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 world health organization estimates that more than 180 million people worldwide have diabetes , and by 2030 it is expected that this number will have doubled . there is an alarming increase in the incidence and prevalence of diabetes mellitus ( dm ) in asian indians . the alveolar capillary network in the lung is a large micro - vascular unit and may be affected by microangiopathy . however , because of its large reserve , substantial loss of the microvascular bed can be tolerated without developing dyspnoea . as a result , pulmonary diabetic micro - angiopathy may be under - recognized clinically . in dm pulmonary functionshave been studied frequently in countries other than india , while in our country there are few studies concerning these abnormalities and their relationship with glycosylated hemoglobin ( hba1c ) and duration of the disease . reduced elastic recoil , reduced lung volume , diminished respiratory muscle performance , chronic low grade inflammation , decrease in pulmonary diffusion capacity for carbon monoxide , autonomic neuropathy involving respiratory muscles are some of the important changes occurring in dm . despite the unclear nature , the relationship between dm and pulmonary function tests ( pfts ) remains important because of potential epidemiological and clinical implications . hence , we hypothesized that pfts are affected in dm in indian population and the changes may correlate with hba1c and the duration of the disease . the study aims to evaluate the pfts in type 2 dm patients and compare them with the age and gender matched healthy controls . we also determine the co - relation of the hba1c and duration of the disease with pfts in type 2 dm patients . the study aims to evaluate the pfts in type 2 dm patients and compare them with the age and gender matched healthy controls . we also determine the co - relation of the hba1c and duration of the disease with pfts in type 2 dm patients . the study was carried out in collaboration with diabetes outpatient department of sassoon general hospitals . sixty male patients of type 2 dm diagnosed by the treating physician , of the age group 4060 years taking oral hypoglycemics , were randomly selected from the diabetes outpatient department . patients having complaints of cough , sputum , or dyspnoea . smokers and patients with any cardio - respiratory illnesses or major diseases . sixty normal healthy males of the same age group and socioeconomic status from patients relatives were selected as control group . those with cardio - respiratory , musculoskeletal , or endocrine diseases were excluded from the study . fasting and postprandial blood glucose levels were measured by glucose oxidase method to rule out type 2 dm in them . informed written consent was taken from patients as well as from controls . all the patients were handed a questionnaire that contained a detailed personal and medical history . pfts of the patients as well as of the controls were performed with turbine flow sensor - based 702 helios - spirometer ( chandigarh , india ) between 11 am and 12 pm . all the tests were conducted according to american thoracic society / european respiratory society ( ats / ers guidelines ) in a quiet room in sitting position by the trained personnel . the controls andpatients performed spirometry three times at the interval of 15 minutes and the best of the three was taken into account . parameters recorded were - forced vital capacity ( fvc ) in liters , forced expiratory volume in 1 second ( fev1 ) , fev1 / fvc in percentage ( % ) , forced expiratory flow during 25 % of fvc ( fef25 ) , forced expiratory flow during 50 % of fvc ( fef50 ) , forced expiratory flow during 75 % of fvc ( fef75 ) , forced expiratory flow during 2575 % of fvc ( fef2575 ) , forced expiratory flow during 0.21.2 liters of fvc ( fef0 .21.2 ) , and peak expiratory flow rate ( pefr ) . for all these parameters percentage of predicted values for the respective age , height , and weight were taken into consideration . nearly 2 ml of venous blood was collected in ethylenediamine tetra acetic acid ( edta ) bulb in all the diabetic patients with aseptic precautions . hba1c of all the patients was estimated by ion exchange resin method by the diagnostic glycohaemoglobin kits of asritha diatech as per the guidelines provided . all data were collected in a data collection form and then transferred to an excel sheet by two independent data entry operators . correlations between fvc and fev1 and hba1c and duration of illness in diabetic patients were analyzed by applying pearsons coefficient . statistical analysis was done by using ssps version 11 and graphic prism pad version 5 ( statistician , b.j . medical college ) . patients having complaints of cough , sputum , or dyspnoea . smokers and patients with any cardio - respiratory illnesses or major diseases . sixty normal healthy males of the same age group and socioeconomic status from patients relatives were selected as control group . those with cardio - respiratory , musculoskeletal , or endocrine diseases were excluded from the study . fasting and postprandial blood glucose levels were measured by glucose oxidase method to rule out type 2 dm in them . informed written consent was taken from patients as well as from controls . all the patients were handed a questionnaire that contained a detailed personal and medical history . pfts of the patients as well as of the controls were performed with turbine flow sensor - based 702 helios - spirometer ( chandigarh , india ) between 11 am and 12 pm . all the tests were conducted according to american thoracic society / european respiratory society ( ats / ers guidelines ) in a quiet room in sitting position by the trained personnel . the controls and patients performed spirometry three times at the interval of 15 minutes and the best of the three was taken into account . parameters recorded were - forced vital capacity ( fvc ) in liters , forced expiratory volume in 1 second ( fev1 ) , fev1 / fvc in percentage ( % ) , forced expiratory flow during 25 % of fvc ( fef25 ) , forced expiratory flow during 50 % of fvc ( fef50 ) , forced expiratory flow during 75 % of fvc ( fef75 ) , forced expiratory flow during 2575 % of fvc ( fef2575 ) , forced expiratory flow during 0.21.2 liters of fvc ( fef0 .21.2 ) , and peak expiratory flow rate ( pefr ) . for all these parameters percentage of predicted values for the respective age , height , and weight were taken into consideration . nearly 2 ml of venous blood was collected in ethylenediamine tetra acetic acid ( edta ) bulb in all the diabetic patients with aseptic precautions . hba1c of all the patients was estimated by ion exchange resin method by the diagnostic glycohaemoglobin kits of asritha diatech as per the guidelines provided . all data were collected in a data collection form and then transferred to an excel sheet by two independent data entry operators . correlations between fvc and fev1 and hba1c and duration of illness in diabetic patients were analyzed by applying pearsons coefficient . statistical analysis was done by using ssps version 11 and graphic prism pad version 5 ( statistician , b.j . table 1 depicts the physical characteristics of the normal controls as well as the patients of dm . age , height , and weight of both the groups were comparable as statistically there was no difference between them ( p 0.05 ) . our study showed that all the pulmonary parameters , that is , fvc , fev1 , fef25 , fef50 , fef75 , fef2575 , fef0 .21.2 , and pefr were significantly reduced except fev1 / fvc in patients of type 2 dm as compared with the healthy controls ( p 0.05 ) . the ratio fev1 / fvc is almost equal in normal controls and diabetic patients ( p 0.05 ) [ table 2 , figure 2 ] . on correlating the fvc and fev1 with duration of illness and hba1c , we found that there was no significant correlation between them ( p 0.05 ) [ table 3 , figures 1 and 2 ] . physical characteristics of subjects comparison of pfts in patients with type 2 dm and healthy controls correlation of hba1c with pfts . p 0.05 - statistically not significant correlation of hba1c and duration of dm with pfts correlation of pfts with duration of diabetes . our study showed that all the pulmonary parameters , that is , fvc , fev1 , fef25 , fef50 , fef75 , fef2575 , fef0 .21.2 , and pefr were significantly reduced except fev1 / fvc in patients of type 2 dm as compared with the healthy controls . this is in accordance with previous studies . some of the prospective and cross sectional studies have shown low vital capacity or restrictive pattern in type 2 dm . meta - analysis by van den borst , et al . showed that dm is associated with statistically significant , impaired pulmonary function in a restrictive pattern . moreover , these results were irrespective of body mass index ( bmi ) , smoking , diabetes duration , and hba1c levels . uchida , et al . found that there was decreased pulmonary diffusing capacity in patients with diabetes with perfusion defect on ventilation perfusion scintigrams . it was not possible for us to analyze the pulmonary diffusing capacity because of practical difficulties . davis , et al . conducted a study in western australia in large number of patients of type 2 dm . they found that vc , fvc , fev1 , and pefr decreased at an average of between 1.1 % and 3.1 % of predicted values / year in type 2 dm patients . ehrlich , et al . showed that patients with type 2 dm were at increased risk of several pulmonary condition like - asthma , chronic obstructive pulmonary disease ( copd ) , fibrosis , and pneumonia . few studies have mentioned that no significant differences were observed in patients of type 2 dm . probably the small sample size is the reason behind these findings . normal lung mechanics and gas exchange are influenced by the integrity of the pulmonary connective tissue and microvaculature . acceleration of aging process in connective tissue cross links and presence of nonenzymatic glycosylation and modification of alveolar surfactant action causes reduction in pfts . there have been reports of histopathological changes in the diabetic patients . in the study by weynand , it was found that alveolar epithelium , endothelium capillary , and basal laminaes were thickened in lungs on electron microscopy , when compared with the controls . in addition , the thickening of basal laminae was of the same magnitude in lung and kidney . moreover , reduced pulmonary capillary blood volume was found , favoring the evidence of microangiopathy . this could lead to redistribution of the pulmonary circulation , resulting in well ventilated areas to become underperfused . stiffening of thorax and lung parenchyma can occur because of nonenzymatic glycosytion of these structural compounds . this may lead to restrictive pattern . in our studies , since the fvc / fev1 ratio is statistically not significantly different in dm patients as compared with normal controls , other pft values are lower in dm patients ; this strongly suggests restrictive pattern in dm patients . studies have even shown diabetic polyneuropathy , which affects respiratory neuromuscular function and thus reducing pulmonary volumes . on correlating the fvc and fev1 with duration of illness and hba1c , we found that there was no significant correlation between them [ table 3 , figures 2 and 3 ] . they argued that hba1c levels are indicators of glycemic control for a short period of 12 months , it was not adequate to conclude that the plasma glucose level was not related to decreased pfts . while some studies have shown that the decline in pfts was negatively correlated with hba1c . there are studies that have reported no significant correlation between pfts and duration of diseases , while some of the studies have reported a strong negative correlation of pfts with duration . since dm is a disease , which involves multiple organs randomly , the study of the effect of duration of the disease on them requires further research . several studies have analyzed the association between impaired lung function and death and found that a 10 % decrease in fev1 was associated with a 12 % increase in all cause mortality in type 2 dm . further studies may clarify whether this should be included as a long - term complication of diabetes . the role of strict glycemic control on pulmonary function in diabetic patients is another interesting aspect and needs further studies . the impairment in pfts can lower the threshold for clinical manifestations of acute or chronic lung disease . it seems to be necessary to repeat pfts and to assess the changes of pulmonary functions among the same subjects . over a long observation coursefurther studies may clarify whether this should be included as a long - term complication of diabetes . the role of strict glycemic control on pulmonary function in diabetic patients is another interesting aspect and needs further studies . the impairment in pfts can lower the threshold for clinical manifestations of acute or chronic lung disease . it seems to be necessary to repeat pfts and to assess the changes of pulmonary functions among the same subjects . over a long observation coursedm being a systemic disease , also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues , reduced pulmonary elastic recoil , and inflammatory changes in lungs . we found that glycemic levels and duration of disease are probably not the major determinants of lung pathology , which requires further research .
output:

agent
background : pulmonary complications of diabetes mellitus ( dm ) have been poorly characterized . some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients . some studies have shown abnormal respiratory parameters in patients of dm . moreover , the duration of dm and glycemic control have varied impact on the pulmonary functions.aims and objectives : the study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects . we correlated forced vital capacity ( fvc ) and forced expiratory volume in 1 second ( fev1 ) in diabetic patients with duration of the disease and glycosylated hemoglobin ( hba1c ) . materials and methods : pulmonary function tests ( pfts ) were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40 - 60 years by using helios 702 spirometer . the pfts recorded were - fvc , fev1 , fev1 / fvc , fef25 , fef50 , fef75 , fef2575 , fef0 .21.2 , and peak expiratory flow rate ( pefr ) . hba1c of all the patients was estimated by ion exchange resin method , which is a very standard method of estimation . pfts of diabetic patients and controls were compared by applying students unpaired t test . associations between fvc and fev1 and hba1c and duration of illness in diabetic patients were analyzed by applying pearsons coefficient.results : the pfts were significantly decreased in diabetic patients compared with the healthy controls except fev1 / fvc . there was no correlation found between fvc and fev1 and duration of illness as well as hba1c.conclusion : dm being a systemic disease , which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues , reduced pulmonary elastic recoil and inflammatory changes in lungs . we found glycemic levels and duration of disease are probably not the major determinants of lung pathology , which requires further research .
***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 world health organization estimates that more than 180 million people worldwide have diabetes , and by 2030 it is expected that this number will have doubled . there is an alarming increase in the incidence and prevalence of diabetes mellitus ( dm ) in asian indians . the alveolar capillary network in the lung is a large micro - vascular unit and may be affected by microangiopathy . however , because of its large reserve , substantial loss of the microvascular bed can be tolerated without developing dyspnoea . as a result , pulmonary diabetic micro - angiopathy may be under - recognized clinically . in dm pulmonary functionshave been studied frequently in countries other than india , while in our country there are few studies concerning these abnormalities and their relationship with glycosylated hemoglobin ( hba1c ) and duration of the disease . reduced elastic recoil , reduced lung volume , diminished respiratory muscle performance , chronic low grade inflammation , decrease in pulmonary diffusion capacity for carbon monoxide , autonomic neuropathy involving respiratory muscles are some of the important changes occurring in dm . despite the unclear nature , the relationship between dm and pulmonary function tests ( pfts ) remains important because of potential epidemiological and clinical implications . hence , we hypothesized that pfts are affected in dm in indian population and the changes may correlate with hba1c and the duration of the disease . the study aims to evaluate the pfts in type 2 dm patients and compare them with the age and gender matched healthy controls . we also determine the co - relation of the hba1c and duration of the disease with pfts in type 2 dm patients . the study aims to evaluate the pfts in type 2 dm patients and compare them with the age and gender matched healthy controls . we also determine the co - relation of the hba1c and duration of the disease with pfts in type 2 dm patients . the study was carried out in collaboration with diabetes outpatient department of sassoon general hospitals . sixty male patients of type 2 dm diagnosed by the treating physician , of the age group 4060 years taking oral hypoglycemics , were randomly selected from the diabetes outpatient department . patients having complaints of cough , sputum , or dyspnoea . smokers and patients with any cardio - respiratory illnesses or major diseases . sixty normal healthy males of the same age group and socioeconomic status from patients relatives were selected as control group . those with cardio - respiratory , musculoskeletal , or endocrine diseases were excluded from the study . fasting and postprandial blood glucose levels were measured by glucose oxidase method to rule out type 2 dm in them . informed written consent was taken from patients as well as from controls . all the patients were handed a questionnaire that contained a detailed personal and medical history . pfts of the patients as well as of the controls were performed with turbine flow sensor - based 702 helios - spirometer ( chandigarh , india ) between 11 am and 12 pm . all the tests were conducted according to american thoracic society / european respiratory society ( ats / ers guidelines ) in a quiet room in sitting position by the trained personnel . the controls andpatients performed spirometry three times at the interval of 15 minutes and the best of the three was taken into account . parameters recorded were - forced vital capacity ( fvc ) in liters , forced expiratory volume in 1 second ( fev1 ) , fev1 / fvc in percentage ( % ) , forced expiratory flow during 25 % of fvc ( fef25 ) , forced expiratory flow during 50 % of fvc ( fef50 ) , forced expiratory flow during 75 % of fvc ( fef75 ) , forced expiratory flow during 2575 % of fvc ( fef2575 ) , forced expiratory flow during 0.21.2 liters of fvc ( fef0 .21.2 ) , and peak expiratory flow rate ( pefr ) . for all these parameters percentage of predicted values for the respective age , height , and weight were taken into consideration . nearly 2 ml of venous blood was collected in ethylenediamine tetra acetic acid ( edta ) bulb in all the diabetic patients with aseptic precautions . hba1c of all the patients was estimated by ion exchange resin method by the diagnostic glycohaemoglobin kits of asritha diatech as per the guidelines provided . all data were collected in a data collection form and then transferred to an excel sheet by two independent data entry operators . correlations between fvc and fev1 and hba1c and duration of illness in diabetic patients were analyzed by applying pearsons coefficient . statistical analysis was done by using ssps version 11 and graphic prism pad version 5 ( statistician , b.j . medical college ) . patients having complaints of cough , sputum , or dyspnoea . smokers and patients with any cardio - respiratory illnesses or major diseases . sixty normal healthy males of the same age group and socioeconomic status from patients relatives were selected as control group . those with cardio - respiratory , musculoskeletal , or endocrine diseases were excluded from the study . fasting and postprandial blood glucose levels were measured by glucose oxidase method to rule out type 2 dm in them . informed written consent was taken from patients as well as from controls . all the patients were handed a questionnaire that contained a detailed personal and medical history . pfts of the patients as well as of the controls were performed with turbine flow sensor - based 702 helios - spirometer ( chandigarh , india ) between 11 am and 12 pm . all the tests were conducted according to american thoracic society / european respiratory society ( ats / ers guidelines ) in a quiet room in sitting position by the trained personnel . the controls and patients performed spirometry three times at the interval of 15 minutes and the best of the three was taken into account . parameters recorded were - forced vital capacity ( fvc ) in liters , forced expiratory volume in 1 second ( fev1 ) , fev1 / fvc in percentage ( % ) , forced expiratory flow during 25 % of fvc ( fef25 ) , forced expiratory flow during 50 % of fvc ( fef50 ) , forced expiratory flow during 75 % of fvc ( fef75 ) , forced expiratory flow during 2575 % of fvc ( fef2575 ) , forced expiratory flow during 0.21.2 liters of fvc ( fef0 .21.2 ) , and peak expiratory flow rate ( pefr ) . for all these parameters percentage of predicted values for the respective age , height , and weight were taken into consideration . nearly 2 ml of venous blood was collected in ethylenediamine tetra acetic acid ( edta ) bulb in all the diabetic patients with aseptic precautions . hba1c of all the patients was estimated by ion exchange resin method by the diagnostic glycohaemoglobin kits of asritha diatech as per the guidelines provided . all data were collected in a data collection form and then transferred to an excel sheet by two independent data entry operators . correlations between fvc and fev1 and hba1c and duration of illness in diabetic patients were analyzed by applying pearsons coefficient . statistical analysis was done by using ssps version 11 and graphic prism pad version 5 ( statistician , b.j . table 1 depicts the physical characteristics of the normal controls as well as the patients of dm . age , height , and weight of both the groups were comparable as statistically there was no difference between them ( p 0.05 ) . our study showed that all the pulmonary parameters , that is , fvc , fev1 , fef25 , fef50 , fef75 , fef2575 , fef0 .21.2 , and pefr were significantly reduced except fev1 / fvc in patients of type 2 dm as compared with the healthy controls ( p 0.05 ) . the ratio fev1 / fvc is almost equal in normal controls and diabetic patients ( p 0.05 ) [ table 2 , figure 2 ] . on correlating the fvc and fev1 with duration of illness and hba1c , we found that there was no significant correlation between them ( p 0.05 ) [ table 3 , figures 1 and 2 ] . physical characteristics of subjects comparison of pfts in patients with type 2 dm and healthy controls correlation of hba1c with pfts . p 0.05 - statistically not significant correlation of hba1c and duration of dm with pfts correlation of pfts with duration of diabetes . our study showed that all the pulmonary parameters , that is , fvc , fev1 , fef25 , fef50 , fef75 , fef2575 , fef0 .21.2 , and pefr were significantly reduced except fev1 / fvc in patients of type 2 dm as compared with the healthy controls . this is in accordance with previous studies . some of the prospective and cross sectional studies have shown low vital capacity or restrictive pattern in type 2 dm . meta - analysis by van den borst , et al . showed that dm is associated with statistically significant , impaired pulmonary function in a restrictive pattern . moreover , these results were irrespective of body mass index ( bmi ) , smoking , diabetes duration , and hba1c levels . uchida , et al . found that there was decreased pulmonary diffusing capacity in patients with diabetes with perfusion defect on ventilation perfusion scintigrams . it was not possible for us to analyze the pulmonary diffusing capacity because of practical difficulties . davis , et al . conducted a study in western australia in large number of patients of type 2 dm . they found that vc , fvc , fev1 , and pefr decreased at an average of between 1.1 % and 3.1 % of predicted values / year in type 2 dm patients . ehrlich , et al . showed that patients with type 2 dm were at increased risk of several pulmonary condition like - asthma , chronic obstructive pulmonary disease ( copd ) , fibrosis , and pneumonia . few studies have mentioned that no significant differences were observed in patients of type 2 dm . probably the small sample size is the reason behind these findings . normal lung mechanics and gas exchange are influenced by the integrity of the pulmonary connective tissue and microvaculature . acceleration of aging process in connective tissue cross links and presence of nonenzymatic glycosylation and modification of alveolar surfactant action causes reduction in pfts . there have been reports of histopathological changes in the diabetic patients . in the study by weynand , it was found that alveolar epithelium , endothelium capillary , and basal laminaes were thickened in lungs on electron microscopy , when compared with the controls . in addition , the thickening of basal laminae was of the same magnitude in lung and kidney . moreover , reduced pulmonary capillary blood volume was found , favoring the evidence of microangiopathy . this could lead to redistribution of the pulmonary circulation , resulting in well ventilated areas to become underperfused . stiffening of thorax and lung parenchyma can occur because of nonenzymatic glycosytion of these structural compounds . this may lead to restrictive pattern . in our studies , since the fvc / fev1 ratio is statistically not significantly different in dm patients as compared with normal controls , other pft values are lower in dm patients ; this strongly suggests restrictive pattern in dm patients . studies have even shown diabetic polyneuropathy , which affects respiratory neuromuscular function and thus reducing pulmonary volumes . on correlating the fvc and fev1 with duration of illness and hba1c , we found that there was no significant correlation between them [ table 3 , figures 2 and 3 ] . they argued that hba1c levels are indicators of glycemic control for a short period of 12 months , it was not adequate to conclude that the plasma glucose level was not related to decreased pfts . while some studies have shown that the decline in pfts was negatively correlated with hba1c . there are studies that have reported no significant correlation between pfts and duration of diseases , while some of the studies have reported a strong negative correlation of pfts with duration . since dm is a disease , which involves multiple organs randomly , the study of the effect of duration of the disease on them requires further research . several studies have analyzed the association between impaired lung function and death and found that a 10 % decrease in fev1 was associated with a 12 % increase in all cause mortality in type 2 dm . further studies may clarify whether this should be included as a long - term complication of diabetes . the role of strict glycemic control on pulmonary function in diabetic patients is another interesting aspect and needs further studies . the impairment in pfts can lower the threshold for clinical manifestations of acute or chronic lung disease . it seems to be necessary to repeat pfts and to assess the changes of pulmonary functions among the same subjects . over a long observation coursefurther studies may clarify whether this should be included as a long - term complication of diabetes . the role of strict glycemic control on pulmonary function in diabetic patients is another interesting aspect and needs further studies . the impairment in pfts can lower the threshold for clinical manifestations of acute or chronic lung disease . it seems to be necessary to repeat pfts and to assess the changes of pulmonary functions among the same subjects . over a long observation coursedm being a systemic disease , also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues , reduced pulmonary elastic recoil , and inflammatory changes in lungs . we found that glycemic levels and duration of disease are probably not the major determinants of lung pathology , which requires further research .
output:
