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: The aim of this study was to determine whether amniotic fluid insulin concentration ( AFI ) is a better parameter than mean maternal blood glucose values ( MBG ) for deciding about insulin therapy in patients with gestational diabetes . MBG 's were calculated on the base of 9 blood glucose levels during a 24 hour period after one week of diet therapy . In a prospect i ve trial between 1987 and 1989 in Karlsburg , 123 gestational diabetic patients were r and omized into two groups . Treatment was either based on the concentration of AFI or MBG levels . In a second series in Berlin , 103 patients were offered amniocentesis . 81 patients agreed and 22 refused . Treatment was then analogous to that in Karlsburg . In both groups of the r and omized population , strict metabolic control was achieved . There was no difference regarding pregnancy complications . Earlier labor induction and higher cesarean section rates were seen in the non-invasive group ( p < 0.05 ) . The incidence of diabetic fetopathy and neonatal hypoglycemia was significantly lower in the invasive group ( p < 0.01 ) , even though the metabolic control parameters did not differ between the two groups . The results in Berlin correspond to these findings . In conclusion , AFI enables the recognition of any hyperinsulinism reaction to the maternal metabolic situation . We recommend the additional measurement of the AFI concentration between 28 and 36 weeks as the direct fetal parameter for deciding about insulin treatment The high prevalence of diabetes and impaired glucose tolerance in women of childbearing age in Mauritius provides an opportunity to assess prospect ively the risks of adverse outcome in pregnancy of these conditions , whether the conditions are known to be present at conception or diagnosed during pregnancy.1 The findings are likely to have consequences for healthcare planning in developing countries . View this table : Outcome of pregnancy in Mauritius , 1993 - 6 , according to diagnostic category of glucose intolerance . Values are number ( percentage ) unless otherwise indicated The study hospital ( catchment population 250 000 ; 4500 deliveries a year ) accounts for 22 % of deliveries of babies in Mauritius , hospital deliveries being 80 % of all deliveries on the isl and .1 Cases were registered in 1993–6 at a joint obstetric and medical service for diabetes , and were also found by monitoring admissions to the obstetric wards , and by monitoring all requests for  obstetric oral glucose tolerance tests . Data were collected from the mother and from hospital and national records . Diabetes and impaired glucose OBJECTIVES The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia , birth trauma , neonatal hypoglycemia , and operative delivery . The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study , by determining realistic accrual rates , and by detecting any major adverse outcomes in the control group that received routine obstetric care . STUDY DESIGN The study was a prospect i ve r and omized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes . Women r and omized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care , and women in the control arm received routine obstetric care . RESULTS Three hundred women with gestational diabetes mellitus were studied . There was no difference in maternal age , weight , or length of gestation between groups . The treatment mean birth weight was 3437 + /- 575 gm compared with 3544 + /- 601 gm in the control group , a difference of 107 gm ( not significant ) . Macrosomia rates were similar . There was no birth trauma in either group . The frequency of neonatal hypoglycemia and other metabolic complications was the same . The mode of delivery also showed similar patterns . The treatment group had significantly lower prepr and ial and postpr and ial glucose levels by 32 weeks ' gestation , which continued to term . CONCLUSION This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight , birth trauma , operative delivery , or neonatal metabolic disorders . It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings OBJECTIVES Replacement of the two-step , 100 gm , 3-hour National Diabetes Data Group procedure by the one-step , 75 gm , 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy . The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood . STUDY DESIGN After a 75 gm oral glucose tolerance test  30 gestational diabetics and 30 metabolically healthy pregnant women were r and omly assigned to a second 75 or 100 gm test within 3+/-1.3 ( mean+/-SD ) days . Glucose levels at both tests was measured in capillary blood and venous plasma , as were insulin and C peptide . RESULTS In controls 1-hour maternal glucose levels ( 112 vs 128 mg/dl ) and 2-hour levels ( 104 vs 113 mg/dl ) differed significantly after a 75 or 100 gm load ( paired t test ) . In gestational diabetes mellitus , however , there was no difference ( 176 vs 178 mg/dl ) but a low insulin/glucose quotient at 1 hour . Only 2-hour levels differed significantly ( 133 vs 149 mg/dl ) . In controls glucose measurement in capillary blood and venous plasma differed significantly at 1 hour ( 126 vs 115 mg/dl ) and 2 hours ( 111 vs 104 mg/dl ) independently of the glucose load . In gestational diabetes mellitus , however , glucose measurement in capillary blood and venous plasma differed neither in 1-hour levels ( 179 vs 174 mg/dl ) nor in 2-hour levels ( 142 vs 139 mg/dl ) . CONCLUSION In metabolically healthy women both different loading and different blood fractions lead to statistically different blood glucose levels at 1 and 2 hours . In gestational diabetes mellitus , however , 1-hour glucose levels do not differ after a 75 or 100 gm load or after glucose measurement in capillary blood or venous plasma . This is due to elevated insulin resistance shown by a low insulin/glucose quotient at 1 hour . For comparison of tests in gestational diabetes mellitus only , 2-hour values must be adjusted by 16 mg/dl after different loading OBJECTIVE To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference ( AC ) measurements in order to select patients for insulin treatment of gestational diabetes mellitus ( GDM ) with fasting hyperglycemia . RESEARCH DESIGN AND METHODS In a pilot study , 98 women with fasting plasma glucose ( FPG ) concentrations of 105 - 120 mg/dl were r and omized . The st and ard group received insulin treatment . The experimental group received insulin if the AC , measured monthly , was > or = 70th percentile and /or if any venous FPG measurement was > 120 mg/dl . Power was projected to detect a 250-g difference in birth weights . RESULTS Gestational ages , maternal glycemia , and AC percentiles were similar at r and omization . After initiation of protocol , venous FPG ( P = 0.003 ) and capillary blood glucose levels ( P = 0.049 ) were significantly lower in the st and ard group . Birth weights ( 3,271 + /- 458 vs. 3,369 + /- 461 g ) , frequencies of birth weights > 90th percentile ( 6.3 vs 8.3 % ) , and neonatal morbidity ( 25 vs. 25 % ) did not differ significantly between the st and ard and experimental groups , respectively . The cesarean delivery rate was significantly lower ( 14.6 vs. 33.3 % , P = 0.03 ) in the st and ard group ; this difference was not explained by birth weights . In the experimental group , infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin ( 3,180 + /- 425 vs. 3,482 + /- 451 g , P = 0.03 ) . CONCLUSIONS In women with GDM and fasting hyperglycemia , glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and result ed in the avoidance of insulin therapy in 38 % of patients without increasing rates of neonatal morbidity We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus . Women with gestational diabetes mellitus ( N = 19 ) were r and omized into either group I , a 6-week diet alone group ( 24 to 30 kcal/kg/24 hours ; 20 % protein , 40 % carbohydrate , 40 % fat ) , or group II , which followed the same diet plus exercise ( 20 minutes three times a week for 6 weeks ) . An arm ergometer was used to maintain heart rate in the training range . Glycemic response was monitored by glycosylated hemoglobin , a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose , and blood glucose self-monitoring , fasting and 1 hour  after meals .  Week 1 glycemic parameters were the same for both groups . Week 6 data ( mean + /- SD ) were as follows : group I glycosylated hemoglobin , 4.7 % + 0.2 % versus group II , 4.2 % + /- 0.2 % ; p less than 0.001 . The group I glucose challenge fasting value was 87.6 + /- 6.2 versus 70.1 + /- 6.6 mg/dl , p less than 0.001 for group II . The group I 1-hour plasma glucose challenge result was 187.5 + /- 12.9 mg/dl versus 105.9 + /- 18.9 mg/dl for group II , p less than 0.001 . The glycemic levels diverged between the groups at week 4 . We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin , fasting , and 1-hour plasma glucose concentrations than diet alone . Arm ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment A r and omised prospect i ve study of treatment with dietary restriction alone or insulin therapy with dietary advice was performed in 15 women with glucose intolerance diagnosed early in the third trimester of pregnancy . Twenty-four hour profiles of plasma glucose and 3-hydroxybutyrate were performed before and four weeks after commencing treatment . The effect on neonatal outcome was assessed . The case history of one of the patients in the study was sent to British physicians with a special interest in diabetes to obtain their opinion about the appropriate initial treatment of women with gestational diabetes OBJECTIVE We tested the hypothesis that intensified management of gestational diabetes mellitus on the basis of stringent glycemic control , verified glucose data , and adherence to an established criterion for insulin initiation results in near normoglycemia control and reduction of adverse outcomes . STUDY DESIGN A prospect i ve , population -based study compared the effect on perinatal outcome of conventional  ( n = 1316 )  and intensified  ( n = 1145 )  management . Group assignment was based on availability of memory-based reflectance meters at entry to the program . A contemporaneous r and omized control group ( nondiabetic , n = 4922 ) was selected . RESULTS The diabetic groups were comparable in demographic characteristics and in factors associated with higher risk for adverse pregnancy outcome , such as  previous macrosomia , previous gestational diabetes mellitus , and family history of diabetes . The control group was younger , less obese , and had a lower rate of previous macrosomia .  The intensified management group had rates of macrosomia , cesarean section , metabolic complications , shoulder dystocia , stillbirth , neonatal intensive care unit days , and respiratory complications lower than those in the conventional management group and comparable to those of the nondiabetic controls . Other maternal complication rates , such as for preeclampsia , chronic hypertension , and infection , were similar for the three groups . Mean blood glucose levels were a good predictor of perinatal outcome . Gestational age at delivery , previous history of macrosomia , and overall mean blood glucose levels were the only significant predictors of birth weight percentile in both diabetic groups ( logistic regression ) . CONCLUSION The intensified management approach is significantly associated with enhanced perinatal outcome . This management strategy clarifies the relationship between glycemic control and neonatal outcome In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome .  One hundred twenty-six women with one abnormal oral gl 
    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: The aim of this study was to determine whether amniotic fluid insulin concentration ( AFI ) is a better parameter than mean maternal blood glucose values ( MBG ) for deciding about insulin therapy in patients with gestational diabetes . MBG 's were calculated on the base of 9 blood glucose levels during a 24 hour period after one week of diet therapy . In a prospect i ve trial between 1987 and 1989 in Karlsburg , 123 gestational diabetic patients were r and omized into two groups . Treatment was either based on the concentration of AFI or MBG levels . In a second series in Berlin , 103 patients were offered amniocentesis . 81 patients agreed and 22 refused . Treatment was then analogous to that in Karlsburg . In both groups of the r and omized population , strict metabolic control was achieved . There was no difference regarding pregnancy complications . Earlier labor induction and higher cesarean section rates were seen in the non-invasive group ( p < 0.05 ) . The incidence of diabetic fetopathy and neonatal hypoglycemia was significantly lower in the invasive group ( p < 0.01 ) , even though the metabolic control parameters did not differ between the two groups . The results in Berlin correspond to these findings . In conclusion , AFI enables the recognition of any hyperinsulinism reaction to the maternal metabolic situation . We recommend the additional measurement of the AFI concentration between 28 and 36 weeks as the direct fetal parameter for deciding about insulin treatment The high prevalence of diabetes and impaired glucose tolerance in women of childbearing age in Mauritius provides an opportunity to assess prospect ively the risks of adverse outcome in pregnancy of these conditions , whether the conditions are known to be present at conception or diagnosed during pregnancy.1 The findings are likely to have consequences for healthcare planning in developing countries . View this table : Outcome of pregnancy in Mauritius , 1993 - 6 , according to diagnostic category of glucose intolerance . Values are number ( percentage ) unless otherwise indicated The study hospital ( catchment population 250 000 ; 4500 deliveries a year ) accounts for 22 % of deliveries of babies in Mauritius , hospital deliveries being 80 % of all deliveries on the isl and .1 Cases were registered in 1993–6 at a joint obstetric and medical service for diabetes , and were also found by monitoring admissions to the obstetric wards , and by monitoring all requests for  obstetric oral glucose tolerance tests . Data were collected from the mother and from hospital and national records . Diabetes and impaired glucose OBJECTIVES The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia , birth trauma , neonatal hypoglycemia , and operative delivery . The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study , by determining realistic accrual rates , and by detecting any major adverse outcomes in the control group that received routine obstetric care . STUDY DESIGN The study was a prospect i ve r and omized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes . Women r and omized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care , and women in the control arm received routine obstetric care . RESULTS Three hundred women with gestational diabetes mellitus were studied . There was no difference in maternal age , weight , or length of gestation between groups . The treatment mean birth weight was 3437 + /- 575 gm compared with 3544 + /- 601 gm in the control group , a difference of 107 gm ( not significant ) . Macrosomia rates were similar . There was no birth trauma in either group . The frequency of neonatal hypoglycemia and other metabolic complications was the same . The mode of delivery also showed similar patterns . The treatment group had significantly lower prepr and ial and postpr and ial glucose levels by 32 weeks ' gestation , which continued to term . CONCLUSION This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight , birth trauma , operative delivery , or neonatal metabolic disorders . It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings OBJECTIVES Replacement of the two-step , 100 gm , 3-hour National Diabetes Data Group procedure by the one-step , 75 gm , 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy . The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood . STUDY DESIGN After a 75 gm oral glucose tolerance test  30 gestational diabetics and 30 metabolically healthy pregnant women were r and omly assigned to a second 75 or 100 gm test within 3+/-1.3 ( mean+/-SD ) days . Glucose levels at both tests was measured in capillary blood and venous plasma , as were insulin and C peptide . RESULTS In controls 1-hour maternal glucose levels ( 112 vs 128 mg/dl ) and 2-hour levels ( 104 vs 113 mg/dl ) differed significantly after a 75 or 100 gm load ( paired t test ) . In gestational diabetes mellitus , however , there was no difference ( 176 vs 178 mg/dl ) but a low insulin/glucose quotient at 1 hour . Only 2-hour levels differed significantly ( 133 vs 149 mg/dl ) . In controls glucose measurement in capillary blood and venous plasma differed significantly at 1 hour ( 126 vs 115 mg/dl ) and 2 hours ( 111 vs 104 mg/dl ) independently of the glucose load . In gestational diabetes mellitus , however , glucose measurement in capillary blood and venous plasma differed neither in 1-hour levels ( 179 vs 174 mg/dl ) nor in 2-hour levels ( 142 vs 139 mg/dl ) . CONCLUSION In metabolically healthy women both different loading and different blood fractions lead to statistically different blood glucose levels at 1 and 2 hours . In gestational diabetes mellitus , however , 1-hour glucose levels do not differ after a 75 or 100 gm load or after glucose measurement in capillary blood or venous plasma . This is due to elevated insulin resistance shown by a low insulin/glucose quotient at 1 hour . For comparison of tests in gestational diabetes mellitus only , 2-hour values must be adjusted by 16 mg/dl after different loading OBJECTIVE To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference ( AC ) measurements in order to select patients for insulin treatment of gestational diabetes mellitus ( GDM ) with fasting hyperglycemia . RESEARCH DESIGN AND METHODS In a pilot study , 98 women with fasting plasma glucose ( FPG ) concentrations of 105 - 120 mg/dl were r and omized . The st and ard group received insulin treatment . The experimental group received insulin if the AC , measured monthly , was > or = 70th percentile and /or if any venous FPG measurement was > 120 mg/dl . Power was projected to detect a 250-g difference in birth weights . RESULTS Gestational ages , maternal glycemia , and AC percentiles were similar at r and omization . After initiation of protocol , venous FPG ( P = 0.003 ) and capillary blood glucose levels ( P = 0.049 ) were significantly lower in the st and ard group . Birth weights ( 3,271 + /- 458 vs. 3,369 + /- 461 g ) , frequencies of birth weights > 90th percentile ( 6.3 vs 8.3 % ) , and neonatal morbidity ( 25 vs. 25 % ) did not differ significantly between the st and ard and experimental groups , respectively . The cesarean delivery rate was significantly lower ( 14.6 vs. 33.3 % , P = 0.03 ) in the st and ard group ; this difference was not explained by birth weights . In the experimental group , infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin ( 3,180 + /- 425 vs. 3,482 + /- 451 g , P = 0.03 ) . CONCLUSIONS In women with GDM and fasting hyperglycemia , glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and result ed in the avoidance of insulin therapy in 38 % of patients without increasing rates of neonatal morbidity We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus . Women with gestational diabetes mellitus ( N = 19 ) were r and omized into either group I , a 6-week diet alone group ( 24 to 30 kcal/kg/24 hours ; 20 % protein , 40 % carbohydrate , 40 % fat ) , or group II , which followed the same diet plus exercise ( 20 minutes three times a week for 6 weeks ) . An arm ergometer was used to maintain heart rate in the training range . Glycemic response was monitored by glycosylated hemoglobin , a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose , and blood glucose self-monitoring , fasting and 1 hour  after meals .  Week 1 glycemic parameters were the same for both groups . Week 6 data ( mean + /- SD ) were as follows : group I glycosylated hemoglobin , 4.7 % + 0.2 % versus group II , 4.2 % + /- 0.2 % ; p less than 0.001 . The group I glucose challenge fasting value was 87.6 + /- 6.2 versus 70.1 + /- 6.6 mg/dl , p less than 0.001 for group II . The group I 1-hour plasma glucose challenge result was 187.5 + /- 12.9 mg/dl versus 105.9 + /- 18.9 mg/dl for group II , p less than 0.001 . The glycemic levels diverged between the groups at week 4 . We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin , fasting , and 1-hour plasma glucose concentrations than diet alone . Arm ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment A r and omised prospect i ve study of treatment with dietary restriction alone or insulin therapy with dietary advice was performed in 15 women with glucose intolerance diagnosed early in the third trimester of pregnancy . Twenty-four hour profiles of plasma glucose and 3-hydroxybutyrate were performed before and four weeks after commencing treatment . The effect on neonatal outcome was assessed . The case history of one of the patients in the study was sent to British physicians with a special interest in diabetes to obtain their opinion about the appropriate initial treatment of women with gestational diabetes OBJECTIVE We tested the hypothesis that intensified management of gestational diabetes mellitus on the basis of stringent glycemic control , verified glucose data , and adherence to an established criterion for insulin initiation results in near normoglycemia control and reduction of adverse outcomes . STUDY DESIGN A prospect i ve , population -based study compared the effect on perinatal outcome of conventional  ( n = 1316 )  and intensified  ( n = 1145 )  management . Group assignment was based on availability of memory-based reflectance meters at entry to the program . A contemporaneous r and omized control group ( nondiabetic , n = 4922 ) was selected . RESULTS The diabetic groups were comparable in demographic characteristics and in factors associated with higher risk for adverse pregnancy outcome , such as  previous macrosomia , previous gestational diabetes mellitus , and family history of diabetes . The control group was younger , less obese , and had a lower rate of previous macrosomia .  The intensified management group had rates of macrosomia , cesarean section , metabolic complications , shoulder dystocia , stillbirth , neonatal intensive care unit days , and respiratory complications lower than those in the conventional management group and comparable to those of the nondiabetic controls . Other maternal complication rates , such as for preeclampsia , chronic hypertension , and infection , were similar for the three groups . Mean blood glucose levels were a good predictor of perinatal outcome . Gestational age at delivery , previous history of macrosomia , and overall mean blood glucose levels were the only significant predictors of birth weight percentile in both diabetic groups ( logistic regression ) . CONCLUSION The intensified management approach is significantly associated with enhanced perinatal outcome . This management strategy clarifies the relationship between glycemic control and neonatal outcome In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome .  One hundred twenty-six women with one abnormal oral gl 
    Output:
    