human
***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 / AIMS This study aim ed to evaluate the efficacy of modified Roux-en-Y gastric bypass for type 2 diabetes mellitus . METHODOLOGY Forty-five type 2 diabetes mellitus patients underwent modified Roux-en-Y gastric bypass at WeiFang People 's Hospital . Data on patient demographics , fasting plasma glucose ( FPG ) , body mass index ( BMI ) , medication use , remission and hemoglobin A1c ( HbAlc ) were prospect ively collected and analyzed . RESULTS At 6 months after surgery , all of these 45 patients obtained remission or a marked improvement . FPG was in the normal range in 39 ( 86.7 % ) patients stopping medicine treatment for their diabetes . Six patients ( 13.3 % ) had an obvious reduced abnormal FPG and they only required lower drug dosage . No statistically significant differences were found between the obese or non-obese groups ( p=0.311 ) . The mean BMI dropped from 28.9±3.0 kg/m2 to 27.4±2.8 kg/m2 ( p=0.000 ) at the third month and 26.3±2.5 kg/m2 ( p=0.000 ) at the sixth month . HbAlc decreased from their preoperative values of 7.4%±2.2 % to 6.3%±1.5 % ( p=0.000 ) at the third month and 5.1%±0.9 % ( p=0.000 ) at the sixth month . CONCLUSIONS Modified Roux-en-Y gastric bypass was effective in treating  type 2 diabetes mellitus , independent of body mass index OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review OBJECTIVE To examine the effect of a large , long st and ing and intentional weight reduction on the incidence of diabetes , hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls . RESEARCH METHODS AND PROCEDURES The ongoing prospect i ve SOS ( Swedish Obese Subjects ) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment . This report is based on 845 surgically treated patients and 845 controls ( BMI 41.0+/-4.6 kg/m2 ( mean+/-st and ard deviation [ S ] ) ) followed for 2 years . RESULTS Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg ( p<0.0001 ) . Two-year incidence of hypertension , diabetes , hyperinsulinemia , and lipid disturbances was compared in the two treatment groups . Adjusted odds ratios ( 95 % CI ) for the surgically treated group versus controls were 0.38 ( 0.22 , 0.65 ) for hypertension , 0.02 ( 0.00 , 0.16 ) for diabetes , 0.10 ( 0.03 , 0.28 ) for hyperinsulinemia , 0 . 10 ( 0.04 , 0.25 ) for hypertriglyceridemia , 0.28 ( 0.16 , 0.49 ) for low HDL-cholesterol and 1.24 ( 0.84 , 1.8 ) for hypercholesterolemia . Compared to controls , the 2-year recovery rates from hypertension , diabetes , hypo-HDL , and hypertriglyceridemia were significantly higher in the surgically treated group . DISCUSSION Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension , diabetes and some lipid disturbances . The results suggest that severe obesity can and should be treated BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) Background Most morbidly obese patients who undergo gastric bypass  experience rapid remission of type 2 diabetes mellitus ( T2DM ) but the response in non-morbidly obese patients is not clear . This trial prospect ively assessed the effect of diabetes remission , glucose metabolism , and the serial changes of insulin secretion after gastric bypass in inadequately controlled T2DM patients with a BMI of 23–35 kg/m2 . Methods A total of 62 consecutive patients with T2DM and a BMI of 23–35 kg/m2 underwent gastric bypass .  Data were prospect ively collected before surgery and 1 , 4 , 12 , 26 , and 52 weeks and 2 years after surgery . Insulin secretion was measured by insulinogenic index and area under the curve ( AUC ) during a st and ard oral glucose tolerance test ( OGTT ) . Remission of type 2 diabetes was defined as fasting glucose level < 110 mg/dl and HbA1c < 6.0 % without any glycemic therapy . Results Of the 62 patients , 24 were men and 38 were women ( age 43.1 ± 10.8 years ) . Their preoperative characteristics were as follows : BMI 30.1 ± 3.3 kg/m2 , waist circumference 99.6 ± 9.6 cm , C-peptide 3.1 ± 1.4 ng/ml , and duration of T2DM 5.4 ± 5.1 years . The mean BMI decreased postoperatively to 22.6 ± 2.3 kg/m2 in 1 year and 23.0 ± 2.7 kg/m2 in 2 years . The mean HbA1c decreased from 9.7 ± 1.9 % to 5.8 ± 0.5 % in 1 year and 5.9 ± 0.5 % in 2 years . Complete remission of T2DM was achieved in 57 % in 1 year and 55 % in 2 years after surgery . Before surgery , the OGTT test showed a blunted insulin secretion pattern with an insulinogenic index of 0.1 ± 0.2 and AUC 
    Output:
    
agent
In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
***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 / AIMS This study aim ed to evaluate the efficacy of modified Roux-en-Y gastric bypass for type 2 diabetes mellitus . METHODOLOGY Forty-five type 2 diabetes mellitus patients underwent modified Roux-en-Y gastric bypass at WeiFang People 's Hospital . Data on patient demographics , fasting plasma glucose ( FPG ) , body mass index ( BMI ) , medication use , remission and hemoglobin A1c ( HbAlc ) were prospect ively collected and analyzed . RESULTS At 6 months after surgery , all of these 45 patients obtained remission or a marked improvement . FPG was in the normal range in 39 ( 86.7 % ) patients stopping medicine treatment for their diabetes . Six patients ( 13.3 % ) had an obvious reduced abnormal FPG and they only required lower drug dosage . No statistically significant differences were found between the obese or non-obese groups ( p=0.311 ) . The mean BMI dropped from 28.9±3.0 kg/m2 to 27.4±2.8 kg/m2 ( p=0.000 ) at the third month and 26.3±2.5 kg/m2 ( p=0.000 ) at the sixth month . HbAlc decreased from their preoperative values of 7.4%±2.2 % to 6.3%±1.5 % ( p=0.000 ) at the third month and 5.1%±0.9 % ( p=0.000 ) at the sixth month . CONCLUSIONS Modified Roux-en-Y gastric bypass was effective in treating  type 2 diabetes mellitus , independent of body mass index OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review OBJECTIVE To examine the effect of a large , long st and ing and intentional weight reduction on the incidence of diabetes , hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls . RESEARCH METHODS AND PROCEDURES The ongoing prospect i ve SOS ( Swedish Obese Subjects ) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment . This report is based on 845 surgically treated patients and 845 controls ( BMI 41.0+/-4.6 kg/m2 ( mean+/-st and ard deviation [ S ] ) ) followed for 2 years . RESULTS Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg ( p<0.0001 ) . Two-year incidence of hypertension , diabetes , hyperinsulinemia , and lipid disturbances was compared in the two treatment groups . Adjusted odds ratios ( 95 % CI ) for the surgically treated group versus controls were 0.38 ( 0.22 , 0.65 ) for hypertension , 0.02 ( 0.00 , 0.16 ) for diabetes , 0.10 ( 0.03 , 0.28 ) for hyperinsulinemia , 0 . 10 ( 0.04 , 0.25 ) for hypertriglyceridemia , 0.28 ( 0.16 , 0.49 ) for low HDL-cholesterol and 1.24 ( 0.84 , 1.8 ) for hypercholesterolemia . Compared to controls , the 2-year recovery rates from hypertension , diabetes , hypo-HDL , and hypertriglyceridemia were significantly higher in the surgically treated group . DISCUSSION Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension , diabetes and some lipid disturbances . The results suggest that severe obesity can and should be treated BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) Background Most morbidly obese patients who undergo gastric bypass  experience rapid remission of type 2 diabetes mellitus ( T2DM ) but the response in non-morbidly obese patients is not clear . This trial prospect ively assessed the effect of diabetes remission , glucose metabolism , and the serial changes of insulin secretion after gastric bypass in inadequately controlled T2DM patients with a BMI of 23–35 kg/m2 . Methods A total of 62 consecutive patients with T2DM and a BMI of 23–35 kg/m2 underwent gastric bypass .  Data were prospect ively collected before surgery and 1 , 4 , 12 , 26 , and 52 weeks and 2 years after surgery . Insulin secretion was measured by insulinogenic index and area under the curve ( AUC ) during a st and ard oral glucose tolerance test ( OGTT ) . Remission of type 2 diabetes was defined as fasting glucose level < 110 mg/dl and HbA1c < 6.0 % without any glycemic therapy . Results Of the 62 patients , 24 were men and 38 were women ( age 43.1 ± 10.8 years ) . Their preoperative characteristics were as follows : BMI 30.1 ± 3.3 kg/m2 , waist circumference 99.6 ± 9.6 cm , C-peptide 3.1 ± 1.4 ng/ml , and duration of T2DM 5.4 ± 5.1 years . The mean BMI decreased postoperatively to 22.6 ± 2.3 kg/m2 in 1 year and 23.0 ± 2.7 kg/m2 in 2 years . The mean HbA1c decreased from 9.7 ± 1.9 % to 5.8 ± 0.5 % in 1 year and 5.9 ± 0.5 % in 2 years . Complete remission of T2DM was achieved in 57 % in 1 year and 55 % in 2 years after surgery . Before surgery , the OGTT test showed a blunted insulin secretion pattern with an insulinogenic index of 0.1 ± 0.2 and AUC 
    Output:
    