***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: Almost three decades ago the Finnish led the way for prevention of coronary heart disease by successfully implementing the community based North Karelia project.1 With the recent publication of their r and omised controlled clinical trial of prevention of type 2 diabetes , Tuomilehto et al have now shown that effective lifestyle changes can prevent another major chronic disease of our time . 2 3 Type 2 diabetes has long been linked with behavioural and environmental factors such as overweight , physical inactivity , and dietary habits.4 The findings from the Finnish trial confirm this link . Major lifestyle changes result ing from industrialisation are contributing to a rapid rise in diabetes worldwide , but especially in industrialising countries . An estimated 135 million people worldwide had diagnosed diabetes in 1995 , and this number is expected to rise to at least 300 million by 2025.4 Between 1995 and 2025 the number of people with diabetes will increase by 42 % ( from 51 to 72 million ) in industrialised countries and by 170 % ( from 84 to 228 million ) in industrialising countries . Diabetes exerts a huge Summary The aims of the present study were to observe the natural history of impaired glucose tolerance and to identify predictors for development of non-insulin-dependent diabetes mellitus ( NIDDM ) . A survey of glucose tolerance was conducted in subjects aged 50–74 years , r and omly selected from the registry of the middle-sized town of Hoorn in the Netherl and s. Based on the mean values of two oral glucose tolerance tests subjects were classified in categories of glucose tolerance according to the World Health Organization criteria . All subjects with impaired glucose tolerance ( n=224 ) were invited to participate in the present study , in which 70 % ( n=158 ) were subsequently enrolled . During follow-up subjects underwent a repeated paired oral glucose tolerance test . The mean follow-up time was 24 months ( range 12–36 months ) . The cumulative incidence of NIDDM was 28.5 % ( 95 % confidence interval 15–42 % ) . Age , sex , and anthropometric and metabolic characteristics at baseline were analysed simultaneously as potential predictors of conversion to NIDDM using multiple logistic regression . The initial 2-h post-load plasma glucose levels and the fasting proinsulin levels were significantly ( p<0.05 ) related to the incidence of NIDDM . Anthropometric characteristics , the 2-h post-load specific insulin levels and the fasting proinsulin/fasting insulin ratio were not related to the incidence of NIDDM . These results suggest that beta-cell dysfunction rather than insulin resistance plays the most important role in the future development of diabetes in a high-risk Caucasian population OBJECTIVE We prospect ively assessed whether the combined measurements of fasting plasma glucose ( FPG ) and A1C were effective for predicting type 2 diabetes . RESEARCH DESIGN AND METHODS Study participants included 6,736 nondiabetic Japanese men aged 40–55 years . Type 2 diabetes was diagnosed in those who had an FPG ≥126 mg/dl or who were being treated with an oral antidiabetic agent or insulin .  The models including FPG , A1C , and both were compared using the area under the receiver operating characteristic ( AUROC ) curves . RESULTS During the 4-year follow-up period , we confirmed 659 diabetes cases . In multivariate analysis , both FPG and A1C were independently associated with the risk of type 2 diabetes . The model including both FPG and A1C had a greater AUROC curve than that including FPG alone ( 0.853 vs. 0.818 ; P < 0.001 ) or A1C alone ( 0.853 vs. 0.771 ; P < 0.001 ) . CONCLUSIONS The combined measurement of FPG and A1C was effective for predicting type 2 diabetes OBJECTIVE We have previously suggested using the paired values of fasting plasma glucose ( FPG ) and HbA1c to identify potential diabetic subjects . In this article , we followed up on 208 nondiabetic subjects and examined their rates of progression to diabetes . We analyzed their likelihood of becoming diabetic according to their baseline FPG and HbA1c concentrations . RESEARCH DESIGN AND METHODS Between 1988 and 1995 , 2,877 Chinese subjects with risk factors for diabetes underwent screening .  Of these , 2,250 had FPG < 7.8 mmol/l and 2-h plasma glucose ( PG ) < 11.1 mmol/l . Of these 2,250 subjects , 265 were r and omly recruited for an annual oral glucose tolerance test ( OGTT ) until they progressed to develop diabetes . Of those 265 subjects , 57 had baseline FPG > or = 7.0 mmol/l and were excluded from the present analysis . Hence , the progression of glucose tolerance  in 208 subjects who were nondiabetic according to the new American Diabetes Association diagnostic criteria ( FPG < 7.0 mmol/l and 2-h PG < 11.1 mmol/l ) was examined RESULTS Of the 208 nondiabetic subjects , 26 ( 12.5 % ) were men and 182 ( 87.5 % ) were women . After a mean follow-up of 1.60 + /- 1.16 years ( range 1 - 7 , median 1 ) , 44 ( 21.2 % ) progressed to develop diabetes and 164 ( 78.8 % ) remained nondiabetic . Those who were diabetic at the end of the study had a high likelihood ratio ( LR ) of 9.3 to have baseline FPG > or = 6.1 mmol/l and baseline HbA1c > or = 6.1 % . This was compared with a low LR of 0.6 - 1.1 in diabetic subjects who had either FPG < 6.1 mmol/l or HbA1c < 6.1 % or both at baseline . The crude rate of progression to diabetes was more than five times higher ( 44.1 vs. 8.1 % ) in those whose baseline FPG was > or = 6.1 mmol/l and baseline HbA1c was > or = 6.1 % compared with those whose baseline FPG was < 6.1 mmol/l and baseline HbA1c was < 6.1 % . CONCLUSIONS For Chinese subjects with risk factors for glucose intolerance , the use of paired FPG and HbA1c values helped to identify potential diabetic subjects . Those with an FPG > or = 6.1 mmol/l and HbA1c > or = 6.1 % had a rate of progression to diabetes more than five times higher than those with an FPG < 6.1 mmol/l and an HbA1c < 6.1 % after a mean follow-up of 1.6 years . Those with an FPG > or = 6.1 but < 7.0 mmol/l , especially if their HbA1c was > or = 6.1 % , should undergo an OGTT to confirm diabetes . Subjects with an FPG < 6.1 mmol/l and /or an HbA1c < 6.1 % should have regular screening using the paired values of FPG and HbA1c Blood glucose 2 h after an oral glucose load ( 2hBG ) and glycohaemoglobin ( GHb ) ( Corning agar-gel electrophoresis ) levels were used as screening tests in a general practice diabetic screening programme . The diagnosis of diabetes ( DM ) was based on a separate oral glucose tolerance test ( OGTT ) in 223 of 1040 screened subjects , selected as a stratified sample biased towards higher levels of 2hBG and GHb . The GHb assay was also repeated at the recall examination and urine was tested for glycosuria before and after glucose administration . At a cut-off level of 8.1 % , the screening GHb assay correctly identified 90 % of all probable diabetics with a specificity of 85.3 % ( 95 % Cl 83.3 - 87.3 % ) and a positive predictive value of 14.0 % ( 9.0 - 19.0 % ) . The specificity of the screening GHb assay  as a screening test for true DM was 45.8 % ( 39.0 - 52.4 % ) at 90 % sensitivity , and that of the recall GHb assay was 64.5 % ( 57.9 - 71.1 % ) . The screening 2hBG was 93.3 % ( 88.9 - 97.7 % ) specific at 90 % sensitivity as a screening test for true DM diagnosed by OGTT at recall . The test characteristics for fasting glycosuria were : sensitivity 16.7 % ( 0 - 37.8 % ) and specificity 98.0 % ( 96.0 - 100.0 % ) . Equivalent values for the post-glucose test for glycosuria were : 72.7 % ( 46.4 - 99.0 % ) and 77.4 % ( 70.1 - 84.7 % ) , respectively . While GHb assay is a poorer screening test for DM than the 2hBG at the single cut-off level quoted , comparison of the accuracy of the two tests shows that the GHb assay is only marginally less accurate . It is superior to testing for glycosuria as a screening test for DM and can be performed on any r and om blood sample , facilitating its use in population screening OBJECTIVE —Early identification of subjects at high risk for diabetes is essential , and r and om HbA1c ( A1C ) may be more practical than fasting plasma glucose ( FPG ) . The predictive value of A1C , in comparison to FPG , is evaluated for 6-year incident diabetes . RESEARCH DESIGN AND METHODS —From the French cohort study Data from an Epidemiological Study on the Insulin Resistance Syndrome ( DESIR ) , 1,383 men and 1,437 women , aged 30–65 years , were volunteers for a routine health check-up .  Incident diabetes was defined by FPG ≥7.0 mmol/l or treatment by antidiabetic drugs . Multivariate logistic regression models were used to predict diabetes at 6 years . Receiver operating characteristic curves compared the predictive values of A1C and FPG . RESULTS —At 6 years , 30 women ( 2.1 % ) and 60 men ( 4.3 % ) had developed diabetes . Diabetes risk increased exponentially with A1C in both sexes ( P < 0.001 ) . After stratifying on FPG , A1C predicted diabetes only in subjects with impaired fasting glucose ( IFG ) ( FPG ≥6.10 mmol/l ) : the odds ratio ( 95 % CI ) for a 1 % increase in A1C was 7.20 ( 3.00–17.00 ) . In these subjects , an A1C of 5.9 % gave an optimal sensitivity of 64 % and specificity of 77 % to predict diabetes . CONCLUSIONS —A1C predicted diabetes , even though the diagnosis of diabetes was based on FPG , but it was less sensitive and specific than FPG . It could be used as a test if fasting blood sampling was not available or in association with FPG . In subjects with IFG , A1C is better than glucose to evaluate diabetes risk , and it could be used to select subjects for intensive early intervention BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention 
    Output:
    
Our systematic review demonstrated that A1C values between 5.5 and 6.5 % were associated with a substantially increased risk for developing diabetes