***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: Background To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus ( RAMP-DM )  led to improvements in biomedical outcomes , observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting . Methods A r and om sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age , sex , and HbA1c level at baseline as the usual care group . Biomedical and cardiovascular outcomes were measured at baseline and at 12-month after the enrollment . Difference-in-differences approach was employed to measure the effect of RAMP-DM on the changes in biomedical outcomes , proportion of subjects reaching treatment targets , observed and predicted cardiovascular risks . Results Compared to the usual care group , RAMP-DM group had lower cardiovascular events incidence ( 1.21 % vs 2.89 % , P = 0.003 ) , and net decrease in HbA1c ( −0.20 % , P < 0.01 ) , SBP ( −3.62 mmHg , P < 0.01 ) and 10-year cardiovascular disease ( CVD ) risks ( total CVD risk , −2.06 % , P < 0.01 ; coronary heart disease ( CHD ) risk , −1.43 % , P < 0.01 ; stroke risk , −0.71 % , P < 0.01 ) . The RAMP-DM subjects witnessed significant rises in the proportion of reaching treatment targets of HbA1c , and SBP/DBP . After adjusting for confounding variables , the significance remained for HbA1c , predicted CHD and stroke risks . Conclusions The RAMP-DM result ed in greater improvements in HbA1c and reduction in observed and predicted cardiovascular risks at 12 months follow-up , which indicated a risk-stratification multidisciplinary intervention was an effective strategy for managing Chinese people with diabetes in the primary care setting .Trial registry Clinical Trials.gov , OBJECTIVE To evaluate the accuracy of the UK Prospect i ve Diabetes Study Outcomes Model ( UKPDS-OM ) in predicting clinical outcomes during the UKPDS posttrial monitoring ( PTM ) period . RESEARCH DESIGN AND METHODS At trial end in 1997 , the 4,031 surviving UKPDS patients , of the 5,102 originally enrolled in the study , returned to their usual care providers , with no attempts made to maintain them in their r and omized therapy groups . PTM risk factor data were collected for 5 years and clinical outcome data for 10 years . The UKPDS-OM was used firstly to forecast likely progression of  HbA1c , systolic blood pressure , total-to-HDL cholesterol ratio  , and smoking status and secondly to estimate the likely first occurrence of seven major diabetes-related complications or death from any cause . Model predictions were compared against observed PTM data for risk factor time paths and survival probabilities for major diabetes complications . RESULTS UKPDS-OM – forecasted risk factor time paths were similar to those observed for HbA1c ( up to 3 years ) and total-to-HDL cholesterol ratio but underestimated for systolic blood pressure and smoking status . Predicted 10-year event probabilities were similar to those observed for blindness , ischemic heart disease , myocardial infa rct ion , and renal failure but were higher for heart failure and death from any cause and lower for stroke and amputation . CONCLUSIONS The UKPDS-OM has good predictive accuracy for two of four risk factor time paths and for 10-year clinical outcome probabilities with the exception of stroke , amputation , heart failure , and death from any cause . An up date d version of the model incorporating PTM data is being developed Summary A total of 6695 diabetic men and women , aged 35 to 54 years , from 14 centres and representing 13 national groups , participated in a vascular disease prevalence survey . A r and om sample was drawn after stratification of each centre 's diabetic base population by sex , duration of diabetes and age . A common agreed protocol , st and ardized examination procedures , and central ized laboratory methods were used in the investigation . Within the age range examined there was considerable variation between centres in a number of variables , including degree of obesity ( measured as Body Mass Index ( BMI ) ) , proportion treated with insulin and proportion of cigarette smokers . The latter also showed considerable sex differences within centres . Subjects with age at onset below 25 years were notably few in Hong Kong , Tokyo and Oklahoma . There was also considerable variation in the apparent prevalence of both large- and small-vessel ( macrovascular and microvascular ) disease between centres . In pooled data , measures of large-vessel disease were significantly and independently associated with age , blood pressure and BMI in both sexes , and with diabetes duration and plasma cholesterol in men only . Within-centre analyses showed blood pressure to be the most consistently associated variable in both sexes . In pooled data , small-vessel disease of the eye was significantly and independently associated with diabetes duration , blood pressure , BMI and type of treatment in both sexes . In within-centre analyses , diabetes duration was the most consistently associated variable , followed by blood pressure . Proteinuria as an index of small-vessel disease of the kidney was , in pooled data , significantly and independently correlated with diabetes duration , blood pressure and plasma cholesterol in both sexes . In within-centre analyses , blood pressure was the most consistently associated variable , with diabetes duration and plasma cholesterol equal second -significant in 12 of the 28 centre/sex groups . Heterogeneity of large-vessel disease prevalence in diabetic subjects is confirmed by this study , and the possibility of heterogeneity in small-vessel disease prevalence and severity is suggested Introduction . The objective of this study was to create a tool that accurately predicts the risk of morbidity and mortality in patients with type 2 diabetes according to an oral hypoglycemic agent .  Material s and Methods . The model was based on a cohort of 33,067 patients with type 2 diabetes who were prescribed a single oral hypoglycemic agent at the Clevel and Clinic between 1998 and 2006 . Competing risk regression models were created for coronary heart disease ( CHD ) , heart failure , and stroke , while a Cox regression model was created for mortality . Propensity scores were used to account for possible treatment bias . A prediction tool was created and internally vali date d using tenfold cross-validation . The results were compared to a Framingham model and a model based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) for CHD and stroke , respectively . Results and Discussion . Median follow-up for the mortality outcome was 769 days . The numbers of patients experiencing events were as follows : CHD ( 3062 ) , heart failure ( 1408 ) , stroke ( 1451 ) , and mortality ( 3661 ) . The prediction tools demonstrated the following concordance indices ( c-statistics ) for the specific outcomes : CHD ( 0.730 ) , heart failure ( 0.753 ) , stroke ( 0.688 ) , and mortality ( 0.719 ) . The prediction tool was superior to the Framingham model at predicting CHD and was at least as accurate as the UKPDS model at predicting stroke . Conclusions . We created an accurate tool for predicting the risk of stroke , coronary heart disease , heart failure , and death in patients with type 2 diabetes . The calculator is available online at http://rcalc.ccf.org under the heading “ Type 2 Diabetes ” and entitled , “ Predicting 5-Year Morbidity and Mortality . ” This may be a valuable tool to aid the clinician ’s choice of an oral hypoglycemic , to better inform patients , and to motivate dialogue between physician and patient OBJECTIVE We sought to vali date Risk Equations for Complications of Type 2 Diabetes ( RECODe ) among diverse population s. RESEARCH DESIGN AND METHODS We compared risk predictions from RECODe equations and from two alternative risk models ( UK Prospect i ve Diabetes Study Outcomes Model 2 [ UKPDS OM2 ] and American College of Cardiology/American Heart Association Pooled Cohort Equations ) to observed outcomes in two studies : the Multi-Ethnic Study of Atherosclerosis ( MESA , n = 1,555 adults with type 2 diabetes , median follow-up 9.1 years ) and the Jackson Heart Study ( JHS , n = 1,746 adults with type 2 diabetes , median follow-up 8.0 years ) . Outcomes included nephropathy by multiple measures ( microalbuminuria , macroalbuminuria , renal failure , end-stage renal disease , and reduction in glomerular filtration rate ) , moderate to severe diabetic retinopathy by Airlie House classification , fatal or nonfatal myocardial infa rct ion , fatal or nonfatal stroke , congestive heart failure , and all-cause mortality . RESULTS RECODe equations for microvascular and cardiovascular outcomes had C-statistics for discrimination ranging from 0.71 to 0.85 in MESA and 0.64 to 0.91 in JHS for alternative outcomes . Calibration slopes in MESA ranged from 0.62 for a composite nephropathy outcome , 0.83–1.04 for individual nephropathy outcomes , 1.07 for retinopathy , 1.00–1.05 for cardiovascular outcomes , and 1.03 for all-cause mortality . Slopes in JHS ranged from 0.47 for retinopathy , 0.97–1.16 for nephropathy , 0.72–1.05 for cardiovascular outcomes , and 1.01 for all-cause mortality . The alternative models had C-statistics 0.50–0.72 and calibration slopes 0.07–0.60 . CONCLUSIONS RECODe equations improved risk estimation for diverse patients with type 2 diabetes , as compared with two commonly used alternatives Objective To develop and vali date version two of the QRISK cardiovascular disease risk algorithm ( QRISK2 ) to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in Engl and and Wales and to compare its performance with the modified version of Framingham score recommended by the National Institute for Health and Clinical Excellence ( NICE ) . Design Prospect i ve open cohort study with routinely collected data from general practice , 1 January 1993 to 31 March 2008 . Setting 531 practice s in Engl and and Wales contributing to the national Q RESEARCH data base . Participants 2.3 million patients aged 35 - 74 ( over 16 million person years ) with 140 000 cardiovascular events . Overall population ( derivation and validation cohorts ) comprised 2.22 million people who were white or whose ethnic group was not recorded , 22 013 south Asian , 11 595 black African , 10 402 black Caribbean , and 19 792 from Chinese or other Asian or other ethnic groups . Main outcome measures First ( incident ) diagnosis of cardiovascular disease ( coronary heart disease , stroke , and transient ischaemic attack ) recorded in general practice records or linked Office for National Statistics death certificates . Risk factors included self assigned ethnicity , age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol : high density lipoprotein cholesterol , body mass index , family history of coronary heart disease in first degree relative under 60 years , Townsend deprivation score , treated hypertension , type 2 diabetes , renal disease , atrial fibrillation , and rheumatoid arthritis . Results The validation statistics indicated that QRISK2 had improved discrimination and calibration compared with the modified Framingham score . The QRISK2 algorithm explained 43 % of the variation in women and 38 % in men compared with 39 % and 35 % , respectively , by the modified Framingham score . Of the 112 156 patients classified as high risk ( that is , ≥20 % risk over 10 years ) by the modified Framingham score , 46 094 ( 41.1 % ) would be reclassified at low risk with QRISK2 . The 10 year observed risk among these reclassified patients was 16.6 % ( 95 % confidence interval 16.1 % to 17.0%)—that is , below the 20 % treatment threshold . Of the 78 024 patients classified at high risk on QRISK2 , 11 962 ( 15.3 % ) would be reclassified at low risk by the modified Framingham score . The 10 year observed risk among these patients was 23.3 % ( 22.2 % to 24.4%)—that is , above the 20 % threshold . In the validation cohort , the annual incidence rate of cardiovascular events among those with a QRISK2 score of ≥20 % was 30.6 per 1000 person years ( 29.8 to 31.5 ) for women and 32.5 per 1000 person years ( 31.9 to 33.1 ) for men . The corresponding figures for the modified Framingham equation were 25.7 per 1000 person years ( 25.0 to 26.3 ) for women and 26.4 ( 26.0 to 26.8 ) for men ) . At the 20 % threshold , the population identified by 
    Output:
    
Overall , the performance of these diabetes-specific stroke prediction models was not satisfactory .