***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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    Input: OBJECTIVES We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infa rct ion affected mortality during the subsequent 12 months of follow-up . BACKGROUND Despite significant improvements in acute coronary care , diabetic patients with acute myocardial infa rct ion still have a high mortality rate . METHODS A total of 620 patients were studied : 306 r and omized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy .  RESULTS The two groups were well matched for baseline characteristics . Blood glucose decreased from 15.4 + /- 4.1 to 9.6 + /- 3.3 mmol/liter ( mean + /- SD ) in the infusion group during the 1st 24 h , and from 15.7 + /- 4.2 to 11.7 + /- 4.1 among control patients ( p < 0.0001 ) . After 1 year 57 subjects ( 18.6 % ) in the infusion group and 82 ( 26.1 % ) in the control group had died ( relative mortality reduction 29 % , p = 0.027 ) . The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment ( 3-month mortality rate 6.5 % in the infusion group vs. 13.5 % in the control group [ relative reduction 52 % , p = 0.046 ] ; 1-year mortality rate 8.6 % in the infusion group vs. 18.0 % in the control group [ relative reduction 52 % , p = 0.020 ] ) . CONCLUSIONS Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infa rct ion 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 OBJECTIVE To determine the independent risk factors for  coronary artery disease ( CAD )  in type 1 diabetes by type of CAD at first presentation . RESEARCH DESIGN AND METHODS This is a historical prospect i ve cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980 . The mean age and duration of diabetes at baseline were 28 ( range 8 - 47 ) and 19 years ( 7 - 37 ) , respectively , and patients were followed for 10 years . Patients with prevalent CAD were excluded from the study .  Electrocardiogram ( ECG ) ischemia  was defined by Minnesota Code ( MC ) 1.3 , 4.1 - 3 , 5.1 - 3 , or 7.1 ; angina was determined by Pittsburgh Epidemiology of Diabetes Complications ( EDC ) study physician diagnosis ; and hard CAD was determined by angiographic stenosis > or = 50 % , revascularization procedure , Q waves ( MC 1.1 - 1.2 ) , nonfatal myocardial infa rct ion ( MI ) , or CAD death . RESULTS A total of 108 incident CAD events occurred during the 10-year follow-up : 17 cases of ECG ischemia , 49 cases of angina , and 42 cases of hard CAD ( 5 CAD deaths , 25 nonfatal MI or major Q waves , and 12 revascularization or > or = 50 % stenosis ) . Blood pressure , lipid levels , inflammatory markers , renal disease , and peripheral vascular disease showed a positive gradient across the groups of no CAD , angina , and hard CAD ( P < 0.01 , trend analysis , all variables ) , although estimated glucose disposal rate ( eGDR ) and physical activity showed inverse associations ( P < 0.01 , trend analysis , both variables ) . In addition , depressive symptomatology predicted angina ( P = 0.016 ) , whereas HbA(1 ) showed no association with subsequent CAD . CONCLUSIONS These data suggest that although the st and ard CAD risk factors are still operative in type 1 diabetes , greater glycemia does not seem to predict future CAD events . In addition , depressive symptomatology predicts angina and insulin resistance ( eGDR ) predicts hard CAD end points OBJECTIVE To describe the 10-year cumulative incidence of and risk factors for lower-extremity amputations in diabetics . DESIGN Cohort study . SETTING Primary care . PARTICIPANTS  Population -based sample ( N = 879 ) of younger-onset diabetic persons ( in whom diabetes was diagnosed before 30 years of age and who were taking insulin ) and a stratified r and om sample ( N = 956 ) of older-onset diabetic persons ( diagnosis at or after 30 years of age ) participating in baseline , 4-year , and 10-year examinations . MAIN OUTCOME MEASURE Amputations of the lower extremities as reported by the participants . RESULTS The 10-year cumulative incidence of lower-extremity amputation was 5.4 % in younger-onset and 7.3 % in older-onset persons . Multivariate analyses were performed by logistic regression . In younger-onset persons , age ( odds ratio [ OR ] for 10 years , 2.0 ; 95 % confidence interval [ CI ] , 1.5 - 2.8 ) , history of ulcers ( OR,4.8 ; 95 % CI , 2.3 - 9.9 ) , diastolic blood pressure ( OR , 2.1 for 10 mm Hg ; 95 % CI , 1.5 - 3.0 ) , glycosylated hemoglobin level ( OR , 1.4 for 1 % ; 95 % CI , 1.2 - 1.6 ) , sex ( OR , 5.2 for men ; 95 % CI , 2.2 - 12.3 ) , and retinopathy ( OR , 1.2 for 2 steps ; 95 % CI , 1.1 - 1.4 ) were significantly associated with incidence of lower-extremity amputation . In older-onset persons , history of ulcers ( OR , 3.3 ; 95 % CI , 1.6 - 6.8 ) , glycosylated hemoglobin level ( OR , 1.3 for 1 % ; 95 % CI , 1.1 - 1.5 ) , duration of diabetes ( OR , 1.6 for 10 years ; 95 % CI , 1.1 - 2.5 ) , sex ( OR , 2.6 for men ; 95 % CI , 1.3 - 4.9 ) , diastolic blood pressure ( OR , 0.7 for 10 mm Hg ; 95 % CI , 0.5 - 1.0 ) , and proteinuria ( OR , 2.4 ; 95 % CI , 1.0 - 5.7 ) were significantly associated with incidence of lower-extremity amputation . CONCLUSION These data show there are several risk factors for lower-extremity  amputation  with potential for modification and preventive strategies Abstract Objective : To examine the value of glycated haemoglobin ( HbA1c ) concentration , a marker of blood glucose concentration , as a predictor of  death from cardiovascular and all causes in men . Design : Prospect i ve population study . Setting : Norfolk cohort of European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Norfolk ) . Subjects : 4662 men aged 45 - 79 years who had had glycated haemoglobin measured at the baseline survey in 1995 - 7 who were followed up to December 1999 . Main outcome measures : Mortality from all causes , cardiovascular disease , ischaemic heart disease , and other causes . Results : Men with known diabetes had increased mortality from all causes , cardiovascular disease , and ischaemic disease ( relative risks 2.2 , 3.3 , and 4.2 , respectively , P < 0.001 independent of age and other risk factors ) compared with men without known diabetes . The increased risk of death among men with diabetes was largely explained by HbA1c concentration . HbA1c was continuously related to subsequent all cause , cardiovascular , and ischaemic heart disease mortality through the whole population distribution , with lowest rates in those with HbA1c concentrations below 5 % . An increase of 1 % in HbA1c was associated with a 28 % ( P<0.002 ) increase in risk of death independent of age , blood pressure , serum cholesterol , body mass index , and cigarette smoking habit ; this effect remained ( relative risk 1.46 , P=0.05 adjusted for age and risk factors ) after men with known diabetes , a HbA1c concentration ≥7 % , or history of myocardial infa rct ion or stroke were excluded . 18 % of the population excess mortality risk associated with a HbA1c concentration ≥5 % occurred in men with diabetes , but 82 % occurred in men with concentrations of 5%-6.9 % ( the majority of the population ) . Conclusions : Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution . Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA1c through behavioural means In most survival studies in NIDDM , microalbuminuria ( urinary albumin excretion rate 20 - 200 microg/min ) predicts early mortality ; in cross-sectional studies , it is associated with coronary heart disease ( CHD ) morbidity . It is unclear , however , whether microalbuminuria is a risk factor for the development of CHD or the result of it , and little is known of the factors that predispose to the development of microalbuminuria in NIDDM . We examined these issues in a 7-year prospect i ve study of a hospital-based cohort comprising 146 white NIDDM patients without clinical albuminuria . Microalbuminuria was a significant risk factor for both all-cause mortality ( relative risk 3.94 , 95 % CI 2.04 - 7.62 ) and CHD mortality ( relative risk 7.40 , 95 % CI 2.94 - 18.7 ) when adjusted for age only . Its independent predictive power did not persist , however , in age-adjusted multivariable survival analysis that allowed for the other significant risk factors : male sex , preexisting CHD , high levels of glycated hemoglobin , and high serum cholesterol . Among men free of CHD at baseline , the independent risk factors for CHD morbidity and mortality were microalbuminuria , current smoking , high diastolic blood pressure , and high serum cholesterol ( all P < 0.05 ) . For the 100 NIDDM patients with normoalbuminuria at baseline , the incidence of microalbuminuria was 29 % over the 7-year period . In that group , fasting plasma glucose , current smoking , preexisting CHD , and high initial urinary albumin excretion rate were risk factors for the development of microalbuminuria ( all P < 0.05 ) . When men and women were analyzed separately , preexisting CHD was a significant risk factor in men only . These results demonstrate that microalbuminuria predicts incident clinical CHD in men with NIDDM . Preexisting CHD is also a risk factor for incident microalbuminuria in men , however , suggesting that microalbuminuria 
    Output:
    
In r and omized clinical trials , improving glycemic control substantially reduces the incidence of microvascular disease in persons with diabetes ( 5 , 6 , 11 ) .