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 Gestational Diabetes Mellitus ( GDM ) increases risks for type 2 diabetes and weight management is recommended to reduce the risk . Conventional dietary recommendations ( energy-restricted , low fat ) have limited success in women with previous GDM . The effect of lowering Glycaemic Index ( GI ) in managing glycaemic variables and body weight in women post-GDM is unknown . Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education , in the management of glucose tolerance and body weight in Asian women with previous GDM . MethodS eventy seven Asian , non-diabetic women with previous GDM , between 20- 40y were r and omised into Conventional healthy dietary recommendation ( CHDR )  and  low GI  ( LGI ) groups . CHDR received conventional dietary recommendations only ( energy restricted , low in fat and refined sugars , high-fibre ) . LGI group received advice on lowering GI in addition . Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test ( 2HPP ) were measured at baseline and 6 months after intervention . Anthropometry and dietary intake were assessed at baseline , three and six months after intervention . The study is registered at the Malaysian National Medical Research Register ( NMRR ) with Research ID : 5183 . Results After 6 months , significant reductions in body weight , BMI and waist-to-hip ratio were observed only in LGI group ( P<0.05 ) . Mean BMI changes were significantly different between groups ( LGI vs. CHDR : -0.6 vs. 0 kg/m2 , P= 0.03 ) . More subjects achieved weight loss ≥5 % in LGI compared to CHDR group ( 33 % vs. 8 % , P=0.01 ) . Changes in 2HPP were significantly different between groups ( LGI vs. CHDR : median ( IQR ) : -0.2(2.8 ) vs. + 0.8 ( 2.0 ) mmol/L , P=0.025 ) . Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group ( −1.9±0.42 vs. + 1.31±1.4 mmol/L , P<0.001 ) . After 6 months , LGI group diets showed significantly lower GI ( 57±5 vs. 64±6 , P<0.001 ) , GL ( 122±33 vs. 142±35 , P=0.04 ) and higher fibre content ( 17±4 vs.13±4 g , P<0.001 ) . Caloric intakes were comparable between groups . Conclusion In women post-GDM , lowering GI of healthy diets result ed in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription Background Gestational diabetes mellitus ( GDM ) is a risk factor for the development of type 2 diabetes . Lifestyle intervention can prevent progression to type 2 diabetes in high risk population s. We design ed a r and omised controlled trial ( RCT ) to evaluate the effectiveness of an established lifestyle intervention compared to st and ard care for delaying diabetes onset in European women with recent GDM . Recruitment into the RCT was more challenging than anticipated with only 89 of 410 ( 22 % ) women agreeing to participate . This paper identifies factors that could enhance participation of the target population in future interventions . Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined , and secondly that it would be possible to predict participation on the bases of those risk factors . To test our hypothesis , we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3 - 5 years following GDM , reducing the sample to 43 participants and 73 decliners . We considered established diabetes risk factors : smoking , daily fruit and vegetable intake , participation in exercise , family history of diabetes , glucose values and BMI scores on post-partum re-screens , use of insulin during pregnancy , and age at delivery . We also analysed narrative data from 156 decliners to further underst and barriers to and facilitators of participation . Results Two factors differentiated participants and decliners : age at delivery ( with women older than 34 years being more likely to participate ) and insulin use during pregnancy ( with women requiring the use of insulin in pregnancy less likely to participate ) . Binary logistic regression confirmed that insulin use negatively affected the odds of participation . The most significant barriers to participation included the accessibility , affordability and practicality of the intervention . Conclusions Women with recent GDM face multiple barriers to lifestyle change . Intervention design ers should consider : ( i ) the practicalities of participation for this population , ( ii ) research design s that capitalise on motivational differences between participants , ( iii ) alleviating concerns about long-term diabetes management . We hope this work will support future research ers in developing interventions that are more relevant , effective and successful in recruiting the desired population .Trial registration Current Controlled Trials IS RCT Objective : To study the possibility of improving blood lipids , glucose tolerance and insulin sensitivity in women with impaired glucose tolerance and a history of gestational diabetes by merely changing the glycaemic index ( GI ) and dietary fibre ( DF ) content of their bread . Design : R and omized crossover study where test subjects were given either low GI/high DF or high GI/low DF bread products during two consecutive 3-week periods , separated by a 3-week washout period . An intravenous glucose tolerance test followed by a euglycaemic – hyperinsulinaemic clamp was performed on days 1 and 21 in both the high- and low-GI periods , to assess insulin secretion and insulin sensitivity . Blood sample s were also collected on days 1 and 21 for analysis of fasting levels of glucose , insulin , HDL-cholesterol and triacylglycerols ( TG ) . Setting : Lund University , Sweden . Subjects : Seven women with impaired glucose tolerance . Results : The study shows that a modest dietary modification , confined to a lowering of the GI character and increasing cereal DF of the bread products , improved insulin economy as judged from the fact that all women lowered their insulin responses to the intravenous glucose challenge on average by 35 % ( 0–60 min ) , in the absence of effect on glycaemia . No changes were found in fasting levels of glucose , insulin , HDL-cholesterol or TG . Conclusion : It is concluded that a combination of low GI and a high content of cereal DF has a beneficial effect on insulin economy in women at risk of developing type II diabetes . This is in accordance with epidemiological data , suggesting that a low dietary GI and /or increased intake of whole grain prevent against development of type II diabetes . Sponsorship : Supported by grants from Cerealia Research Foundation BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin OBJECTIVE The optimum diet composition for weight loss in obese women with or without previous gestational diabetes mellitus remains to be determined . Weight loss may be especially important for the latter group in terms of preventing future gestational as well as non-insulin dependent diabetes mellitus . We studied 40 % vs. 55 % carbohydrate calorically restricted diets to compare weight loss and metabolic response . METHODS We performed a prospect i ve , 12-week , blinded , r and omized crossover study of 25 obese women ; 13 of whom had previous gestational diabetes . Each woman was allocated to a treatment regimen for 6 weeks and then " crossed over " to the alternative regimen for an additional 6 weeks . Calories were provided in the form of nutritional supplement bars except for the evening meal that comprised 1/3 of the caloric needs . All subjects were seen and weighed weekly . Metabolic variables including glucose tolerance , glycated proteins , lipids , and percent body fat were measured at the beginning , crossover , and end of the study . RESULTS Women with previous gestational diabetes mellitus were comparable to obese women without a history of previous gestational diabetes except that the former had higher maximum levels of glucose on a glucose tolerance test and higher fasting insulin levels consistent with greater insulin resistance . Weight loss was comparable for all groups during the first 6 weeks but attenuated in all groups during the second 6 weeks of the trial regardless of diabetes history or treatment group allocation . Women with or without a previous history of gestational diabetes had higher triglycerides while on a 55 % carbohydrate diet than while on a 40 % carbohydrate diet . CONCLUSIONS A weight loss regimen consisting of 40 % carbohydrate results in lower triglyceride levels than those achieved with a 55 % carbohydrate content diet in obese women . Thus , the hypocaloric diet with the higher fat content produced the more favorable lipid profile in all obese women Summary : Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus ( NIDDM ) . The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes , which identifies many women with impaired glucose tolerance . Two hundred of these women were entered into a r and omized controlled trial of intensive versus routine dietary advice . Seven women were lost to follow‐up . The annual incidence rates of diabetes mellitus for the 2 groups were 6.1 % ( intervention ) and 7.3 % ( control ) , an incident rate ratio of 0.83 , 95 % confidence interval 0.47–1.48 , p = 0.50 . Overall , there was a return to normal glucose tolerance in 44 % of patients . Multivariate analysis showed that body mass index , fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus . Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification ( diet and /or exercise ) . We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and /or exercise , the latter providing a therapy that it would be unethical to exclude on the evidence presently available 
    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 Gestational Diabetes Mellitus ( GDM ) increases risks for type 2 diabetes and weight management is recommended to reduce the risk . Conventional dietary recommendations ( energy-restricted , low fat ) have limited success in women with previous GDM . The effect of lowering Glycaemic Index ( GI ) in managing glycaemic variables and body weight in women post-GDM is unknown . Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education , in the management of glucose tolerance and body weight in Asian women with previous GDM . MethodS eventy seven Asian , non-diabetic women with previous GDM , between 20- 40y were r and omised into Conventional healthy dietary recommendation ( CHDR )  and  low GI  ( LGI ) groups . CHDR received conventional dietary recommendations only ( energy restricted , low in fat and refined sugars , high-fibre ) . LGI group received advice on lowering GI in addition . Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test ( 2HPP ) were measured at baseline and 6 months after intervention . Anthropometry and dietary intake were assessed at baseline , three and six months after intervention . The study is registered at the Malaysian National Medical Research Register ( NMRR ) with Research ID : 5183 . Results After 6 months , significant reductions in body weight , BMI and waist-to-hip ratio were observed only in LGI group ( P<0.05 ) . Mean BMI changes were significantly different between groups ( LGI vs. CHDR : -0.6 vs. 0 kg/m2 , P= 0.03 ) . More subjects achieved weight loss ≥5 % in LGI compared to CHDR group ( 33 % vs. 8 % , P=0.01 ) . Changes in 2HPP were significantly different between groups ( LGI vs. CHDR : median ( IQR ) : -0.2(2.8 ) vs. + 0.8 ( 2.0 ) mmol/L , P=0.025 ) . Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group ( −1.9±0.42 vs. + 1.31±1.4 mmol/L , P<0.001 ) . After 6 months , LGI group diets showed significantly lower GI ( 57±5 vs. 64±6 , P<0.001 ) , GL ( 122±33 vs. 142±35 , P=0.04 ) and higher fibre content ( 17±4 vs.13±4 g , P<0.001 ) . Caloric intakes were comparable between groups . Conclusion In women post-GDM , lowering GI of healthy diets result ed in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription Background Gestational diabetes mellitus ( GDM ) is a risk factor for the development of type 2 diabetes . Lifestyle intervention can prevent progression to type 2 diabetes in high risk population s. We design ed a r and omised controlled trial ( RCT ) to evaluate the effectiveness of an established lifestyle intervention compared to st and ard care for delaying diabetes onset in European women with recent GDM . Recruitment into the RCT was more challenging than anticipated with only 89 of 410 ( 22 % ) women agreeing to participate . This paper identifies factors that could enhance participation of the target population in future interventions . Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined , and secondly that it would be possible to predict participation on the bases of those risk factors . To test our hypothesis , we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3 - 5 years following GDM , reducing the sample to 43 participants and 73 decliners . We considered established diabetes risk factors : smoking , daily fruit and vegetable intake , participation in exercise , family history of diabetes , glucose values and BMI scores on post-partum re-screens , use of insulin during pregnancy , and age at delivery . We also analysed narrative data from 156 decliners to further underst and barriers to and facilitators of participation . Results Two factors differentiated participants and decliners : age at delivery ( with women older than 34 years being more likely to participate ) and insulin use during pregnancy ( with women requiring the use of insulin in pregnancy less likely to participate ) . Binary logistic regression confirmed that insulin use negatively affected the odds of participation . The most significant barriers to participation included the accessibility , affordability and practicality of the intervention . Conclusions Women with recent GDM face multiple barriers to lifestyle change . Intervention design ers should consider : ( i ) the practicalities of participation for this population , ( ii ) research design s that capitalise on motivational differences between participants , ( iii ) alleviating concerns about long-term diabetes management . We hope this work will support future research ers in developing interventions that are more relevant , effective and successful in recruiting the desired population .Trial registration Current Controlled Trials IS RCT Objective : To study the possibility of improving blood lipids , glucose tolerance and insulin sensitivity in women with impaired glucose tolerance and a history of gestational diabetes by merely changing the glycaemic index ( GI ) and dietary fibre ( DF ) content of their bread . Design : R and omized crossover study where test subjects were given either low GI/high DF or high GI/low DF bread products during two consecutive 3-week periods , separated by a 3-week washout period . An intravenous glucose tolerance test followed by a euglycaemic – hyperinsulinaemic clamp was performed on days 1 and 21 in both the high- and low-GI periods , to assess insulin secretion and insulin sensitivity . Blood sample s were also collected on days 1 and 21 for analysis of fasting levels of glucose , insulin , HDL-cholesterol and triacylglycerols ( TG ) . Setting : Lund University , Sweden . Subjects : Seven women with impaired glucose tolerance . Results : The study shows that a modest dietary modification , confined to a lowering of the GI character and increasing cereal DF of the bread products , improved insulin economy as judged from the fact that all women lowered their insulin responses to the intravenous glucose challenge on average by 35 % ( 0–60 min ) , in the absence of effect on glycaemia . No changes were found in fasting levels of glucose , insulin , HDL-cholesterol or TG . Conclusion : It is concluded that a combination of low GI and a high content of cereal DF has a beneficial effect on insulin economy in women at risk of developing type II diabetes . This is in accordance with epidemiological data , suggesting that a low dietary GI and /or increased intake of whole grain prevent against development of type II diabetes . Sponsorship : Supported by grants from Cerealia Research Foundation BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin OBJECTIVE The optimum diet composition for weight loss in obese women with or without previous gestational diabetes mellitus remains to be determined . Weight loss may be especially important for the latter group in terms of preventing future gestational as well as non-insulin dependent diabetes mellitus . We studied 40 % vs. 55 % carbohydrate calorically restricted diets to compare weight loss and metabolic response . METHODS We performed a prospect i ve , 12-week , blinded , r and omized crossover study of 25 obese women ; 13 of whom had previous gestational diabetes . Each woman was allocated to a treatment regimen for 6 weeks and then " crossed over " to the alternative regimen for an additional 6 weeks . Calories were provided in the form of nutritional supplement bars except for the evening meal that comprised 1/3 of the caloric needs . All subjects were seen and weighed weekly . Metabolic variables including glucose tolerance , glycated proteins , lipids , and percent body fat were measured at the beginning , crossover , and end of the study . RESULTS Women with previous gestational diabetes mellitus were comparable to obese women without a history of previous gestational diabetes except that the former had higher maximum levels of glucose on a glucose tolerance test and higher fasting insulin levels consistent with greater insulin resistance . Weight loss was comparable for all groups during the first 6 weeks but attenuated in all groups during the second 6 weeks of the trial regardless of diabetes history or treatment group allocation . Women with or without a previous history of gestational diabetes had higher triglycerides while on a 55 % carbohydrate diet than while on a 40 % carbohydrate diet . CONCLUSIONS A weight loss regimen consisting of 40 % carbohydrate results in lower triglyceride levels than those achieved with a 55 % carbohydrate content diet in obese women . Thus , the hypocaloric diet with the higher fat content produced the more favorable lipid profile in all obese women Summary : Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus ( NIDDM ) . The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes , which identifies many women with impaired glucose tolerance . Two hundred of these women were entered into a r and omized controlled trial of intensive versus routine dietary advice . Seven women were lost to follow‐up . The annual incidence rates of diabetes mellitus for the 2 groups were 6.1 % ( intervention ) and 7.3 % ( control ) , an incident rate ratio of 0.83 , 95 % confidence interval 0.47–1.48 , p = 0.50 . Overall , there was a return to normal glucose tolerance in 44 % of patients . Multivariate analysis showed that body mass index , fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus . Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification ( diet and /or exercise ) . We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and /or exercise , the latter providing a therapy that it would be unethical to exclude on the evidence presently available 
    Output:
    