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: To test the feasibility of conducting a pragmatic r and omized controlled trial ( RCT ) comparing the International Association of Diabetes in Pregnancy Study Groups ( IADPSG ) versus Carpenter – Coustan diagnostic criteria for gestational diabetes ( GDM ) , and to examine patient and provider views on GDM screening . A single-blinded pragmatic pilot RCT . Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was < 200 mg/dL were r and omized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter – Coustan criteria . Primary outcome was the feasibility of r and omization and screening . Secondary outcomes included patient and provider views ( or preferences ) on GDM testing .  Sixty-eight women were recruited , 48 ( 71 % ) enrolled and 47 ( 69 % ) were r and omized . Participants in both study arms identified the main challenges to GDM testing to be : drinking the glucola , fasting prior to testing , waiting to have blood drawn , and multiple venipuntures . Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy . Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values . Both pregnant women and providers value GDM screening , and pregnant women can be recruited to a blinded , r and omized GDM screening trial with minimal attrition and missing data STUDY OBJECTIVE To compare the diagnostic performances of 75 g and 100 g oral glucose tolerance tests in detecting  Gestational Diabetes Mellitus in Nigerian pregnant women . MATERIAL S AND METHODS 248 women in 3rd trimester attending antenatal clinic of the Lagos University Teaching Hospital , Lagos , between November 1997 and July 1999 were r and omly subjected to st and ard oral glucose tolerance tests ( OGTT ) . 110 had 100 g OGTT while 138 had 75 g OGTT . The plasma glucose response ( PGR ) was assessed and glucose tolerance status of each patient was determined using WHO ( 1985 ) criteria to interpret 75 g OGTT and National Diabetes Data Group ( NDDG ) ( 1979 ) criteria for 100 g OGTT . The PGR in the two study groups were compared . The prevalence rates of GDM using either of the two criteria were evaluated and compared . Incidences of foetal macrosomia in GDM cases diagnosed by either set of criteria were also compared . RESULTS The mean age of the study subjects was 30.7(+/-4.2 ) years while the BMI was 25.4(+/-4.9 ) kg/m2 . The mean parity was 1.33 . Traditional risk factors for GDM were found in 47.5 % of them . The plasma glucose response ( PGR ) to 100 g OGTT was found to be higher than that of 75 g OGTT at 1 hour , 2hour and 3 hour sampling times but the difference was only significant at 3rd hour ( p values = 0.68 , 0.137 , 0.007 respectively ) . The total area under the glucose response curve ( AUC ) for 75 g OGTT was 345.1 ( + /-49.5 ) AAU while for 100 g OGTT , it was 363.4(+/-61.4 ) AAU . The difference was not statistically significant ( p value > 0.05 ) . The prevalence rate of GDM diagnosed by 75 g OGTT was 11.6 % while that of 100 g OGTT was 4.5 % . The difference was significant ( p value = 0.04 ) . The incidence rate of foetal macrosomia among GDM cases diagnosed by 100 g OGTT was 66.7 % as against 23.1 % among those diagnosed by 75 g OGTT . Statistical difference could not be determined because of the small number . CONCLUSION Plasma glucose response to OGTT among Nigerian pregnant women has little or no respect for the load of the glucose administered . 100 g OGTT- based NDDG criteria was more stringent than 75 g OGTT-based WHO criteria in identifying GDM . However it appears to be more specific for detecting the complications associated with the condition though it will require a larger study to vali date this cl aim OBJECTIVE To demonstrate a role of early insulin secretion on plasma glucose levels after different amounts of oral glucose loads in pregnant women . MATERIAL AND METHOD Forty-one pregnant women with normal glucose tolerance according to the Carpenter and Coustan ' s criteria and 25 non-pregnant women ( control group ) with normal glucose tolerance according to the World Health Organization criteria were enrolled . Each subject was r and omly scheduled to perform both the 100-g and 75-g OGTT within a 1-week interval . Venous blood was drawn at fasting , 30- , 60- , 120- , and 180-minute intervals during both tests for determination of plasma glucose and serum insulin levels . RESULTS The mean ( + /- SE ) ages of the pregnant and control groups were 33.3 + /- 0.9 and 31.8 + /- 1.4 years , respectively . The mean gestational age at the time of performing OGTT of the pregnant group was 28.7 + /- 0.6 weeks . In the non-pregnant group , the plasma glucose concentrations were not different between 75-g and 100-g OGTT whereas the serum insulin levels at the 30 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . In the pregnant group , both plasma glucose and serum insulin concentrations at the 120 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . CONCLUSION The limited ability of early insulin secretion to increase when glucose load increased in the pregnant women could explain the high plasma glucose levels at 2 and 3 hours of 100-g OGTT compared to those of 75-g OGTT Background The risks associated with gestational diabetes mellitus ( GDM ) are well recognized , and there is increasing evidence to support treatment of the condition . However , clear guidance on the ideal approach to screening for GDM is lacking . Professional groups continue to debate whether selective screening ( based on risk factors ) or universal screening is the most appropriate approach . Additionally , there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment . Furthermore , the implication s of possible screening options on health care costs are not well established . In response to this uncertainty there have been repeated calls for well- design ed , r and omised trials to determine the efficacy of screening , diagnosis , and management plans for GDM . We describe a r and omised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care setting s. Methods / Design This will be an unblinded , two-group , parallel r and omised controlled trial ( RCT ) . The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Irel and : Galway University Hospital and Mayo General Hospital . Participants will be offered  universal screening for GDM  at 24 to 28 weeks gestation in either primary care ( n = 392 ) or secondary care ( n = 392 ) locations . The primary outcome variable is the uptake rate of screening . Secondary outcomes include indicators of clinical effectiveness of screening at each screening site ( primary and secondary ) including gestational week at time of screening , time to access antenatal diabetes services for women diagnosed with GDM , and pregnancy and neonatal outcomes for women with GDM . In addition , parallel economic and qualitative evaluations will be conducted . The trial will cover the period from the woman ’s first hospital antenatal visit at 12 to 18 weeks gestation , until the completion of the pregnancy . Trial registration Current Controlled Trials : IS RCT 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 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 examine the effect of prior meal ingestion on the glucose , insulin , and C-peptide response to a 50-g glucose challenge test in the third trimester of pregnancy . RESEARCH DESIGN AND METHODS Ten pregnant women with gestational diabetes mellitus and 12 
    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: To test the feasibility of conducting a pragmatic r and omized controlled trial ( RCT ) comparing the International Association of Diabetes in Pregnancy Study Groups ( IADPSG ) versus Carpenter – Coustan diagnostic criteria for gestational diabetes ( GDM ) , and to examine patient and provider views on GDM screening . A single-blinded pragmatic pilot RCT . Participants with a singleton pregnancy between 24 and 28 weeks gestation received a 50 g oral glucose challenge test and if the value was < 200 mg/dL were r and omized to either the 2 h 75 g OGTT using the IADPSG criteria or the 3 h 100 g OGTT using the Carpenter – Coustan criteria . Primary outcome was the feasibility of r and omization and screening . Secondary outcomes included patient and provider views ( or preferences ) on GDM testing .  Sixty-eight women were recruited , 48 ( 71 % ) enrolled and 47 ( 69 % ) were r and omized . Participants in both study arms identified the main challenges to GDM testing to be : drinking the glucola , fasting prior to testing , waiting to have blood drawn , and multiple venipuntures . Women in both study arms would prefer the 2 h 75 g OGTT or whichever test is recommended by their doctor in a future pregnancy . Physicians and nurse midwives endorsed screening and were comfortable with being blinded to the GDM testing strategy and results values . Both pregnant women and providers value GDM screening , and pregnant women can be recruited to a blinded , r and omized GDM screening trial with minimal attrition and missing data STUDY OBJECTIVE To compare the diagnostic performances of 75 g and 100 g oral glucose tolerance tests in detecting  Gestational Diabetes Mellitus in Nigerian pregnant women . MATERIAL S AND METHODS 248 women in 3rd trimester attending antenatal clinic of the Lagos University Teaching Hospital , Lagos , between November 1997 and July 1999 were r and omly subjected to st and ard oral glucose tolerance tests ( OGTT ) . 110 had 100 g OGTT while 138 had 75 g OGTT . The plasma glucose response ( PGR ) was assessed and glucose tolerance status of each patient was determined using WHO ( 1985 ) criteria to interpret 75 g OGTT and National Diabetes Data Group ( NDDG ) ( 1979 ) criteria for 100 g OGTT . The PGR in the two study groups were compared . The prevalence rates of GDM using either of the two criteria were evaluated and compared . Incidences of foetal macrosomia in GDM cases diagnosed by either set of criteria were also compared . RESULTS The mean age of the study subjects was 30.7(+/-4.2 ) years while the BMI was 25.4(+/-4.9 ) kg/m2 . The mean parity was 1.33 . Traditional risk factors for GDM were found in 47.5 % of them . The plasma glucose response ( PGR ) to 100 g OGTT was found to be higher than that of 75 g OGTT at 1 hour , 2hour and 3 hour sampling times but the difference was only significant at 3rd hour ( p values = 0.68 , 0.137 , 0.007 respectively ) . The total area under the glucose response curve ( AUC ) for 75 g OGTT was 345.1 ( + /-49.5 ) AAU while for 100 g OGTT , it was 363.4(+/-61.4 ) AAU . The difference was not statistically significant ( p value > 0.05 ) . The prevalence rate of GDM diagnosed by 75 g OGTT was 11.6 % while that of 100 g OGTT was 4.5 % . The difference was significant ( p value = 0.04 ) . The incidence rate of foetal macrosomia among GDM cases diagnosed by 100 g OGTT was 66.7 % as against 23.1 % among those diagnosed by 75 g OGTT . Statistical difference could not be determined because of the small number . CONCLUSION Plasma glucose response to OGTT among Nigerian pregnant women has little or no respect for the load of the glucose administered . 100 g OGTT- based NDDG criteria was more stringent than 75 g OGTT-based WHO criteria in identifying GDM . However it appears to be more specific for detecting the complications associated with the condition though it will require a larger study to vali date this cl aim OBJECTIVE To demonstrate a role of early insulin secretion on plasma glucose levels after different amounts of oral glucose loads in pregnant women . MATERIAL AND METHOD Forty-one pregnant women with normal glucose tolerance according to the Carpenter and Coustan ' s criteria and 25 non-pregnant women ( control group ) with normal glucose tolerance according to the World Health Organization criteria were enrolled . Each subject was r and omly scheduled to perform both the 100-g and 75-g OGTT within a 1-week interval . Venous blood was drawn at fasting , 30- , 60- , 120- , and 180-minute intervals during both tests for determination of plasma glucose and serum insulin levels . RESULTS The mean ( + /- SE ) ages of the pregnant and control groups were 33.3 + /- 0.9 and 31.8 + /- 1.4 years , respectively . The mean gestational age at the time of performing OGTT of the pregnant group was 28.7 + /- 0.6 weeks . In the non-pregnant group , the plasma glucose concentrations were not different between 75-g and 100-g OGTT whereas the serum insulin levels at the 30 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . In the pregnant group , both plasma glucose and serum insulin concentrations at the 120 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT . CONCLUSION The limited ability of early insulin secretion to increase when glucose load increased in the pregnant women could explain the high plasma glucose levels at 2 and 3 hours of 100-g OGTT compared to those of 75-g OGTT Background The risks associated with gestational diabetes mellitus ( GDM ) are well recognized , and there is increasing evidence to support treatment of the condition . However , clear guidance on the ideal approach to screening for GDM is lacking . Professional groups continue to debate whether selective screening ( based on risk factors ) or universal screening is the most appropriate approach . Additionally , there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment . Furthermore , the implication s of possible screening options on health care costs are not well established . In response to this uncertainty there have been repeated calls for well- design ed , r and omised trials to determine the efficacy of screening , diagnosis , and management plans for GDM . We describe a r and omised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care setting s. Methods / Design This will be an unblinded , two-group , parallel r and omised controlled trial ( RCT ) . The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Irel and : Galway University Hospital and Mayo General Hospital . Participants will be offered  universal screening for GDM  at 24 to 28 weeks gestation in either primary care ( n = 392 ) or secondary care ( n = 392 ) locations . The primary outcome variable is the uptake rate of screening . Secondary outcomes include indicators of clinical effectiveness of screening at each screening site ( primary and secondary ) including gestational week at time of screening , time to access antenatal diabetes services for women diagnosed with GDM , and pregnancy and neonatal outcomes for women with GDM . In addition , parallel economic and qualitative evaluations will be conducted . The trial will cover the period from the woman ’s first hospital antenatal visit at 12 to 18 weeks gestation , until the completion of the pregnancy . Trial registration Current Controlled Trials : IS RCT 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 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 examine the effect of prior meal ingestion on the glucose , insulin , and C-peptide response to a 50-g glucose challenge test in the third trimester of pregnancy . RESEARCH DESIGN AND METHODS Ten pregnant women with gestational diabetes mellitus and 12 
    Output:
    