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: Existing st and ards of the management of the diabetic patients are not efficient enough , and further improvement is needed . The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system design ed and applied for intensive treatment of pregnant type 1 diabetic women . The developed system operates automatically , every night transferring all the data recorded during the day in the patient 's glucometer memory to a central clinical unit . In order to assess the efficiency of the design ed and developed system , a 3-year r and omized prospect i ve clinical trial was conducted , using the study group and the control group , each consisting of 15 pregnant type 1 diabetic women . All patients were treated by the same diabetologist . In the presented analysis , two indices calculated weekly were used for the assessment of glycemic control : MBG represents mean blood glucose level , and the universal J-index is sensitive to the glycemic level and glycemic variations . The most important results from the study concern : ( a ) better glycemic control in the study group in comparison with the control group during the course of treatment , as assessed by the average differences of the MBG and J indices calculated weekly ( n = 24 ) ( deltaMBG = -3.2 + /- 4.3 mg/dL , p = 0.0016 , deltaJ = -1.4 + /- 2.3 , p = 0.0065 ) ; ( b ) much more similar results in glycemic control among members of the study group compared to each other , than among members of the control group compared to each other , as indicated by significantly lower variations of the applied glycemic control indices ( SDMBG : 11.9 vs. 18.7 mg/dL , p = 0.0498 ; SDJ : 6.5 vs. 10.9 , p = 0.0318 ) ; ( c ) the observed tendency of a better glycemic control for patients with a lower level of intelligence ( IQ < 100 ) supported by the telematic system in comparison with all other assessed groups of patients . The last result was not statistically significant ( p > 0.05 ) . This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy . It also allows the diabetologist 's strategy to be much more precise than if it were conducted without telematic support . This telematic system is inexpensive and simple in use BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life Objective . To evaluate the feasibility of a telemedicine system based on Internet and a short message service in pregnancy and its influence on delivery and neonatal outcomes of women with gestational diabetes mellitus ( GDM ) . Methods . 100 women diagnosed of GDM were r and omized into two parallel groups , a control group based on traditional face-to-face outpatient clinic visits and an intervention group , which was provided with a Telemedicine system for the transmission of capillary glucose data and short text messages with weekly professional feedback .  97 women completed the study ( 48/49 , resp . ) . Main Outcomes Measured . The percentage of women achieving HbA1c values < 5.8 % , normal vaginal delivery and having a large for-gestational-age newborn were evaluated . Results . Despite a significant reduction in outpatient clinic visits in the experimental group , particularly in insulin-treated women ( 2.4 versus 4.6 hours per insulin-treated woman resp . ; P < .001 ) , no significant differences were found between the experimental and traditional groups regarding HbA1c levels ( all women had HbA1c < 5.8 % during pregnancy ) , normal vaginal delivery ( 40.8 % versus 54.2 % , resp . ; P > .05 ) and large-for-gestational-age newborns ( 6.1 % versus 8.3 % , resp . ; P > .05 ) . Conclusions . The system significantly reduces the need for outpatient clinic visits and achieves similar pregnancy , delivery , and newborn outcomes Introduction The prevalence of gestational diabetes mellitus ( GDM ) is rising in the UK . Good glycaemic control improves maternal and neonatal outcomes . Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course . Novel technologies that allow home blood glucose ( BG ) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good- quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation . We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control , costs , patient satisfaction and maternal and neonatal outcomes compared to st and ard clinic care in a single large publicly funded ( National Health Service ( NHS ) ) maternity unit . Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually r and omised to either the GDm-health system and half the normal clinic visits or normal clinic care . Primary outcome is mean BG in each group from recruitment to delivery calculated , with adjustments made for number of BG measurements , proportion of prepr and ial and postpr and ial readings and length of time in study , and compared between the groups . The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime , maternal and neonatal outcomes , glycaemic control using glycated haemoglobin ( HbA1c ) and other BG metrics , and patient attitudes to care assessed using a question naire and re source use . Ethics and dissemination Thresholds for treatment , dietary advice and clinical management are the same in both groups . The results of the study will be published in a peer- review ed journal and disseminated electronically and in print . Trial registration number NCT01916694 ; Pre- results BACKGROUND Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions . The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus ( GDM ) over the Internet . METHODS Women with GDM were r and omized to either the Internet group ( n = 32 ) or the control group ( n = 25 ) . Patients in the Internet group were provided with computers and /or Internet access if needed . A website was established for documentation of glucose values and communication between the patient and the health care team . Women in the control group maintained paper logbooks , which were review ed at each prenatal visit . Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery . RESULTS Women in the Internet group accessed the system and sent on average 21.8 ( + /- 16.9 ) sets of data . There was no difference between the two groups in regards either fasting or post-pr and ial blood glucose values , although more women in the Internet group received insulin therapy ( 31 % vs. 4 % ; P < 0.05 ) . There were also no significant differences in pregnancy and neonatal outcomes between the two groups . Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study 's end . CONCLUSIONS The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system . Although system use was not associated with improved pregnancy outcomes , women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy Background : The increase in gestational diabetes mellitus ( GDM ) is challenging maternity services . We have developed an interactive , smartphone-based , remote blood glucose ( BG ) monitoring system , GDm-health . Aims : The objective was to determine women ’s satisfaction with using the GDm-health system and their attitudes toward their diabetes care . Methods : In a service development program involving 52 pregnant women ( September 2012 to June 2013 ) , BG was monitored using GDm-health from diagnosis until delivery . Following birth , women completed a structured question naire assessing ( 1 ) general satisfaction , ( 2 ) equipment issues , and ( 3 ) relationship with the diabetes care team . Responses were scored on a 7-point Likert-type scale . Reliability and validity of the question naire were assessed using statistical methods . Results : Of 52 women , 49 completed the question naire ; 32 had glucose tolerance test confirmed GDM ( gestation at recruitment 29 ± 4 weeks ( mean ± SD ) , and 17 women previous GDM recommended for BG monitoring ( 18 ± 6 weeks ) . In all , 45 of 49 women agreed their care was satisfactory and the best for them , 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively , 42 of 49 agreed GDm-health fitted into their lifestyle , and 46 of 49 agreed they had a good relationship with their care team . Written comments supported these findings , with very positive reactions from the majority of women . Cronbach ’s alpha was .89 with factor analysis corresponding with question thematic trends . Conclusions : This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women . Effects on clinical and economic outcomes are currently under investigation in a r and omized trial ( clinical trials.gov NCT01916694 ) BACKGROUND Health information technology has been proven to be a successful tool for the management of patients with multiple medical conditions . The purpose of this study was to examine the impact of an enhanced telemedicine system on glucose control and pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . SUBJECTS AND METHODS We used an Internet-based telemedicine system to also allow interactive voice response phone communication between patients and providers and to provide automated reminders to transmit data . Women with GDM were r and omized to either the telemedicine group ( n=40 ) or the control group ( n=40 ) and asked to monitor their blood glucose levels four times a day . Women in the intervention group transmitted those values via the telemedicine system , whereas women in the control group maintained paper logbooks , which were review ed at prenatal visits . Primary outcomes were infant birth weight and maternal glucose control . Data collection included blood glucose records , transmission rates for the intervention group , and chart review . RESULTS There were no significant differences between the two groups ( telemedicine vs. controls ) in regard to maternal blood glucose values or infant birth weight . However , adding telephone access and reminders increased transmission rates of data in the intervention group compared with the intervention group in our previous study ( 35.6±32.3 sets of data vs.17.4±16.9 sets of data ; P<0.01 ) . CONCLUSIONS Our enhanced telemedicine monitoring system increased system utilization and contact between women with GDM and their healthcare providers but did not impact upon pregnancy outcomes Good diabetic control requires that treatment be continuously adapted to the patient behavior . We investigated whether the use of telemedicine could present an advantage to the management of the diabetic woman during pregnancy . A system completely automatic ( DIANET system ) was used . Twenty IDDM women participated in the study : 10 treated by telemedicine and 10 by conventional system , at times " entry " ( 9.5 weeks ) , " basal " ( 9.5 - 16.8 weeks ) , " 1st month " of investigation , and " end " ( near delivery ) . All women used intensified protocol s of insulin administration . The treatment with DIANET vs conventional showed a better metabolic control as estimated by profile of blood glucose absolute values ( at time " end " : values significantly lower before breakfast : 
    Output:
    
agent
***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: Existing st and ards of the management of the diabetic patients are not efficient enough , and further improvement is needed . The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system design ed and applied for intensive treatment of pregnant type 1 diabetic women . The developed system operates automatically , every night transferring all the data recorded during the day in the patient 's glucometer memory to a central clinical unit . In order to assess the efficiency of the design ed and developed system , a 3-year r and omized prospect i ve clinical trial was conducted , using the study group and the control group , each consisting of 15 pregnant type 1 diabetic women . All patients were treated by the same diabetologist . In the presented analysis , two indices calculated weekly were used for the assessment of glycemic control : MBG represents mean blood glucose level , and the universal J-index is sensitive to the glycemic level and glycemic variations . The most important results from the study concern : ( a ) better glycemic control in the study group in comparison with the control group during the course of treatment , as assessed by the average differences of the MBG and J indices calculated weekly ( n = 24 ) ( deltaMBG = -3.2 + /- 4.3 mg/dL , p = 0.0016 , deltaJ = -1.4 + /- 2.3 , p = 0.0065 ) ; ( b ) much more similar results in glycemic control among members of the study group compared to each other , than among members of the control group compared to each other , as indicated by significantly lower variations of the applied glycemic control indices ( SDMBG : 11.9 vs. 18.7 mg/dL , p = 0.0498 ; SDJ : 6.5 vs. 10.9 , p = 0.0318 ) ; ( c ) the observed tendency of a better glycemic control for patients with a lower level of intelligence ( IQ < 100 ) supported by the telematic system in comparison with all other assessed groups of patients . The last result was not statistically significant ( p > 0.05 ) . This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy . It also allows the diabetologist 's strategy to be much more precise than if it were conducted without telematic support . This telematic system is inexpensive and simple in use BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life Objective . To evaluate the feasibility of a telemedicine system based on Internet and a short message service in pregnancy and its influence on delivery and neonatal outcomes of women with gestational diabetes mellitus ( GDM ) . Methods . 100 women diagnosed of GDM were r and omized into two parallel groups , a control group based on traditional face-to-face outpatient clinic visits and an intervention group , which was provided with a Telemedicine system for the transmission of capillary glucose data and short text messages with weekly professional feedback .  97 women completed the study ( 48/49 , resp . ) . Main Outcomes Measured . The percentage of women achieving HbA1c values < 5.8 % , normal vaginal delivery and having a large for-gestational-age newborn were evaluated . Results . Despite a significant reduction in outpatient clinic visits in the experimental group , particularly in insulin-treated women ( 2.4 versus 4.6 hours per insulin-treated woman resp . ; P < .001 ) , no significant differences were found between the experimental and traditional groups regarding HbA1c levels ( all women had HbA1c < 5.8 % during pregnancy ) , normal vaginal delivery ( 40.8 % versus 54.2 % , resp . ; P > .05 ) and large-for-gestational-age newborns ( 6.1 % versus 8.3 % , resp . ; P > .05 ) . Conclusions . The system significantly reduces the need for outpatient clinic visits and achieves similar pregnancy , delivery , and newborn outcomes Introduction The prevalence of gestational diabetes mellitus ( GDM ) is rising in the UK . Good glycaemic control improves maternal and neonatal outcomes . Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course . Novel technologies that allow home blood glucose ( BG ) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good- quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation . We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control , costs , patient satisfaction and maternal and neonatal outcomes compared to st and ard clinic care in a single large publicly funded ( National Health Service ( NHS ) ) maternity unit . Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually r and omised to either the GDm-health system and half the normal clinic visits or normal clinic care . Primary outcome is mean BG in each group from recruitment to delivery calculated , with adjustments made for number of BG measurements , proportion of prepr and ial and postpr and ial readings and length of time in study , and compared between the groups . The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime , maternal and neonatal outcomes , glycaemic control using glycated haemoglobin ( HbA1c ) and other BG metrics , and patient attitudes to care assessed using a question naire and re source use . Ethics and dissemination Thresholds for treatment , dietary advice and clinical management are the same in both groups . The results of the study will be published in a peer- review ed journal and disseminated electronically and in print . Trial registration number NCT01916694 ; Pre- results BACKGROUND Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions . The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus ( GDM ) over the Internet . METHODS Women with GDM were r and omized to either the Internet group ( n = 32 ) or the control group ( n = 25 ) . Patients in the Internet group were provided with computers and /or Internet access if needed . A website was established for documentation of glucose values and communication between the patient and the health care team . Women in the control group maintained paper logbooks , which were review ed at each prenatal visit . Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery . RESULTS Women in the Internet group accessed the system and sent on average 21.8 ( + /- 16.9 ) sets of data . There was no difference between the two groups in regards either fasting or post-pr and ial blood glucose values , although more women in the Internet group received insulin therapy ( 31 % vs. 4 % ; P < 0.05 ) . There were also no significant differences in pregnancy and neonatal outcomes between the two groups . Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study 's end . CONCLUSIONS The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system . Although system use was not associated with improved pregnancy outcomes , women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy Background : The increase in gestational diabetes mellitus ( GDM ) is challenging maternity services . We have developed an interactive , smartphone-based , remote blood glucose ( BG ) monitoring system , GDm-health . Aims : The objective was to determine women ’s satisfaction with using the GDm-health system and their attitudes toward their diabetes care . Methods : In a service development program involving 52 pregnant women ( September 2012 to June 2013 ) , BG was monitored using GDm-health from diagnosis until delivery . Following birth , women completed a structured question naire assessing ( 1 ) general satisfaction , ( 2 ) equipment issues , and ( 3 ) relationship with the diabetes care team . Responses were scored on a 7-point Likert-type scale . Reliability and validity of the question naire were assessed using statistical methods . Results : Of 52 women , 49 completed the question naire ; 32 had glucose tolerance test confirmed GDM ( gestation at recruitment 29 ± 4 weeks ( mean ± SD ) , and 17 women previous GDM recommended for BG monitoring ( 18 ± 6 weeks ) . In all , 45 of 49 women agreed their care was satisfactory and the best for them , 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively , 42 of 49 agreed GDm-health fitted into their lifestyle , and 46 of 49 agreed they had a good relationship with their care team . Written comments supported these findings , with very positive reactions from the majority of women . Cronbach ’s alpha was .89 with factor analysis corresponding with question thematic trends . Conclusions : This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women . Effects on clinical and economic outcomes are currently under investigation in a r and omized trial ( clinical trials.gov NCT01916694 ) BACKGROUND Health information technology has been proven to be a successful tool for the management of patients with multiple medical conditions . The purpose of this study was to examine the impact of an enhanced telemedicine system on glucose control and pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . SUBJECTS AND METHODS We used an Internet-based telemedicine system to also allow interactive voice response phone communication between patients and providers and to provide automated reminders to transmit data . Women with GDM were r and omized to either the telemedicine group ( n=40 ) or the control group ( n=40 ) and asked to monitor their blood glucose levels four times a day . Women in the intervention group transmitted those values via the telemedicine system , whereas women in the control group maintained paper logbooks , which were review ed at prenatal visits . Primary outcomes were infant birth weight and maternal glucose control . Data collection included blood glucose records , transmission rates for the intervention group , and chart review . RESULTS There were no significant differences between the two groups ( telemedicine vs. controls ) in regard to maternal blood glucose values or infant birth weight . However , adding telephone access and reminders increased transmission rates of data in the intervention group compared with the intervention group in our previous study ( 35.6±32.3 sets of data vs.17.4±16.9 sets of data ; P<0.01 ) . CONCLUSIONS Our enhanced telemedicine monitoring system increased system utilization and contact between women with GDM and their healthcare providers but did not impact upon pregnancy outcomes Good diabetic control requires that treatment be continuously adapted to the patient behavior . We investigated whether the use of telemedicine could present an advantage to the management of the diabetic woman during pregnancy . A system completely automatic ( DIANET system ) was used . Twenty IDDM women participated in the study : 10 treated by telemedicine and 10 by conventional system , at times " entry " ( 9.5 weeks ) , " basal " ( 9.5 - 16.8 weeks ) , " 1st month " of investigation , and " end " ( near delivery ) . All women used intensified protocol s of insulin administration . The treatment with DIANET vs conventional showed a better metabolic control as estimated by profile of blood glucose absolute values ( at time " end " : values significantly lower before breakfast : 
    Output:
    