***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: UNLABELLED We have investigated the incidence of newly diagnosed Type 2 diabetes in the Poole area and extrapolated it to the rest of the UK . METHODS this prospect i ve observational study used a surveillance programme in primary and secondary care . We identified all cases of newly diagnosed Type 2 diabetes mellitus occurring from 1st May 1996 to 30th June 1998 through the normal health care process without any active screening in 186889 people registered with 24 primary care practice s in the Poole area . RESULTS the 1996 prevalence of diagnosed Type 2 diabetes in this population was 1.59 ( 95 % CI 1.53 - 1.65%)% . During the first 24 months of the study , 706 new cases of Type 2 diabetes mellitus , 382 men and 324 women , were identified . The crude annual incidence of newly diagnosed Type 2 diabetes , thus was 1.93/1000 ( 95 % CI 1.73 - 2.13 % ) and age/sex adjusted incidence was 1.67/1000 ( 95 % CI 1.49 - 1.84 % ) . The age-adjusted incidence was higher in men , 1.86/1000 ( 95 % CI 1.60 - 2.13 ) , than in women , 1.48/1000 ( 95 % CI 1.25 - 1.71 % ) , relative risk 1.26 ( 95 % CI 0.997 - 1.527 % ) , but this difference did not reach statistical significance . Mean HbA1c at diagnosis was 10.8 ( S.D. 2.9%)% . Men were younger at diagnosis than women ( mean age , 62.9 vs. 65.9 % , P<0.01 ) . CONCLUSION in UK , prior to the change in the WHO diagnostic criteria for diabetes , we estimate that over 98000 new cases of Type 2 diabetes were diagnosed each year CONTEXT Elderly persons and women were underrepresented in r and omized controlled trials ( RCTs ) prior to 1990 . Since then , efforts have been made to correct these biases , but their effect is unclear . OBJECTIVE To determine whether the percentage of elderly persons and women in published clinical trials of acute coronary syndromes has increased and how this enrollment compared with disease prevalence . DATA SOURCES The MEDLINE and Cochrane data bases were search ed for English- language articles from January 1966 to March 2000 regarding myocardial infa rct ion , unstable angina , or acute coronary syndromes . Additional data sources included meta-analyses , review articles , and cardiology textbooks . Estimates of community-based myocardial infa rct ion rates came from the National Registry of Myocardial Infa rct ion and the Worcester Heart Study . STUDY SELECTION Published RCTs of acute coronary syndrome patients were included and trials enrolling 50 patients or fewer , those without clinical end points , papers published in a language other than English , and unpublished manuscripts were excluded . Of 7645 studies identified , 593 RCTs were selected for review . DATA EXTRACTION The RCTs were abstract ed by 2 of the authors for year of publication , source of support ( ie , funding ) , pharmacotherapy , study phase , number of study sites , trial location , number of patients , mean age of the study population , and any age exclusion criteria for enrollment . DATA SYNTHESIS The number of published RCTs with explicit age exclusions has declined from 58 % during 1966 - 1990 to 40 % during 1991 - 2000 . Trial enrollment of patients aged 75 years or older increased from 2 % for studies published during 1966 - 1990 to 9 % during 1991 - 2000 , but remains well below their representation among all patients with myocardial infa rct ion ( 37 % ) in the United States . Enrollment of women has risen from 20 % for studies published between 1966 - 1990 to 25 % during 1991 - 2000 , but remains well below their proportion of all patients with myocardial infa rct ion ( 43 % ) in the United States . CONCLUSIONS Attempts at making cardiovascular RCTs more inclusive appear to have had limited success ; thus , women and elderly persons remain underrepresented in published trial literature relative to their disease prevalence . Because safety and efficacy can vary as a function of sex and age , these enrollment biases undermine efforts to provide evidence -based care to all cardiac patients Abstract Objectives : To identify all patients with diabetes in a community using  electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care . Design : Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics , all encashed prescriptions for diabetes related drugs and monitoring equipment , all patients discharged from hospital , patients attending a mobile unit for eye screening , and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry data base . Diabetes registers from primary care were from a r and om sample of eight Tayside general practice s. A detailed manual study of relevant records for the 35 144 patients registered with these eight general practice s allowed for validation of the case ascertainment . Setting : Tayside region of Scotl and , population 391 274 on 1 January 1996 . Main outcome measures : Prevalence of diabetes ; population of patients identified by different data sources ; sensitivity and positive predictive value of ascertainment methods . Results : Electronic record linkage identified 7596 diabetic patients , giving a prevalence of known diabetes of 1.94 % ( 0.21 % insulin dependent diabetes , 1.73 % non-insulin dependent ) : 63 % of patients had attended hospital diabetes clinics , 68 % had encashed diabetes related prescriptions , 72 % had attended the mobile eye screening unit , and 48 % had biochemical results diagnostic of diabetes . A further 701 patients had isolated hyperglycaemia ( plasma glucose > 11.1 mmol/l ) but were not considered diabetic by general practitioners . Validation against the eight general practice s ( 636 diabetic patients ) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes . General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98 . Conclusions : Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18 % of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes . Key messages It has been recommended that regional registers of patients with diabetes are established in order to facilitate effective monitoring and treatment of diabetes In Tayside we created a diabetes register by record linkage of multiple data sources : all patients attending hospital diabetes clinics , all encashed prescriptions for diabetes related drugs and monitoring equipment  , all patients discharged from hospital , patients attending a mobile unit for eye screening , and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry data base This register identified 7596 patients with diabetes in Tayside , giving a prevalence of diabetes of 1.94 % Record linkage was more sensitive than general practice registers in ascertaining cases of known diabetes A unique patient identifier , the community health number , was fundamental for successful record In 1981 - 1982 , 5699 persons representing 92.9 % of the total population aged 60 - 74 years living in Fredericia , Denmark , were interviewed about a possible history of diabetes and had a fasting blood glucose measured . A total of 236 gave a positive history of diabetes ; 88 had one fasting blood glucose of 7 mmol/L or more . For each of these prob and s , an age- and gender-matched control person with normal fasting blood glucose and no history of diabetes was selected r and omly . Of the 236 , 91.5 % had NIDDM as judged by glucagon-stimulated C-peptide tests . At the end of December 1995 , the participants were traced through the National Register and their status ( alive or dead ) was determined . The date of death was confirmed . The median observation time from screening and inclusion in the study till death or the end of the observation period in December 1995 was 12.81 years , the maximum was 14.91 , and the 25th and 75th percentile values were 6.36 and 13.94 years , respectively . At the end of 1995 , 165 ( 74.4 % ) of 228 persons with known diabetes at the time of ascertainment had died opposed to 90 ( 40.4 % ) of the 223 nondiabetic control persons . The difference is statistically highly significant ( p < 0.00001 , log-rank test ) . Within the first 5 years of observation , 42.9 % of diabetic men died and only 22.5 % of non-diabetic men . This percentage of deaths in diabetic men was found already in the 60 - 64 year age interval ( 46.2 % ) . The mortality rate for the non-diabetic population seems to increase later . After 13 years of observation , 74 ( 81.3 % ) of 91 men with known diabetes had died , in the age-matched control men , 50 ( 56.2 % ) of 89 ( p = 0.00006 ) . Ninety-one ( 66.4 % ) of 137 diabetic women had died : 40 ( 29.9 % ) of 134 control women ( p < 0.00001 ) . The difference between mortality in diabetic men and women , and between nondiabetic men and women is highly significant ( p = 0.00285 and 0.00001 , respectively ) . The over-mortality of established diabetic persons decreases with age . In the age group 60 - 74 years , the over-mortality is about 2.5 without gender difference The results of recent studies suggest that a relative hypogonadism in men is associated with several established risk factors for prevalent diseases . Therefore , we determined  total and free testosterone , luteinizing hormone ( LH ) , and sex-hormone binding globulin ( SHBG )  in a cohort of r and omly selected men ( n = 659 ) at 67 years of age . These data were analyzed cross-sectionally in relation to blood glucose and serum insulin , which were measured while fasting and after an oral glucose tolerance test , in addition to plasma lipids and blood pressure . The data were also analyzed in relation to impaired glucose tolerance ( IGT ) and diabetes , which were discovered at examination or earlier diagnosis . Risk factors for the development of diabetes up to 80 years of age were analyzed with univariate and multivariate statistics . Total and free testosterone and SHBG concentrations correlated negatively with glucose and insulin values ; total testosterone and SHBG , with triglycerides ; and SHBG , with blood pressure ( from P < 0.05 to P < 0.01 ) . Men with IGT or newly diagnosed diabetes had higher BMI values ( 26.2 ± 0.31 and 27.0 ± 0.59 [ mean ± SE ] , respectively ) and waist circumference ( 99.0 ± 1.03 and 100.5 ± 1.57 ) than nondiabetic men ( BMI , 25.1 ± 0.14 ; waist circumference , 95.4 ± 0.47 ; P < 0.05 ) , indicating abdominal obesity . Such men and men with previously diagnosed diabetes had , in general , lower total and free testosterone and SHBG levels , while those for LH were not different . In multivariate analyses that included BMI , waist-to-hip ratio , total and free testosterone , and SHBG , the remaining independent predictors for the development of diabetes were low total testosterone ( P = 0.015 ) and , on the borderline , low SHBG ( P = 0.053 ) . In relation to nondiabetic men , the risk ratio for mortality , myocardial infa rct ion , and stroke increased gradually and significantly from 1.18 to 1.68 , from 1.51 to 1.78 , and from 1.72 to 2.46 in men with IGT , newly diagnosed diabetes , and previously known diabetes , respectively . It was concluded that  low testosterone and SHBG concentrations in elderly men are associated with established risk factors for diabetes and in established diabetes . Moreover , low testosterone levels independently predict the risk of developing diabetes . In different degrees of expression , the diabetic state predicts strongly ( and gradually mortality from ) myocardial infa rct ion and stroke . It has been suggested that a relative hypogonadism might be a primary event , because other studies have shown that testosterone deficiency is followed by insulin resistance , which is ameliorated by testosterone substitution . The data suggest that the relative hypogonadism involved might be of both central and peripheral origin The life expectancy of well controlled diabetics has been considered to be approximately that of the normal individual . A 2 
    Output:
    
Increased mortality associated with a diagnosis of type 2 diabetes at an older age is lower than that reported for the general older diabetic population