***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: OBJECTIVE -Impaired endothelial function of resistance and conduit arteries can be detected in patients with type 1 diabetes . We studied whether a persistent improvement of endothelial function can be achieved by regular physical training . RESEARCH DESIGN AND METHODS -The study included 26 patients with type 1 diabetes of 20 + /- 10 years ' duration and no overt angiopathy ; 18 patients ( 42 + /- 10 years old ) participated in a  bicycle exercise training program  , and 8 patients with type 1 diabetes ( 33 + /- 11 years old ) served as control subjects .  Vascular function of conduit arteries was assessed by flow-mediated and endothelium-independent dilation of the brachial artery and of resistance vessels by the response of ocular fundus pulsation amplitudes to intravenous N(G)-monomethyl-L-arginine ( L-NMMA ) at baseline , after 2 and 4 months of training , and 8 months after cessation of regular exercise . RESULTS -Training increased peak oxygen uptake ( VO(2max ) ) by 13 % after 2 months and by 27 % after 4 months ( P = 0.04 ) . Flow-mediated dilation ( FMD ) of the brachial artery increased from 6.5 + /- 1.1 to 9.8 + /- 1.1 % ( P = 0.04 ) by training . L-NMMA administration decreased fundus pulsation amplitude ( FPA ) by 9.1 + /- 0.9 % before training and by 13.4 + /- 1.5 % after 4 months of training ( P = 0.02 ) . VO(2max ) , FMD , and FPA were unchanged in the control group . Vascular effects from training were abrogated 8 months after cessation of exercise . CONCLUSIONS -Our study demonstrates that aerobic exercise training can improve endothelial function in different vascular beds in patients with long-st and ing type 1 diabetes , who are at considerable risk for diabetic angiopathy . However , the beneficial effect on vascular function is not maintained in the absence of exercise OBJECTIVES This study aim ed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes . RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy ( FinnDiane ) study is a national multicenter prospect i ve follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals , 33 district hospitals , and 26 primary health care centers across Finl and . RESULTS During a median 7 years of follow-up , there were 291 deaths ( 7 % ) , 3.6-fold ( 95 % CI 3.2–4.0 ) more than that observed in the age- and sex-matched general population . Excess mortality was only observed in individuals with chronic kidney disease . Individuals with normoalbuminuria showed no excess mortality beyond the general population ( st and ardized mortality ratio [ SMR ] 0.8 , 95 % CI 0.5–1.1 ) , independent of the duration of diabetes . The presence of microalbuminuria , macroalbuminuria , and end-stage kidney disease was associated with 2.8 , 9.2 , and 18.3 times higher SMR , respectively . The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease . In addition , the glomerular filtration rate was independently associated with mortality , such that individuals with impaired kidney function , as well as those demonstrating hyperfiltration , had an increased risk of death . CONCLUSIONS An independent grade d association was observed between the presence and severity of kidney disease and mortality in a large contemporary cohort of individuals with type 1 diabetes . These findings highlight the clinical and public health importance of chronic kidney disease and its prevention in the management of type 1 diabetes Objective : To investigate the impact of intensive lifestyle education on dietary practice s , exercise and metabolic measurements in people with insulin-dependent diabetes mellitus ( IDDM ) . Design : Sixty-one volunteer subjects with IDDM were r and omised to intensive ( Group 1 ) or st and ard ( Group 2 ) education programmes for six months . During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice ( phase 2 ) . Current insulin regimens were modified to optimise glycaemic control before the start of the intervention phase . Nutrient intakes , weight , blood pressure , glycated haemoglobin ( HbA ) , plasma lipids , lipoproteins and maximal oxygen consumption ( VO max ) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2 . Setting : Department of Human Nutrition at the University of Otago . Results : Glycated haemoglobin decreased significantly in both groups between recruitment and r and omisation , the improvement being sustained during the six months of the r and omised trial and for group 1 during the six months of post trial observation . A further decrease was seen in Group 2 during the second six month period when they were given intensive advice . Comparable changes were seen with total and low density lipoprotein ( LDL ) cholesterol in Group 1 during the trial , but significant decreases were only seen in Group 2 in association with intensive intervention ( phase 2 ) . These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids , a reduction in intakes of total and saturated fat , and an improvement in maximum oxygen consumption . Conclusions : A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits sufficient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime . More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater beneficial changes than those observed here . Sponsorship : This study was supported by the Eli Lilly Research Grant ( Eli Lilly and Company ( New Zeal and ) Ltd ) , The Deans Research Grant ( Otago Medical School , New Zeal and ) and The New Zeal and Dietetic Association ( Abbott Award ) Physical inactivity is highly common in adults with type 1 diabetes ( T1D ) as specific barriers ( i.e. , hypoglycemia ) may prevent them from being active . The objective of this study was to examine the efficacy of the Physical Exercise Promotion program in type 1 diabetes ( PEP-1 ) program , a group program of physical activity ( PA ) promotion ( intervention ) compared with an information leaflet ( control ) , to improve total energy expenditure ( TEE ) in adults with T1D after 12 weeks . TEE was measured with a motion sensor over a 7-day period at inclusion , after the program ( 12 weeks ) and 1-year after inclusion . The 12 weekly sessions of the program included a 30-min information session ( glycemic control and PA ) and 60 min of PA .  A total of 48 adults , aged 18 to 65 years with a reported PA practice < 150 min per week , were recruited ( 45.8 % men ; aged 44.6 ± 13.3 years ; 8.0 % ± 1.1 % glycated hemoglobin ( A1c ) ) and r and omized in this pilot trial . Ninety percent of participants completed the program and 88 % completed the 1-year follow-up . No change was observed for TEE and A1c in both groups . After the 12-week program , the mean peak oxygen uptake increased ( 14 % ; p = 0.003 ) in the intervention group ; however , at the 1-year follow-up , it was no longer different from baseline . In the control group , no difference was observed for the peak oxygen uptake . These results suggest that the PEP-1 pilot program could increase cardiorespiratory fitness . However , this benefit is not sustained over a long-term period . The PEP-1 program did not increase TEE in patients with T1D and other strategies remain necessary to counteract physical inactivity in this population Summary No objective evidence has been presented to support the beneficial effect of physical training on glycaemic control in Type 1 ( insulin-dependent ) diabetic patients trained two to three times a week for several months . In the present study we examined the possibility that a daily exercise programme would be more suitable for improving glycaemic control .  Thirteen patients completed a 5-month study ; 6 were r and omized to exercise training ( 20 min daily bicycle exercise ) and 7 served as non-exercising controls .  The training result ed in an 8 % increase in maximal oxygen uptake ( p < 0.05 ) . No change in glycaemic control occurred during the study period in either group . In addition , serum lipid and lipoprotein levels were followed . Total cholesterol decreased during the study period irrespective of training . No effect was noted on the levels of LDL , VLDL , HDL and HDL2 cholesterol . A significant training effect was obtained in the HDL3 subfraction ( −10%,p < 0.05 ) . Total triglycerides were unchanged , but a decrease in the level of LDL triglycerides was observed with training ( −12%,p < 0.01 ) . It is concluded that , in female Type 1 diabetic patients  , daily physical training for several months does not improve glycaemic control and results only in minor changes in serum lipoprotein profiles BACKGROUND Intensive diabetes therapy aim ed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes . We studied whether the use of intensive therapy as compared with conventional therapy during the Diabetes Control and Complications Trial ( DCCT ) affected the long-term incidence of cardiovascular disease . METHODS The DCCT r and omly assigned 1441 patients with type 1 diabetes to intensive or conventional therapy , treating them for a mean of 6.5 years between 1983 and 1993 . Ninety-three percent were subsequently followed until February 1 , 2005 , during the observational Epidemiology of Diabetes Interventions and Complications study . Cardiovascular disease ( defined as nonfatal myocardial infa rct ion , stroke , death from cardiovascular disease , confirmed angina , or the need for coronary-artery revascularization ) was assessed with st and ardized measures and classified by an independent committee . RESULTS During the mean 17 years of follow-up , 46 cardiovascular disease events occurred in 31 patients who had received intensive treatment in the DCCT , as compared with 98 events in 52 patients who had received conventional treatment . Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent ( 95 percent confidence interval , 9 to 63 percent ; P=0.02 ) and the risk of nonfatal myocardial infa rct ion , stroke , or death from cardiovascular disease by 57 percent ( 95 percent confidence interval , 12 to 79 percent ; P=0.02 ) . The decrease in glycosylated hemoglobin values during the DCCT was significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease . Microalbuminuria and albuminuria were associated with a significant increase in the risk of cardiovascular disease , but differences between treatment groups remained significant ( P < or = 0.05 ) after adjusting for these factors . CONCLUSIONS Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes BACKGROUND Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention .  We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes . METHODS We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes , using Cox proportional-hazards models with adjustment for covariates measured at baseline and after r and omization . RESULTS During a median follow-up period of 5 years , 231 patients ( 2.1 % ) had at least one severe hypoglycemic episode ; 150 had been assigned to intensive glucose control ( 2.7 % of the 5571 patients in that group ) , and 81 had been assigned to st and ard glucose control ( 1.5 % of the 5569 patients in that group ) . The median times from the onset of severe hypoglycemia to the first major macrovascular event , the first major microvascular event , and death were 1.56 years ( interquartile range , 0.84 to 2.41 ) , 0.99 years ( interquartile range , 0.40 to 2.17 ) , and 1.05 years ( interquartile range , 0.34 to 2.41 ) , respectively . During follow-up , severe hypoglycemia was associated with a significant increase in the adjusted risks of major macrovascular events ( hazard ratio , 2.88 ; 95 % confidence interval [ CI ] , 2.01 to 4.12 ) , major microvascular events ( hazard ratio , 1.81 ; 95 % CI , 1.19 to 2.74 ) , death from a cardiovascular cause ( hazard ratio , 2.68 ; 95 % CI , 1.72 to 4.19 ) , and death from any cause ( hazard ratio , 2.69 ; 95 % 
    Output:
    
Exercise training did not lead to consistent changes in body mass index ( BMI ) , blood pressure , triglycerides , high-density lipoprotein cholesterol ( HDL-C ) , or low-density lipoprotein cholesterol ( LDL-C ) .
In persons living with T1D  , exercise training is associated with a beneficial cardiovascular profile , including improvements in lipid profile , glycemic control ( decreased daily insulin dosage and HbA1c ) , and aerobic fitness