16,492 patients with type 2 diabetes who had a history of , or were at risk for , cardiovascular events to receive saxagliptin or placebo and followed them for a median of 2.1 years . Physicians were permitted to adjust other medications , including antihyperglycemic agents . The primary end point was a composite of cardiovascular death , myocardial infa rct ion , or ischemic stroke . RESULTS A primary end-point event occurred in 613 patients in the saxagliptin group and in 609 patients in the placebo group ( 7.3 % and 7.2 % , respectively , according to 2-year Kaplan-Meier estimates ; hazard ratio with saxagliptin , 1.00 ; 95 % confidence interval [ CI ] , 0.89 to 1.12 ; P=0.99 for superiority ; P<0.001 for noninferiority ) ; the results were similar in the " on-treatment " analysis ( hazard ratio , 1.03 ; 95 % CI , 0.91 to 1.17 ) . The major secondary end point of a composite of cardiovascular death , myocardial infa rct ion , stroke , hospitalization for unstable angina , coronary revascularization , or heart failure occurred in 1059 patients in the saxagliptin group and in 1034 patients in the placebo group ( 12.8 % and 12.4 % , respectively , according to 2-year Kaplan-Meier estimates ; hazard ratio , 1.02 ; 95 % CI , 0.94 to 1.11 ; P=0.66 ) . More patients in the saxagliptin group than in the placebo group were hospitalized for heart failure ( 3.5 % vs. 2.8 % ; hazard ratio , 1.27 ; 95 % CI , 1.07 to 1.51 ; P=0.007 ) . Rates of adjudicated cases of acute and chronic pancreatitis were similar in the two groups ( acute pancreatitis , 0.3 % in the saxagliptin group and 0.2 % in the placebo group ; chronic pancreatitis , < 0.1 % and 0.1 % in the two groups , respectively ) . CONCLUSIONS DPP-4 inhibition with saxagliptin did not increase or decrease the rate of ischemic events , though the rate of hospitalization for heart failure was increased . Although saxagliptin improves glycemic control , other approaches are necessary to reduce cardiovascular risk in patients with diabetes . ( Funded by AstraZeneca and Bristol-Myers Squibb ; SAVOR-TIMI 53 Clinical Trials.gov number , NCT01107886 . ) 
    Output:
    
AUTHORS ' CONCLUSIONS There is no firm evidence that DPP-4 inhibitors or GLP-1 analogues compared mainly with placebo substantially influence the risk of T2DM and especially its associated complications in people at increased risk for the development of T2DM .