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 There are no r and omised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus ( GDM ) diagnosed by the International Association of Diabetes and Pregnancy Study Group ’s ( IADPSG ) criteria . We tested the effectiveness of lifestyle modifications implemented in a 3-tier ’s shared care ( SC ) on pregnancy outcomes of GDM . Methods Between December 2010 and October 2012 , we r and omly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 ( interquartile range : 25.4 - 27.3 ) gestational weeks in Tianjin , China , to receive SC or usual care ( UC ) . The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group . The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension ( PIH ) . Results Women in the SC ( n = 339 ) and UC ( n = 361 ) groups delivered their infants at similar gestational weeks . Birth weight of infants in the SC group was lower than that in the UC group ( 3469 vs. 3371 grams , P = 0.021 ) . The rate of macrosomia was 11.2 % ( 38/339 ) in the SC group compared to 17.5 % ( 63/361 ) in the UC group with relative risk ( RR ) of 0.64 ( 95 % CI : 0.44 - 0.93 ) . The rate of PIH was 8.0 % ( 27/339 ) in the SC compared to 4.4 % ( 16/361 ) in the UC with RR of 1.80 ( 0.99 - 3.28 ) . Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC . Conclusions Lifestyle modifications using a SC system  improved pregnancy outcomes in Chinese women with GDM.Trial registration Clinical trials.gov ; NCT01565564 Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus AIM To compare treatment with metformin alone , metformin plus insulin and insulin alone in women with gestational diabetes ( GDM ) . METHOD A total of 150 gestational diabetic patients who fulfilled the eligibility criteria were included in this prospect i ve r and omized control open labeled study . A risk factor based screening was done followed by a GCT and then local GTT criteria from antenatal clinics . They were initially divided into two groups with odd numbers assigned to metformin treatment and even numbers to insulin treatment . Metformin and /or insulin treatment was given and target blood sugar levels aim ed at FBS ≤ 100 mg/dl and postpr and ial levels ≤ 126 mg/dl . Supplemental insulin was added to metformin treatment group to maintain the glycemic targets if required . Patients were followed until delivery and maternal fetal outcomes and pharmacotherapeutic characteristics were recorded on a performa . RESULTS Less maternal weight gain was found in the metformin treated groups ( 9.8 ± 1.5 kg [ metformin alone ] vs. 9.8 ± 1.4 kg [ metformin plus insulin ] vs. 12.5 ± 1.1 kg [ insulin alone ] P < 0.000 ) . Preeclampsia was significantly less in metformin treated groups . There were no perinatal deaths in the study . Mean birth weight was significantly less in metformin treated groups ( 3.4 ± 0.4 kg vs. 3.3 ± 0.5 kg vs. 3.7 ± 0.5 kg P < 0.01 ) . Less neonatal morbidity was observed in metformin groups . 42.7 % of patients required supplemental insulin ( mean dose of 13.6 ± 2 units ) in the  metformin group . Mean gestational age at which insulin was added was 31.8 ± 5.9 weeks . CONCLUSION Metformin is an effective and cheap treatment option for women with gestational diabetes with or without supplemental insulin OBJECTIVES To study glibenclamide as a treatment for gestational diabetes mellitus ( GDM ) and its impact on newborn birth weight and neonatal glycemia as compared to insulin . METHODS A r and omized and open-label clinical trial , conducted from October 1st , 2003 to March 8 , 2005 . Seventy-two pregnant women with gestational diabetes mellitus requiring drug therapy were r and omized and allocated into two groups -- insulin and glibenclamide . RESULTS The general characteristics in both groups were similar , except for the results of the 75 g OGTT , which were higher in the glibenclamide group ( p= 0.02 ) . Maternal fasting and postpr and ial glucose levels presented no difference . Six ( 18.75 % ) pregnant women received the maximum dose of glibenclamide with no glycemic control . The birth weight was higher in the group treated with glibenclamide ( p= 0.01 ) , and the incidence of macrosomic newborns statistically different ( p= 0.01 ) . Neonatal hypoglycemia was more frequent ( p= 0.01 ) in newborns of glibenclamide group , with one single case of persistent hypoglycemia . CONCLUSION Glibenclamide can be the first line drug for glycemic control in most GDM patients . The birth weight and incidence of hypoglycemia were higher in the glibenclamide group , but with one single case of persistent hypoglycemia that required intravenous infusion of glucose Abstract Objective : To evaluate the perinatal impact of metformin and glyburide in the treatment of gestational diabetes mellitus ( GDM ) . Methods : A r and omized clinical trial conducted from July 2008 until September 2010 studied 200 pregnant women with GDM who required adjunctive therapy to diet and physical activity . Patients were r and omized to use metformin ( n=104 ) or glyburide ( n=96 ) . The drugs were replaced by insulin when they reached the maximum dose without glycemic control . Assessed outcomes : weight and neonatal blood glucose . Results : : No difference was found ( P>0.05 ) between the groups regarding maternal age , gestational age at inclusion , body mass index , glucose levels in oral glucose tolerance test ( OGTT ) 75 g and glycemic control . Difference was found in the number of previous pregnancies ( 2.84 vs. 2.47 , P=0.04 ) and weight gain during pregnancy ( 7.78 vs. 9.84 , P=0.04 ) in the metformin group and glyburide respectively . The perinatal results showed no difference ( P>0.05 ) in the percentage of cesarean deliveries , gestational age at delivery , number of newborns large for gestational age ( LGA ) , neonatal hypoglycemia , admission to intensive care unit and perinatal death . We found differences in weight ( 3193 g vs. 3387 g , P=0.01 ) and ponderal index ( 2.87 vs. 2.96 , P=0.05 ) of newborns , and in neonatal blood glucose levels at the 1st ( 59.78 vs. 54.08 , P=0.01 ) and 3rd h ( 61.53 vs. 55.89 , P=0.01 ) after birth between the metformin and glyburide groups respectively . Conclusions : Weight and ponderal index were lower in the newborns of the metformin group ; glucose levels ( 1st and 3rd h after birth ) were lower in the glyburide group Background / Objectives : The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM).Subjects/ Methods : This r and omized controlled clinical trial was performed among 52 women diagnosed with GDM . Participants were r and omly assigned to consume either the control ( n=26 ) or the DASH diet ( n=26 ) for 4 weeks . The control diet was design ed to contain 45–55 % carbohydrates , 15–20 % protein and 25–30 % total fat . The DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg/day sodium . The numbers of women who commenced insulin therapy after dietary intervention , the mode of delivery and prevalence of polyhydramnios were assessed . The length , weight and head circumference of infants were measured during the first 24 h after birth . Results : Whereas 46.2 % of women in the DASH diet needed to have a cesarean section , this percentage for the control group was 80.8 % ( P=0.01 ) . The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups ( 23 % for DASH vs 73 % for control group , P<0.0001 ) . Infants born to mothers on the DASH diet had significantly lower weight ( 3222.7 vs 3818.8 g , P<0.0001 ) , head circumference ( 34.2 vs 35.1 cm , P=0.01 ) and ponderal index ( 2.50 vs 2.87 kg/m3 , P<0.0001 ) compared with those born to mothers on the control diet . Conclusions : In conclusion , consumption of DASH diet for 4 weeks among pregnant women with GDM result ed in improved pregnancy outcomes Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Sum 
    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: Background There are no r and omised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus ( GDM ) diagnosed by the International Association of Diabetes and Pregnancy Study Group ’s ( IADPSG ) criteria . We tested the effectiveness of lifestyle modifications implemented in a 3-tier ’s shared care ( SC ) on pregnancy outcomes of GDM . Methods Between December 2010 and October 2012 , we r and omly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 ( interquartile range : 25.4 - 27.3 ) gestational weeks in Tianjin , China , to receive SC or usual care ( UC ) . The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group . The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension ( PIH ) . Results Women in the SC ( n = 339 ) and UC ( n = 361 ) groups delivered their infants at similar gestational weeks . Birth weight of infants in the SC group was lower than that in the UC group ( 3469 vs. 3371 grams , P = 0.021 ) . The rate of macrosomia was 11.2 % ( 38/339 ) in the SC group compared to 17.5 % ( 63/361 ) in the UC group with relative risk ( RR ) of 0.64 ( 95 % CI : 0.44 - 0.93 ) . The rate of PIH was 8.0 % ( 27/339 ) in the SC compared to 4.4 % ( 16/361 ) in the UC with RR of 1.80 ( 0.99 - 3.28 ) . Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC . Conclusions Lifestyle modifications using a SC system  improved pregnancy outcomes in Chinese women with GDM.Trial registration Clinical trials.gov ; NCT01565564 Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus AIM To compare treatment with metformin alone , metformin plus insulin and insulin alone in women with gestational diabetes ( GDM ) . METHOD A total of 150 gestational diabetic patients who fulfilled the eligibility criteria were included in this prospect i ve r and omized control open labeled study . A risk factor based screening was done followed by a GCT and then local GTT criteria from antenatal clinics . They were initially divided into two groups with odd numbers assigned to metformin treatment and even numbers to insulin treatment . Metformin and /or insulin treatment was given and target blood sugar levels aim ed at FBS ≤ 100 mg/dl and postpr and ial levels ≤ 126 mg/dl . Supplemental insulin was added to metformin treatment group to maintain the glycemic targets if required . Patients were followed until delivery and maternal fetal outcomes and pharmacotherapeutic characteristics were recorded on a performa . RESULTS Less maternal weight gain was found in the metformin treated groups ( 9.8 ± 1.5 kg [ metformin alone ] vs. 9.8 ± 1.4 kg [ metformin plus insulin ] vs. 12.5 ± 1.1 kg [ insulin alone ] P < 0.000 ) . Preeclampsia was significantly less in metformin treated groups . There were no perinatal deaths in the study . Mean birth weight was significantly less in metformin treated groups ( 3.4 ± 0.4 kg vs. 3.3 ± 0.5 kg vs. 3.7 ± 0.5 kg P < 0.01 ) . Less neonatal morbidity was observed in metformin groups . 42.7 % of patients required supplemental insulin ( mean dose of 13.6 ± 2 units ) in the  metformin group . Mean gestational age at which insulin was added was 31.8 ± 5.9 weeks . CONCLUSION Metformin is an effective and cheap treatment option for women with gestational diabetes with or without supplemental insulin OBJECTIVES To study glibenclamide as a treatment for gestational diabetes mellitus ( GDM ) and its impact on newborn birth weight and neonatal glycemia as compared to insulin . METHODS A r and omized and open-label clinical trial , conducted from October 1st , 2003 to March 8 , 2005 . Seventy-two pregnant women with gestational diabetes mellitus requiring drug therapy were r and omized and allocated into two groups -- insulin and glibenclamide . RESULTS The general characteristics in both groups were similar , except for the results of the 75 g OGTT , which were higher in the glibenclamide group ( p= 0.02 ) . Maternal fasting and postpr and ial glucose levels presented no difference . Six ( 18.75 % ) pregnant women received the maximum dose of glibenclamide with no glycemic control . The birth weight was higher in the group treated with glibenclamide ( p= 0.01 ) , and the incidence of macrosomic newborns statistically different ( p= 0.01 ) . Neonatal hypoglycemia was more frequent ( p= 0.01 ) in newborns of glibenclamide group , with one single case of persistent hypoglycemia . CONCLUSION Glibenclamide can be the first line drug for glycemic control in most GDM patients . The birth weight and incidence of hypoglycemia were higher in the glibenclamide group , but with one single case of persistent hypoglycemia that required intravenous infusion of glucose Abstract Objective : To evaluate the perinatal impact of metformin and glyburide in the treatment of gestational diabetes mellitus ( GDM ) . Methods : A r and omized clinical trial conducted from July 2008 until September 2010 studied 200 pregnant women with GDM who required adjunctive therapy to diet and physical activity . Patients were r and omized to use metformin ( n=104 ) or glyburide ( n=96 ) . The drugs were replaced by insulin when they reached the maximum dose without glycemic control . Assessed outcomes : weight and neonatal blood glucose . Results : : No difference was found ( P>0.05 ) between the groups regarding maternal age , gestational age at inclusion , body mass index , glucose levels in oral glucose tolerance test ( OGTT ) 75 g and glycemic control . Difference was found in the number of previous pregnancies ( 2.84 vs. 2.47 , P=0.04 ) and weight gain during pregnancy ( 7.78 vs. 9.84 , P=0.04 ) in the metformin group and glyburide respectively . The perinatal results showed no difference ( P>0.05 ) in the percentage of cesarean deliveries , gestational age at delivery , number of newborns large for gestational age ( LGA ) , neonatal hypoglycemia , admission to intensive care unit and perinatal death . We found differences in weight ( 3193 g vs. 3387 g , P=0.01 ) and ponderal index ( 2.87 vs. 2.96 , P=0.05 ) of newborns , and in neonatal blood glucose levels at the 1st ( 59.78 vs. 54.08 , P=0.01 ) and 3rd h ( 61.53 vs. 55.89 , P=0.01 ) after birth between the metformin and glyburide groups respectively . Conclusions : Weight and ponderal index were lower in the newborns of the metformin group ; glucose levels ( 1st and 3rd h after birth ) were lower in the glyburide group Background / Objectives : The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM).Subjects/ Methods : This r and omized controlled clinical trial was performed among 52 women diagnosed with GDM . Participants were r and omly assigned to consume either the control ( n=26 ) or the DASH diet ( n=26 ) for 4 weeks . The control diet was design ed to contain 45–55 % carbohydrates , 15–20 % protein and 25–30 % total fat . The DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg/day sodium . The numbers of women who commenced insulin therapy after dietary intervention , the mode of delivery and prevalence of polyhydramnios were assessed . The length , weight and head circumference of infants were measured during the first 24 h after birth . Results : Whereas 46.2 % of women in the DASH diet needed to have a cesarean section , this percentage for the control group was 80.8 % ( P=0.01 ) . The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups ( 23 % for DASH vs 73 % for control group , P<0.0001 ) . Infants born to mothers on the DASH diet had significantly lower weight ( 3222.7 vs 3818.8 g , P<0.0001 ) , head circumference ( 34.2 vs 35.1 cm , P=0.01 ) and ponderal index ( 2.50 vs 2.87 kg/m3 , P<0.0001 ) compared with those born to mothers on the control diet . Conclusions : In conclusion , consumption of DASH diet for 4 weeks among pregnant women with GDM result ed in improved pregnancy outcomes Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Sum 
    Output:
    