***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: CONTEXT The worldwide explosive increase in type 2 diabetes mellitus and its cardiovascular morbidity are becoming major health concerns . OBJECTIVE To evaluate the effect of decreasing postpr and ial hyperglycemia with acarbose , an alpha-glucosidase inhibitor , on the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance ( IGT ) . DESIGN , SETTING , AND PARTICIPANTS International , multicenter double-blind , placebo-controlled , r and omized trial , undertaken in hospitals in Canada , Germany , Austria , Norway , Denmark , Sweden , Finl and , Israel , and Spain from July 1998 through August 2001 . A total of 1429 patients with IGT were r and omized with 61 patients ( 4 % ) excluded because they did not have IGT or had no postr and omization data , leaving 1368 patients for a modified intent-to-treat analysis . Both men ( 49 % ) and women ( 51 % ) participated with a mean ( SD ) age of 54.5 ( 7.9 ) years and body mass index of 30.9 ( 4.2 ) . These patients were followed up for a mean ( SD ) of 3.3 ( 1.2 ) years . INTERVENTION Patients with IGT were r and omized to receive either placebo ( n = 715 ) or 100 mg of acarbose 3 times a day ( n = 714 ) . MAIN OUTCOME MEASURES The development of major cardiovascular events ( coronary heart disease , cardiovascular death , congestive heart failure , cerebrovascular event , and peripheral vascular disease ) and hypertension ( > or = 140/90 mm Hg ) . RESULTS Three hundred forty-one patients ( 24 % ) discontinued their participation prematurely , 211 in the acarbose-treated group and 130 in the placebo group ; these patients were also followed up for outcome parameters . Decreasing postpr and ial hyperglycemia with acarbose was associated with a 49 % relative risk reduction in the development of cardiovascular events ( hazard ratio [ HR ] , 0.51 ; 95 % confidence interval [ CI ] ; 0.28 - 0.95 ; P = .03 ) and a 2.5 % absolute risk reduction . Among cardiovascular events , the major reduction was in the risk of myocardial infa rct ion ( HR , 0.09 ; 95 % CI , 0.01 - 0.72 ; P = .02 ) . Acarbose was also associated with a 34 % relative risk reduction in the incidence of new cases of hypertension ( HR , 0.66 ; 95 % CI , 0.49 - 0.89 ; P = .006 ) and a 5.3 % absolute risk reduction . Even after adjusting for major risk factors , the reduction in the risk of cardiovascular events ( HR , 0.47 ; 95 % CI , 0.24 - 0.90 ; P = .02 ) and hypertension ( HR , 0.62 ; 95 % CI , 0.45 - 0.86 ; P = .004 ) associated with acarbose treatment was still statistically significant . CONCLUSION This study suggests that treating IGT patients with acarbose is associated with a significant reduction in the risk of cardiovascular disease and hypertension BACKGROUND Improved blood-glucose control decreases the progression of diabetic microvascular disease , but the effect on macrovascular complications is unknown . There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation . We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a r and omised controlled trial . METHODS 3867 newly diagnosed patients with type 2 diabetes , median age 54 years ( IQR 48 - 60 years ) , who after 3 months ' diet treatment had a mean of two fasting plasma glucose ( FPG ) concentrations of 6.1 - 15.0 mmol/L were r and omly assigned intensive policy with a sulphonylurea ( chlorpropamide , glibenclamide , or glipizide ) or with insulin , or conventional policy with diet . The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group , the aim was the best achievable FPG with diet alone ; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment :  any diabetes-related endpoint ( sudden death , death from hyperglycaemia or hypoglycaemia , fatal or non-fatal myocardial infa rct ion , angina , heart failure , stroke , renal failure , amputation [ of at least one digit ] , vitreous haemorrhage , retinopathy requiring photocoagulation , blindness in one eye , or cataract extraction ) ; diabetes-related death ( death from myocardial infa rct ion , stroke , peripheral vascular disease , renal disease , hyperglycaemia or hypoglycaemia , and sudden death ) ; all-cause mortality . Single clinical endpoints and surrogate sub clinical endpoints were also assessed . All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy . FINDINGS Over 10 years , haemoglobin A1c ( HbA1c ) was 7.0 % ( 6.2 - 8.2 ) in the intensive group compared with 7.9 % ( 6.9 - 8.8 ) in the conventional group -- an 11 % reduction . There was no difference in HbA1c among agents in the intensive group . Compared with the conventional group , the risk in the intensive group was 12 % lower ( 95 % CI 1 - 21 , p=0.029 ) for any diabetes-related endpoint ; 10 % lower ( -11 to 27 , p=0.34 ) for any diabetes-related death ; and 6 % lower ( -10 to 20 , p=0.44 ) for all-cause mortality . Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25 % risk reduction ( 7 - 40 , p=0.0099 ) in microvascular endpoints , including the need for retinal photocoagulation . There was no difference for any of the three aggregate endpoints between the three intensive agents ( chlorpropamide , glibenclamide , or insulin ) . Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis ( both p<0.0001 ) . The rates of major hypoglycaemic episodes per year were 0.7 % with conventional treatment , 1.0 % with chlorpropamide , 1.4 % with glibenclamide , and 1.8 % with insulin .  Weight gain was significantly higher in the intensive group ( mean 2.9 kg ) than in the conventional group ( p<0.001 ) , and patients assigned insulin had a greater gain in weight ( 4.0 kg ) than those assigned chlorpropamide ( 2.6 kg ) or glibenclamide ( 1.7 kg ) . INTERPRETATION Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications , but not macrovascular disease , in patients with type 2 diabetes . ( ABSTRACT TRUNCATED Background —Postpr and ial hyperglycemia may be a risk factor for cardiovascular disease . We compared the effects of two insulin secretagogues , repaglinide and glyburide , known to have different efficacy on postpr and ial hyperglycemia , on carotid intima-media thickness ( CIMT ) and markers of systemic vascular inflammation in type 2 diabetic patients . Methods and Results —We performed a r and omized , single-blind trial on 175 drug-naive patients with type 2 diabetes mellitus ( 93 men and 82 women ) , 35 to 70 years of age , selected from a population of 401 patients who participated in an epidemiological analysis assessing the relation of postpr and ial hyperglycemia to surrogate measures of atherosclerosis . Eighty-eight patients were r and omly assigned to receive repaglinide and 87 patients to glyburide , with a titration period of 6 to 8 weeks for optimization of drug dosage and a subsequent 12-month treatment period . The effects of repaglinide ( 1.5 to 12 mg/d ) and glyburide ( 5 to 20 mg/d ) on CIMT were compared by using blinded , serial assessment s of the far wall . After 12 months , postpr and ial glucose peak was 148±28 mg/dL in the repaglinide group and 180±32 mg/dL in the glyburide group ( P < 0.01 ) . HbA1c showed a similar decrease in both groups ( −0.9 % ) . CIMT regression , defined as a decrease of > 0.020 mm , was observed in 52 % of diabetics receiving repaglinide and in 18 % of those receiving glyburide ( P < 0.01 ) . Interleukin-6 ( P = 0.04 ) and C-reactive protein ( P = 0.02 ) decreased more in the repaglinide group than in the glyburide group . The reduction in CIMT was associated with changes in postpr and ial but not fasting hyperglycemia . Conclusions —Reduction of postpr and ial hyperglycemia in type 2 diabetic patients is associated with CIMT regression BACKGROUND New diagnostic criteria for diabetes based on fasting blood glucose ( FBG ) level were approved by the American Diabetes Association . The impact of using FBG only has not been evaluated thoroughly . The fasting and the 2-hour glucose ( 2h-BG ) criteria were compared with regard to the prediction of mortality . METHODS Existing baseline data on glucose level at fasting and 2 hours after a 75-g oral glucose tolerance test from 10 prospect i ve European cohort studies including 15 388 men and 7126 women aged 30 to 89 years , with a median follow-up of 8.8 years , were analyzed . Hazards ratios for death from all causes , cardiovascular disease , coronary heart disease , and stroke were estimated . RESULTS Multivariate Cox regression analyses showed that the inclusion of FBG did not add significant information on the prediction of 2h-BG alone ( P>.10 for various causes ) , whereas the addition of 2h-BG to FBG criteria significantly improved the prediction ( P<.001 for all causes and P<.005 for cardiovascular disease ) . In a model including FBG and 2h-BG simultaneously , hazards ratios ( 95 % confidence intervals ) in subjects with diabetes on 2h-BG were 1.73 ( 1.45 - 2.06 ) for all causes , 1.40 ( 1.02 - 1.92 ) for cardiovascular disease , 1.56 ( 1.03 - 2.36 ) for coronary heart disease , and 1.29 ( 0.66 - 2.54 ) for stroke mortality , compared with the normal 2h-BG group . Compared with the normal FBG group , the corresponding hazards ratios in subjects with diabetes on FBG were 1.21 ( 1.01 - 1.44 ) , 1.20 ( 0.88 - 1.64 ) , 1.09 ( 0.71 - 1.67 ) , and 1.64 ( 0.88 - 3.07 ) , respectively . The largest number of excess deaths was observed in subjects who had impaired glucose tolerance but normal FBG levels . CONCLUSION The 2h-BG is a better predictor of deaths from all causes and cardiovascular disease than is FBG Summary The Diabetes Intervention Study ( DIS ) is a prospect i ve population -based multicentre trial of newly detected cases of non-insulin-dependent diabetes mellitus ( NIDDM ) . This report analyses the risk factors for subsequent coronary heart disease and all-cause death during the 11-year follow-up . The prognostic significance of the categories of the NIDDM Policy Group was vali date d with respect to the incidence of coronary heart disease and mortality . At baseline 1139 subjects , aged 30–55 years at the time of diabetes detection and classified as diet controlled after a 6-week screening phase , were included . Of the patients 112 ( 15.2 % ) suffered from myocardial infa rct ion , 197 ( 19.82 % ) of 994 had died . The odds ratio for all-cause mortality compared to the general population for males at the age of 36–45 years was 5.1 and for females 7.0 . In multivariate analysis age , blood pressure and smoking were independent risk factors for myocardial infa rct ion and male sex , age , blood pressure , triglycerides , postpr and ial blood glucose and smoking for death , respectively . The categories of the NIDDM Policy Group target parameters for blood glucose , triglycerides and blood pressure were significant predictors of both CHD and death . Thus , it appears 
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Despite this , the few available studies show that higher PPG is associated with increased all-cause and cardiovascular death , incidence of major cardiovascular events ( including myocardial infa rct ion and stroke ) , and progression of diabetic retinopathy