***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 
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    ***EXAMPLES*** 
    Input: Background Six of the top ten countries in the world with the highest prevalence of diabetes mellitus are in the Middle East . The objective of this investigation was to evaluate the prevalence of diabetes in Basrah , Southern Iraq . Methods A population -based , cross-sectional , simple r and om study screened 5,445 persons aged 19–94 years in Basrah , with glycated hemoglobin measured in 88.3 % of the population and fasting plasma glucose in 18.7 % .  Body mass index  and other  demographic parameters  were also measured . Results Of the 5,445 persons screened , 8.7 % had already been diagnosed with diabetes and 11 % were found by screening to have undiscovered diabetes , giving an age-adjusted prevalence of diabetes of 19.7 % , with 55.7 % of those with diabetes being previously undiagnosed . In addition , 29.1 % of the screened population had prediabetes , giving a prevalence of dysglycemia of 48.8 % , with only 51.2 % of the persons screened being normoglycemic . The prevalence of diabetes in both sexes peaked at age 46–60 years . Diabetes was slightly more prevalent in females than in males , and about 70.3 % of diabetic individuals had a body mass index ≥25 kg/m2 . Conclusion The prevalence of diabetes in Basrah , Iraq , is very high , affecting one in five adults . The epidemic of diabetes will result in strain on the financial re sources of health care systems OBJECTIVE The goal of the present work was to examine the prevalence and associated risk factors of undiagnosed diabetes among urban Moroccan Sahraoui women . DESIGN AND SETTING R and omised sample of adult women living in the city of Laayoune in south Morocco who visited public health centres during an immunisation campaign .  Body weight , height , waist and hip circumferences , blood pressure , fasting plasma glucose ( FPG ) , triglycerides , dietary intake and physical activity  were collected . SUBJECTS Data were obtained on 249 urban women aged 15 years and older , who were not pregnant . Only subjects identified as of Sahraoui origin were eligible for this investigation . RESULTS The prevalence of impaired fasting glucose ( IFG ) was 5.5 % and that of undiagnosed diabetes 6.4 % . Diabetes and IFG were more common among older and obese women as well as among women with hypertension or a family history of diabetes . In addition , sucrose intakes were higher in women with diabetes than in those with normal FPG . Also , physical activity estimated as the time spent in walking was negatively associated with FPG . Regression analyses showed an independent association of age , obesity , family history of diabetes and triglycerides with diabetes . CONCLUSION The high proportion of unknown diabetes suggests the need for increased diabetes awareness in this population . The data suggest also the involvement of obesity in diabetes and the potential importance of intervention strategies to reduce population adiposity for the prevention and management of cardiovascular risk factors CONTEXT Microvascular processes have been hypothesized to play a role in the pathogenesis of type 2 diabetes mellitus , but prospect i ve clinical data regarding this hypothesis are unavailable . OBJECTIVE To examine the relation of retinal arteriolar narrowing , a marker of microvascular damage from aging , hypertension , and inflammation , to incident  diabetes in healthy middle-aged persons . DESIGN , SETTING , AND PARTICIPANTS The Atherosclerosis Risk in Communities Study , an ongoing population -based , prospect i ve cohort study in 4 US communities that began in 1987 - 1989 . Included in this analysis were 7993 persons aged 49 to 73 years without diabetes , of whom retinal photographs were taken during the third examination ( 1993 - 1995 ) . MAIN OUTCOME MEASURES Incident diabetes ( defined as fasting glucose levels of > or = 126 mg/dL [ 7.0 mmol/L ] , casual levels of > or = 200 mg/dL [ 11.1 mmol/L ] , diabetic medications use , or physician diagnosis of diabetes at the fourth examination ) by quartile of retinal arteriole-to-venule ratio ( AVR ) . RESULTS After a median follow-up of 3.5 years , 291 persons ( 3.6 % ) had incident diabetes . The incidence of diabetes was higher in persons with lower AVR at baseline ( 2.4 % , 3.1 % , 4.0 % , and 5.2 % , from highest to lowest AVR quartile ; P for trend < .001 ) . After controlling for fasting glucose and insulin levels , family history of diabetes , adiposity , physical activity , blood pressure , and other factors , persons in the lowest quartile of AVR were 71 % more likely to develop diabetes than those in the highest quartile ( odds ratio [ OR ] , 1.71 ; 95 % confidence interval [ CI ] , 1.13 - 2.57 ; P for trend = .002 ) . This association persisted with different diagnostic criteria ( OR , 1.92 ; 95 % CI , 1.10 - 3.36 ; P for trend = .01 , using a fasting glucose level of > or = 141 mg/dL [ 7.8 mmol/L ] as a cutoff ) , and was seen even in people at lower risk of diabetes , including those without a family history of diabetes , without impaired fasting glucose , and with lower measures of adiposity . CONCLUSIONS Retinal arteriolar narrowing is independently associated with risk of diabetes , supporting a microvascular role in the development of clinical diabetes The YMCA ’s Diabetes Prevention Program gives you the skills you need and the support you deserve to make lasting healthy lifestyle changes . WHAT IS PREDIABETES ? Prediabetes occurs when blood sugar levels are higher than normal but not high enough for a type 2 diabetes diagnosis . Risk for developing type 2 diabetes may be reduced or eliminated by weight loss , healthier eating and increased physical activity OBJECTIVE Glucose intolerance is a risk factor for coronary disease , but there is uncertainty about the shape of the dose-response relationship between glucose level and risk of coronary mortality . We examined the prospect i ve relation of 2-h postload blood glucose ( 2hBG ) with coronary and other major causes of mortality over 33 years . RESEARCH DESIGN AND METHODS A 50-g oral glucose tolerance test ( OGTT ) was performed at baseline ( 1967 - 1969 ) in 17,869 male civil servants aged 40 - 64 years . RESULTS There were 3,561 coronary deaths during 451,787 person-years of observation . All-cause , cardiovascular , and respiratory mortality were elevated among participants with glucose intolerance . The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l ( 83 mg/dl [ 95 % CI 4.2 - 5.3 ] ) . The dose-response relation was best fitted by a single slope above this level , with no evidence of nonlinearity , compared with Cox models using other threshold levels , and those containing log 2hBG terms . There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l . Between this level and 11.1 mmol/l ( 200 mg/dl ) , the age-adjusted hazard ratio was 3.62 ( 95 % CI 2.3 - 5.6 ) . The grade d relationship was attenuated by 45 % after adjustment for baseline coronary heart disease ( CHD ) , BMI , systolic blood pressure , blood cholesterol , smoking , physical activity , lung function , and employment grade . CONCLUSIONS A threshold model with linear slope best described the dose-response relationship between postload blood glucose and CHD mortality risk AIMS To determine the prevalence of diabetes mellitus and impaired fasting glucose by age , gender , and by region and compare results with the 1991 survey ; and estimate previously undiagnosed diabetes mellitus in the Omani population . METHODS Cross-sectional survey containing a probability r and om sample of 5838 Omani adults aged > or= 20 years .  Diabetes and impaired fasting glucose ( IFG ) were assessed by  fasting venous plasma glucose  using 1999 World Health Organization 's diagnostic criteria ( normoglycaemia < 6.1 mmol/l , IFG > or= 6.1 but < 7 mmol/l , and diabetes > or= 7 mmol/l ) . The 1991 survey was reanalysed using the same diagnostic criteria , and results were compared . RESULTS In 2000 , the  age-adjusted prevalence of diabetes among Omanis aged 30 - 64 years reached 16.1 % ( 95 % confidence interval ( CI ) 14.7 - 17.4 ) compared with 12.2 % ( 95 % CI11.0 - 13.4 ) in 1991 . IFG was found among 7.1 % ( 95 % CI6.2 - 8.1 ) of males and 5.1 % ( 95 % CI 4.4 - 6.0 ) of females . Generally , diabetes was more common in urban then rural regions . Only one-third of diabetic subjects knew that they had diabetes . Nearly half of the study population had a body mass index > 25 kg/m2 . CONCLUSIONS The prevalence of diabetes is high in Oman and has increased over the past decade . The high rate of abnormal fasting glucose together with high rates of overweight and obesity in the population make it likely that diabetes will continue to be a major health problem in Oman . Primary prevention programmes are urgently needed to counteract major risk factors that promote the development of 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 BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) OBJECTIVE We assessed the association between fiber intake and fruit/vegetable consumption with the likelihood of weight gain in the previous 5 y in a Mediterranean population . METHODS We conducted a cross-sectional analysis of participants 
    Output:
    
Conclusions T2DM and pre-DM are common in women of childbearing age in MENA countries .