***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: OBJECTIVE To examine whether intensive glycemic control could decrease the frequency or severity of diabetic microvascular complications , an 8-year prospect i ve study of Japanese patients with type 2 diabetes was performed . RESEARCH DESIGN AND METHODS A total of 110 patients with type 2 diabetes ( 55 with no retinopathy [ the primary prevention cohort ] and 55 with simple retinopathy [ the secondary intervention cohort ] ) were r and omly assigned to multiple insulin injection therapy ( MIT ) groups and administered three or more daily insulin injections or assigned to conventional insulin injection therapy ( CIT ) groups and administered one or two daily intermediate-acting insulin injections . Worsening of microvascular complications was regularly assessed during 8 years . Two or more steps up in the 19 stages of the modified Early Treatment of Diabetic Retinopathy Study classification in retinopathy and one or more stages up among three stages in nephropathy ( normoalbuminuria , microalbuminuria , and albuminuria ) were defined as worsening of complications . RESULTS In both primary prevention and secondary intervention cohorts , the cumulative percentages of worsening in retinopathy and nephropathy were significantly lower ( P < 0.05 ) in the MIT group than in the CIT group . In neurological tests after 8 years , the MIT group showed significant improvement ( P < 0.05 ) in the median nerve conduction velocities ( motor and sensory nerves ) , whereas the CIT group showed significant deterioration ( P < 0.05 ) in the nerve conduction velocities and vibration threshold . From this study , the glycemic threshold to prevent the onset and progression of diabetic microvascular complications was as follows : HbA1c < 6.5 % , fasting blood glucose concentration < 110 mg/dl , and 2-h postpr and ial blood glucose concentration < 180 mg/dl . CONCLUSIONS Intensive glycemic control can delay the onset and progression of the early stages of diabetic microvascular complications in Japanese patients with type 2 diabetes 74 insulin-dependent diabetic patients with background retinopathy were r and omised to continue with usual diabetic care ( group U ) or to a more intensive programme ( group A ) using ultralente insulin as basal cover and soluble insulin at mealtimes . Group A attended the clinic more frequently , received closer dietary supervision , and were taught home blood glucose monitoring . Group A had a significantly lower mean glycosylated haemoglobin level during the study , although the mean level also fell in group U towards the end of year 2 . Renal and sensory-nerve function were significantly better preserved in group A than in group U. Significant improvements were also seen in low-density-lipoprotein-cholesterol and whole-blood low-shear viscosity . The rate of progression of retinopathy was similar in both groups . It appears that a modest improvement in diabetic control , obtainable in most clinics , has been associated with a reduction in the progression of diabetic tissue damage To determine whether a difference in HbA(1c ) could be safely sustained between a st and ard therapy ( STD ) arm and an intensive therapy ( INT ) arm , while maintaining HbA(1c ) levels in both arms within a range acceptable in community practice . The effects of intensive treatment on various parameters were studied in this feasibility trial . We report here the results of 24 months of INT on peripheral and autonomic neuropathy . A prospect i ve trial was conducted in five medical centers in 153 men of 60 + /- 6 years of age who had a known diagnosis of diabetes for 7.8 + /- 4 years . They were r and omly assigned to a st and ard insulin treatment group ( one morning injection per day ) or to an intensive therapy group design ed to attain near-normal glycemia and a clinical ly significant separation of glycohemoglobin from the st and ard arm . A four-step plan was used in the intensive therapy group along with daily self-monitoring of glucose : ( 1 ) an evening insulin injection , ( 2 ) the same injection adding daytime glipizide , ( 3 ) two injections of insulin alone , and ( 4 ) multiple daily injections . Peripheral neuropathy was diagnosed clinical ly by a history and physical examination , and by abnormal autonomic neuropathy Valsalva ratio ( VR < 1.2 ) and RR variation ( RRV < 10 ) . An average HbA(1c ) separation of 2.07 % was achieved with INT , having HbA(1c ) at or below 7.3 % ( p = 0 . 001 versus STD ) . Baseline prevalence of peripheral neuropathy was 53 % in STD , and 48 % in INT . By 24 months , the prevalence increased to 69 % in STD ( p = 0.005 versus baseline ) , and to 64 % in INT ( p = 0 . 008 versus baseline , but no different than STD ) . Though INT did not reverse all elements of peripheral neuropathy , there was a decreased prevalence of cranial neuropathy ( p = 0.053 versus STD ) and more frequent preservation of touch sensation in the upper extremities ( p = 0.03 versus STD ) in INT . At baseline , an abnormal Valsalva ratio and /or RR variation was seen in 38 % of STD and 31 % of INT . By 24 months in STD , the prevalence rose to 55 % ( p = 0.0067 versus baseline ) , and in INT , to 48 % ( p = 0.012 versus baseline and no different from STD ) . The prevalence of erectile dysfunction increased from 53 % at baseline to 73 % at 2 years , p = 0.002 in STD , and from 51 % to 73 % at 2 years ( p = 0.003 versus baseline ) and no different from STD . There was no change in the frequency of abnormal gastrointestinal or sweating symptoms . Our conclusion was that 2 years of meticulous glycemic control did not decrease overall prevalence of peripheral or autonomic neuropathy . In fact , the prevalence rose equivalently and significantly in both treatment arms . There was some benefit , however , in decreased frequency of cranial neuropathy and better preservation of touch sensation in INT A prospect i ve , stratified , r and omized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years . The goals for conventional glucose control were the mean of fasting and 80-minute postpr and ial plasma glucose of 150 mg/dl for non-insulin-dependent diabetes and 200 mg/dl for insulin-dependent diabetes . The goal of rigorous glucose control was an approximation of nondiabetic glucose control . No significant difference in glucose control or peripheral nerve function was observed between the rigorously and the conventionally controlled groups . Eight patients in the conventional-control group spontaneously achieved glucose control in the range that was the objective for the rigorous-control group , and five patients in the rigorous-control group never achieved the desired glucose control . In the remaining 20 patients , with similar baseline glucose control and peripheral nerve function characteristics , observed over a median of 2 years , improved blood glucose control ( P less than 0.01 ) was not associated with any significant improvement in peripheral nerve function . Nevertheless , a significant ( P less than 0.05 ) correlation was found between the degree of abnormal nerve function at entry into the study and change in nerve function during the study . If control of hyperglycemia benefits peripheral nerve function of diabetic patients , its demonstration may require a closer approximation of normoglycemia , a larger difference in glucose control between the two study groups , a longer duration of treatment , and the use of patients with more advanced  peripheral nerve function  abnormalities than those in this study Objectives ‐ To study the occurrence of diabetic neuropathy and the effect of insulin treatment in elderly Type 2 diabetic patients . Material and methods ‐In 38 patients and 20 controls  symptoms and neurophysiological examinations including electroneurography , vibration perception and temperature discrimination thresholds were investigated . Patients were r and omized to insulin ( n= 18 ) or sulfonylurea ( n= 16 ) treatment and were re‐investigated after 1 year . Results ‐ Neuropathy was present in 21/38 patients ( 56 % ) . It was asymptomatic in 17/38 ( 45 % ) and symptomatic in 4/38 ( 11 % ) . The occurrence of neuropathy was less common in healthy controls , 3/20 ( 15 % ) ( P<0.01 ) . Temperature discrimination thresholds was the test that most often revealed pathology . The metabolic control after 1 year was significantly improved in the insulin treated group and unchanged in the sulfonylurea treated group . There were no changes as regards occurrence of neuropathy between or within the two treatment groups after 1 year . Conclusion ‐ Diabetic neuropathy is common among elderly Type 2 diabetic patients . It is mostly asymptomatic . Improvement was not seen after 1 year of insulin treatment tion between ARC/IRC and the presence of nephropathy , neuropathy and retinopathy in the 4 groups were examined . Responses of aldosterone and its precursors , 1 1 -desoxycorticosterone ( DOC ) , corticosterone ( B ) and 18-hydroxy-corticosterone ( 1 8-OHB ) to ACTHor angiotensin II ( A II )  were measured in normal subjects and in the 4 groups of diabetic patients in order to examineadrenal bio synthesis in this disorder . PRA in the diabetic patients was elevated to 2.4±2.2 from 0.8±0.6 ng/ml/h ( 3.2±1.7 from 1.2± 0.7 in normals ) 2 h after furosemide ( 1 mg/kg ) in an upright position . ARC was 15.8±3.3 , 9.0±3.0 , 13.7 + 2.2 and 17.4±3.0 pg/mlin diabetic groups I-IV , respectively ( 23.7±4.6 pg/ml Forty five insulin dependent diabetics were r and omised to treatment with continuous subcutaneous insulin infusion ( CSII ) , multiple insulin injections ( five or six daily ) , or conventional twice daily insulin injections . Near normoglycaemia was obtained with CSII and multiple injections but not with conventional treatment ( p less than 0.01 ) . Hypoglycaemic coma was observed less frequently with CSII than with multiple injections and conventional treatment ( p less than 0.001 ) , but blood glucose concentrations below 2.5 mmol/l ( 45 mg/100 ml ) were more common . After two years fewer retinal microaneurysms and haemorrhages had developed in the patients given CSII and multiple injections compared with those given conventional treatment , in whom the number had increased significantly ( p less than 0.01 ) . Motor nerve conduction velocity deteriorated in the patients given conventional treatment ; in those given CSII it was unchanged during the first year but had improved after two years ( p less than 0.01 ) . Glomerular hyperfiltration was reduced with CSII , but no change occurred in urine albumin excretion rates . Long term near normoglycaemia may prevent the progression of early stages of late diabetic complications BACKGROUND The effects of intensive glucose control on cardiovascular events in patients with long-st and ing type 2 diabetes mellitus remain uncertain . METHODS We r and omly assigned 1791 military veterans ( mean age , 60.4 years ) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or st and ard glucose control . Other cardiovascular risk factors were treated uniformly . The mean number of years since the diagnosis of diabetes was 11.5 , and 40 % of the patients had already had a cardiovascular event . The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level , as compared with the st and ard-therapy group . The primary outcome was the time from r and omization to the first occurrence of a major cardiovascular event , a composite of myocardial infa rct ion , stroke , death from cardiovascular causes , congestive heart failure , surgery for vascular disease , inoperable coronary disease , and amputation for ischemic gangrene . RESULTS The median follow-up was 5.6 years . Median glycated hemoglobin levels were 8.4 % in the st and ard-therapy group and 6.9 % in the intensive-therapy group . The primary outcome occurred in 264 patients in the st and ard-therapy group and 235 patients in the intensive-therapy group ( hazard ratio in the intensive-therapy group , 0.88 ; 95 % confidence interval [ CI ] , 0.74 to 1.05 ; P=0.14 ) . There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause ( hazard ratio , 1.07 ; 95 % CI , 0.81 to 1.42 ; P=0 
    Output:
    
Most secondary outcomes were significantly in favor of intensive treatment in both population s. However , both types of diabetic participants also had a significant increase in severe adverse events including hypoglycemic events .
AUTHORS ' CONCLUSIONS According to high- quality evidence , enhanced glucose control significantly prevents the development of clinical neuropathy and reduces nerve conduction and vibration threshold abnormalities in type 1 diabetes mellitus .
In type 2 diabetes mellitus , enhanced glucose control reduces the incidence of clinical neuropathy , although this was not formally statistically significant ( P = 0.06 ) .
However , enhanced glucose control does significantly reduce nerve conduction and vibration threshold abnormalities .