***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 To determine the safety and efficacy of the long-acting insulin analog , insulin glargine , as a component of basal bolus therapy in patients with type 1 diabetes . RESEARCH DESIGN AND METHODS Patients with type 1 diabetes receiving basal-bolus insulin treatment with NPH human insulin and insulin lispro  were r and omized to receive insulin glargine ( HOE 901 ) , a long-acting basal insulin analog , once a day ( n = 310 ) or NPH human insulin ( n = 309 ) as basal treatment with continued bolus insulin lispro for 16 weeks in an open-label study NPH  insulin  patients maintained their prior schedule of administration once or twice a day , whereas insulin glargine patients received basal insulin once a day at bedtime . RESULTS Compared with all NPH insulin patients , insulin glargine patients had significant decreases in fasting blood glucose measured at home ( means + /- SEM , -42.0 + /- 4.7 vs. -12.4 + /- 4.7 mg/dl [ -2.33 + /- 0.26 vs. -0.69 + /- 0.26 mmol/l ] ; P = 0.0001 ) . These differences were evident early and persisted throughout the study More patients in the insulin glargine group ( 29.6 % ) than in the NPH group ( 16.8 % ) reached a target fasting blood glucose of 119 mg/dl ( < 6.6 mmol/l ) . However , there were no differences between the groups with respect to change in GHb . Insulin glargine treatment was also associated with a significant decrease in the variability of fasting blood glucose values ( P = 0.0124 ) . No differences in the occurrence of symptomatic hypoglycemia , including nocturnal hypoglycemia , were observed . Overall , adverse events were similar in the two treatment groups with the exception of injection site pain , which was more common in the insulin glargine group ( 6.1 % ) than in the NPH group ( 0.3 % ) . Weight gain was 0.12 kg in insulin glargine patients and 0.54 kg in NPH insulin patients ( P = 0.034 ) . CONCLUSIONS Basal insulin therapy with insulin glargine once a day appears to be as safe and at least as effective as using NPH insulin once or twice a day in maintaining glycemic control in patients with type 1 diabetes receiving basal-bolus insulin treatment with insulin lispro In this open study of clinical practice , 142 paediatric patients with type 1 diabetes mellitus ( > 1 year duration ) , stratified by age , received pr and ial insulin ( regular or lispro ) and either once daily insulin glargine ( GLAR ; n=74 ) , titrated to target fasting blood glucose ( FBG ) levels 4.4 - 7.8 mmol/l , or NPH/semilente insulin ( NPH insulin , administered once , twice or three times daily ; n=68 ) , titrated to target FBG 4.4 - 8.9 mmol/l . Both groups were treated for 20 + /- 10 months . HbA(1c ) significantly increased in GLAR ( 7.3 + /- 1.0 % to 7.6 + /- 1.1 % ; p = 0.003 ) and NPH/semilente insulin ( 7.7 + /- 1.6 % to 8.3 + /- 1.5 % ; p = 0.0001 ) treated patients . The incidence of symptomatic hypoglycaemia was comparable between GLAR versus NPH/semilente insulin at endpoint ( 2.19 vs. 1.94 episodes/week ) ; however , the overall incidence of severe hypoglycaemia was significantly lower with GLAR versus NPH/semilente insulin ( 0.14 vs. 0.73 events/patient-year ; p = 0.002 ) . The daily insulin dose was similar between the treatment groups ; however , perceived quality of life ( QoL ) was better with GLAR . GLAR is associated with equivalent glycaemic control , less severe hypoglycaemia and improved QoL compared with NPH/semilente insulin In the present study , the equivalence of paper and pencil assessment versus computer assessment of two self-administered question naires was investigated by means of a r and omized cross-over design . Therefore , 105 out- patients with diabetes were invited to participate ; 76 patients completed both the computer and the paper and pencil version of the Well-being Question naire ( WBQ ) and the Diabetes Treatment Satisfaction Question naire ( DTSQ ) in a r and omized order , with a mean interval of 7 days . The scales showed high test-retest correlations and the means , dispersions , kurtosis and skewness were found to be approximately the same in both versions . In both modes of assessment , the depression and the energy scale proved to be sensitive for carry-over effects , result ing in better well-being scores at the second measurement . Almost all subjects reported that using the personal computer in the realization of a question naire was easy . It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent . Therefore , the norms and cut-off scores obtained from paper and pencil assessment s can be used in computerized versions of the WBQ and DTSQ and vice versa OBJECTIVE To define the relationship between HbA(1c ) and plasma glucose ( PG ) levels in patients with type 1 diabetes using data from the Diabetes Control and Complications Trial ( DCCT ) . RESEARCH DESIGN AND METHODS The DCCT was a multicenter , r and omized clinical trial design ed to compare intensive and conventional therapies and their relative effects on the development and progression of diabetic complications in patients with type 1 diabetes . Quarterly HbA(1c ) and corresponding seven-point  capillary blood glucose profiles ( premeal , postmeal , and bedtime ) obtained in the DCCT were analyzed to define the relationship between HbA(1c ) and PG . Only data from complete profiles with corresponding HbA(1c ) were used ( n = 26,056 ) . Of the 1,441 subjects who participated in the study , 2 were excluded due to missing data .  Mean plasma glucose ( MPG ) was estimated by multiplying capillary blood glucose by 1.11 . Linear regression analysis weighted by the number of observations per subject was used to correlate MPG and HbA(1c ) . RESULTS Linear regression analysis , using MPG and HbA(1c ) summarized by patient ( n = 1,439 ) , produced a relationship of MPG ( mmol/l ) = ( 1.98 . HbA(1c ) ) - 4.29 or MPG ( mg/dl ) = ( 35.6 . HbA(1c ) ) - 77.3 , r = 0.82 ) . Among individual time points , afternoon and evening PG ( postlunch , predinner , postdinner , and bedtime ) showed higher correlations with HbA(1c ) than the morning time points ( prebreakfast , postbreakfast , and prelunch ) . CONCLUSIONS We have defined the relationship between HbA(1c ) and PG as assessed in the DCCT . Knowing this relationship can help patients with diabetes and their healthcare providers set day-to-day targets for PG to achieve specific HbA(1c ) goals OBJECTIVE Insulin glargine ( 21A-Gly-30Ba-L-Arg-30Bb-L-Arg-human insulin ) is a biosynthetic insulin analog with a prolonged duration of action compared with NPH human insulin . This study compared insulin glargine with NPH human insulin in subjects with type 1 diabetes who had been previously treated with multiple daily injections of NPH insulin and regular insulin .  RESEARCH DESIGN AND METHODS This study was a multicenter r and omized parallel-group study in which subjects were r and omized to receive premeal regular insulin and either insulin glargine ( at bedtime ) or NPH insulin ( at bedtime for patients on once-daily therapy and at bedtime and in the morning for patients on twice-daily therapy ) for up to 28 weeks . Dose titration of both basal insulins was based on capillary fasting whole blood glucose ( FBG ) levels ; the goal was a premeal blood glucose concentration of 4.4 - 6.7 mmol/l . RESULTS A total of 534 well-controlled type 1 diabetic subjects ( mean GHb 7.7 % , mean fasting plasma glucose [ FPG ] 11.8 mmo/l ) were treated . A small decrease in GHb levels was noted with both insulin glargine ( -0.16 % ) and NPH insulin ( -0.21 % ; P > 0.05 ) . Significant reductions in median FPG levels from baseline ( -1.67 vs. -0.33 mmol/l with NPH insulin , P = 0.0145 ) and a trend for a reduction in capillary FBG levels were achieved with insulin glargine . After the 1-month titration phase , significantly fewer subjects receiving insulin glargine experienced symptomatic hypoglycemia ( 39.9 vs. 49.2 % , P = 0.0219 ) or nocturnal hypoglycemia ( 18.2 vs. 27.1 % , P = 0.0116 ) with a blood glucose level < 2.0 mmol/l compared with subjects receiving NPH insulin . CONCLUSIONS Lower FPG levels with fewer episodes of hypoglycemia were achieved with insulin glargine compared with once- or twice-daily NPH insulin as part of a basal-bolus regimen in patients with type 1 diabetes 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 OBJECTIVE Insulin glargine offers sustained insulin delivery for 24 h. Change to glargine treatment consistently results in lower fasting glucose and fewer hypoglycemic episodes in children with type 1 diabetes compared to continuation of NPH , although glargine has not been shown to improve HbA1c in r and omized trials . Studies comparing glargine and NPH in multiple injection therapy in children treated from diagnosis of type 1 diabetes are lacking . METHODS HbA1c and insulin requirement were compared in a retrospective study of children ( 7 - 17 yr of age ) with type 1 diabetes treated from diagnosis with basal insulin glargine ( n = 49 ) or NPH ( n = 49 ) in a multiple injection therapy ( MIT ) regimen  with a rapid-acting insulin analogue . Patients were followed every third month for 1 yr . HbA1c , insulin dose , and weight data were retrieved . RESULTS HbA1c ( mean ± SD ) was lower at 3 - 5 months ( 5.5 ± 0.89 vs. 6.2 ± 0.89 % , p < 0.05 ) and 6 - 9 months ( 5.6 ± 1.14 vs. 6.6 ± 0.99 % ; p < 0.001 ) in glargine treated . After 12 months , HbA1c was significantly lower in glargine treated ( 6.3 ± 1.56 vs. 7.1 ± 1.28 ; p < 0.01 ) . Reported total insulin doses were similar at nadir ( 0.5 U/kg BW × 24 h ) , but significantly lower at 12 months in glargine treated ( 0.64 ± 0.23 vs. 0.86 ± 0.3 U/kg BW × 24 h ; 
    Output:
    
The systematic review did not consistently show any significant difference overall in QoL scores , whether as part of subsets or combined into a single score , with the use of GLA versus neutral protamine Hagedorn ( NPH ) insulin .
Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin , but not using the Well-being Inquiry for Diabetics ( WED ) scale .
Conclusion There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated .