***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: Background Prevalence of type 2 diabetes ( T2D ) is increasing worldwide . T2D prevention by lifestyle intervention is effective . Pragmatic scalable interventions are needed , with evidence to efficiently target and monitor such interventions . We report pooled analyses of data from three European trial cohorts : to analyse T2D incidence , sustained weight loss and utility of risk predictors . Methods We analysed data on 749 adults with impaired glucose tolerance ( 278 men and 471 women , mean age 56 years , mean BMI 31 kgm−2 ) recruited between 1993 and 2003 , and r and omised to intensive lifestyle intervention ( I ) or lifestyle advice control ( C ) . The intervention aim ed to increase physical activity , modify diet , and promote weight loss≥5 % . Using Cox-regression survival analysis , we assessed T2D incidence and the impact on T2D incidence of sustained weight loss , and of baseline cut-point values of FINDRISC score , fasting plasma glucose ( FPG ) , and HbA1c . Results Mean follow-up duration was 3.1 years . T2D was diagnosed in 139 participants ( I = 45/379 , C = 94/370 ) . Cumulative T2D incidence was 57 % lower in the intervention compared with the control group ( HR 0.42 ( 95 % CI 0.29 to 0.60 ) P<0.001 ) . Participants with ≥5 % weight loss at one year had 65 % lower T2D incidence ( HR 0.35 ( 95 % CI 0.22 to 0.56 ) P<0.001 ) ; maintaining ≥5 % weight loss for two and three years further reduced T2D incidence . Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study ( EDIPS ) participants with similar hazard-ratios for intervention effect . Conclusions Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention . Analysis showed the preventive effect of ≥5 % weight loss , especially if maintained long term , which has utility for intervention monitoring . Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit , to efficiently target interventions and suggests evidence is needed to define clinical policy . Trial registration s The Finnish Diabetes Prevention study , Helsinki , Finl and : Clinical Trials.gov ; NCT00518167 The SLIM diabetes prevention study , Maastricht , The Netherl and s : Clinical Trials.gov ; NCT00381186 The EDIPS-Newcastle diabetes prevention study , Newcastle upon Tyne , UK : International St and ard R and omised Controlled Trial Number ; IS RCT N15670600 Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = 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 OBJECTIVE Participants in the Diabetes Prevention Program ( DPP ) r and omized to intensive lifestyle modification  ( ILS ) or metformin had a significantly reduced incidence of diabetes compared with those r and omized to placebo , yet most were still at risk because they had pre-diabetes . We explored the effect of baseline characteristics , weight change , ILS , and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation ( NGR ) defined by American Diabetes Association criteria . RESEARCH DESIGN AND METHODS The DPP was a prospect i ve r and omized trial . Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up . RESULTS Lower baseline fasting ( hazard ratio 1.52 , P < 0.01 ) and 2-h ( 1.24 , P < 0.01 ) glucose predicted regression to NGR , as did younger age ( 1.07 , P < 0.01 ) and greater insulin secretion ( 1.09 , P = 0.04 ) .  ILS  ( 2.05 , P < 0.01 ) and weight loss ( 1.34 , P < 0.01 ) had significant and independent effects on regression . A nonsignificant trend for regression was also observed for metformin ( 1.25 , P = 0.06 ) , male sex ( 1.17 , P = 0.08 ) , and insulin sensitivity ( 1.07 , P = 0.09 ) . In those entering the study with both impaired fasting glucose ( IFG ) and impaired glucose tolerance ( IGT ) , male sex and insulin sensitivity predicted regression to isolated IFG , whereas ILS , metformin , female sex , and greater insulin secretion predicted regression to isolated IGT . CONCLUSIONS Insulin secretion , and other biologic processes retained with younger age , are key in restoring NGR in people with pre-diabetes . However , NGR may also be attained through weight loss and additional aspects of ILS BACKGROUND Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone . In an analysis of data from a nonr and omized , prospect i ve , controlled study , we examined the effects of bariatric surgery on the prevention of type 2 diabetes . METHODS In this analysis , we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls ( with matching performed on a group , rather than individual , level ) . None of the participants had diabetes at baseline . Patients in the bariatric-surgery cohort underwent b and ing  ( 19 % ) , vertical b and ed gastroplasty ( 69 % ) , or gastric bypass ( 12 % ) ; nonr and omized , matched , prospect i ve controls received usual care . Participants were 37 to 60 years of age , and the body-mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) was 34 or more in men and 38 or more in women . This analysis focused on the rate of incident type 2 diabetes , which was a prespecified secondary end point in the main study . At the time of this analysis ( January 1 , 2012 ) , participants had been followed for up to 15 years . Despite matching , some baseline characteristics differed significantly between the groups ; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group . At 15 years , 36.2 % of the original participants had dropped out of the study , and 30.9 % had not yet reached the time for their 15-year follow-up examination . RESULTS During the follow-up period , type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group , corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years , respectively ( adjusted hazard ratio with bariatric surgery , 0.17 ; 95 % confidence interval , 0.13 to 0.21 ; P<0.001 ) . The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose ( P=0.002 for the interaction ) but not by BMI ( P=0.54 ) . Sensitivity analyses , including end-point imputations , did not change the overall conclusions . The postoperative mortality was 0.2 % , and 2.8 % of patients who underwent bariatric surgery required reoperation within 90 days owing to complications . CONCLUSIONS Bariatric surgery appears to be markedly more efficient than usual care in the prevention of  type 2 diabetes in obese persons . ( Funded by the Swedish Research Council and others ; Clinical Trials.gov number , NCT01479452 . ) BACKGROUND Rosiglitazone is a thiazolidinedione that reduces insulin resistance and might preserve insulin secretion . The aim of this study was to assess prospect ively the drug 's ability to prevent type 2 diabetes in individuals at high risk of developing the condition . METHODS 5269 adults aged 30 years or more with impaired fasting glucose or impaired glucose tolerance , or both , and no previous cardiovascular disease were recruited from 191 sites in 21 countries and r and omly assigned to receive rosiglitazone  ( 8 mg daily ; n=2365 ) or placebo ( 2634 ) and followed for a median of 3 years . The primary outcome was a composite of incident diabetes or death . Analyses were done by intention to treat . This trial is registered at Clinical Trials.gov , number NCT00095654 . FINDINGS At the end of study , 59 individuals had dropped out from the rosiglitazone group and 46 from the placebo group . 306 ( 11.6 % ) individuals given rosiglitazone and 686 ( 26.0 % ) given placebo developed the composite primary outcome ( hazard ratio 0.40 , 95 % CI 0.35 - 0.46 ; p<0.0001 ) ; 1330 ( 50.5 % ) individuals in the rosiglitazone group and 798 ( 30.3 % ) in the placebo group became normoglycaemic ( 1.71 , 1.57 - 1.87 ; p<0.0001 ) . Cardiovascular event rates were much the same in both groups , although 14 ( 0.5 % ) participants in the rosiglitazone group and two ( 0.1 % ) in the placebo group developed heart failure ( p=0.01 ) . INTERPRETATION Rosiglitazone at 8 mg daily for 3 years substantially reduces incident type 2 diabetes and increases the likelihood of regression to normoglycaemia in adults with impaired fasting glucose or impaired glucose tolerance , or both BACKGROUND It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance . METHODS In this double-blind , r and omized clinical trial with a 2-by-2 factorial design , we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan ( up to 160 mg daily ) or placebo ( and nateglinide or placebo ) in addition to lifestyle modification . We then followed the patients for a median of 5.0 years for the development of diabetes ( 6.5 years for vital status ) . We studied the effects of valsartan on the occurrence of three co primary outcomes : the development of diabetes ; an extended composite outcome of death from cardiovascular causes , nonfatal myocardial infa rct ion , nonfatal stroke , hospitalization for heart failure , arterial revascularization , or hospitalization for unstable angina ; and a core composite outcome that excluded unstable ang 
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At meta-regression analysis , factors associated with effectiveness were weight loss , young age and fasting insulin levels .
These data indicate that several strategies , with different effectiveness , can prevent T2DM in obese subjects