***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 Type 2 diabetes mellitus is a worldwide challenge . Practice guidelines promote structured self-monitoring of blood glucose ( SMBG ) for informing health care providers about glycemic control and providing patient feedback to increase knowledge , self-efficacy , and behavior change .  Paired glucose testing — pairs of glucose results obtained before and after a meal or physical activity — is a method of structured SMBG . However , frequent access to glucose data to interpret values and recommend actions is challenging . A complete feedback loop— data collection and interpretation combined with feedback to modify treatment — has been associated with improved outcomes , yet there remains limited integration of SMBG feedback in diabetes management . Incorporating telehealth remote monitoring and asynchronous electronic health record ( EHR ) feedback from certified diabetes educators (CDEs)—specialists in glucose pattern management — employ the complete feedback loop to improve outcomes . Objective The purpose of this study was to evaluate a telehealth remote monitoring intervention using paired glucose testing and asynchronous data analysis in adults with type 2 diabetes . The primary aim was change in glycated hemoglobin (A1c)—a measure of overall glucose management — between groups after 6 months . The secondary aims were change in self-reported Summary of Diabetes Self-Care Activities ( SDSCA ) , Diabetes Empowerment Scale , and Diabetes Knowledge Test . Methods A 2-group r and omized clinical trial was conducted comparing usual care to telehealth remote monitoring with paired glucose testing and asynchronous virtual visits .  Participants were aged 30 - 70 years , not using insulin with A1c levels between 7.5 % and 10.9 % ( 58 - 96 mmol/mol ) . The telehealth remote monitoring tablet computer transmitted glucose data and facilitated a complete feedback loop to educate participants , analyze actionable glucose data , and provide feedback . Data from paired glucose testing were analyzed asynchronously using computer-assisted pattern analysis and were shared with patients via the EHR weekly . CDEs called participants monthly to discuss paired glucose testing trends and treatment changes . Separate mixed-effects models were used to analyze data . Results Participants ( N=90 ) were primarily white ( 64 % , 56/87 ) , mean age 58 ( SD 11 ) years , mean body mass index 34.1 ( SD 6.7 ) kg/m2 , with diabetes for mean 8.2 ( SD 5.4 ) years , and a mean A1c of 8.3 % ( SD 1.1 ; 67 mmol/mol ) . Both groups lowered A1c with an estimated average decrease of 0.70 percentage points in usual care group and 1.11 percentage points in the treatment group with a significant difference of 0.41 percentage points at 6 months ( SE 0.08 , t159=–2.87 , P=.005 ) . Change in medication ( SE 0.21 , t157=–3.37 , P=.009 ) was significantly associated with lower A1c level . The treatment group significantly improved on the SDSCA subscales carbohydrate spacing ( P=.04 ) , monitoring glucose ( P=.001 ) , and foot care ( P=.02 ) . Conclusions An eHealth model incorporating a complete feedback loop with telehealth remote monitoring and paired glucose testing with asynchronous data analysis significantly improved A1c levels compared to usual care . Trial Registration Clinical trials.gov NCT01715649 ; https://www . clinical trials.gov/ct2/show/NCT01715649 ( Archived by WebCite at http://www.webcitation.org/6ZinLl8D0 ) AIM This paper is a report of a study conducted to assess the effectiveness of an educational intervention for people with type 2 diabetes based on self-completed instruments to identify particular areas of self-care needs . BACKGROUND Diabetes is a dem and ing disease which requires self-care . Instruments that identify self-care needs or factors affecting self-care can be helpful to detect level of self-care , distress or knowledge among individuals with diabetes . METHODS Participants were r and omized into intervention ( n = 28 ) or control groups ( n = 25 ) . Both groups answered five vali date d instruments three times , at baseline and after 3 and 6 months , and biological measurements were conducted simultaneously . The intervention was based on an empowerment approach . The study started in November 2005 and lasted until March 2007 . FINDINGS There was no statistically significant difference between groups in level of glycated haemoglobin postintervention as it reduced statistically significantly in both groups between baseline and 3 months but increased again after 6 months . There was no statistically significant difference between groups in body mass index reduction ; the intervention group achieved a statistically significant body mass index reduction but this was unchanged in the control group . No statistically significant differences between groups were found in scores for empowerment , well-being and distress . There was a statistically significant difference between groups in knowledge postintervention . CONCLUSION Use of instruments to identify self-care needs can enable patient-tailored care as it allows direct focusing on issues that are challenging and of relevance for each individual . It seems to be feasible to use the telephone to conduct an empowering educational intervention after one meeting Purpose The purpose of this pilot study was to evaluate the effects of a culturally sensitive , empowerment-based diabetes self-management education program for Spanish-speaking Hispanic/Latinos . Methods A prospect i ve quasi-experimental repeated measures design tested the effectiveness of the ¡ Si , Yo Puedo Controlar Mi Diabetes ! diabetes self-management education program . In sum , 144 persons residing in 2 Texas counties at the Texas-Mexico border ( Starr and Hidalgo ) served as participants . Two groups were formed , an intervention and a control ( wait list ) . Clinical ( A1C ) , cognitive , attitudinal , behavioral , and cultural assessment s were collected at baseline and 3 months . Results Demographic characteristics for the intervention and control groups were similar . Both groups were predominately female , low income , older than 40 years , and minimally acculturated . Baseline and posttest findings showed that the intervention group had a significant reduction in A1C values ; median difference was 0.3 ( n = 45 ) , especially for those with higher baseline values . Participants in the intervention group also improved in their self-efficacy and self-care scores . Conclusions Findings from the study suggest that additional dissemination of a diabetes self-management education program for Spanish-speaking Hispanic/Latinos is warranted to improve clinical outcomes and associated diabetes self-efficacy and self-care behaviors AIMS To assess the efficacy ( change in HbA1c ) of a patient-held communication , self-empowerment and educational device for people with diabetes  ( the New Zeal and Diabetes Passport ) in patients with poor glycaemic control . RESEARCH DESIGN AND METHODS A 12-month , multicentre , general practice -based r and omized controlled trial in urban , provincial and rural New Zeal and involving 398 people with poorly controlled Type 1 or Type 2 diabetes . The intervention included a specifically design ed and piloted New Zeal and Diabetes Passport including information relating to diabetes knowledge , self- assessment s , and guidance concerning how to engage with diabetes health professionals . The primary end point was change in HbA1c . Assessment s were made at 0 , 6 and 12 months . RESULTS Two hundred and twenty-two patients received the Passport , 176 the control booklet , coming from 69 and 66 general practitioners , respectively . Use of the Passport was associated with a relative reduction in HbA1c of 0.4 % ( P = 0.017 ) and a relative increase in weight of 1.0 kg/m2 ( P = 0.028 ) , but no changes in diabetes knowledge , attitudes to diabetes or risk factors for diabetic tissue damage . CONCLUSIONS The dissemination of the New Zeal and Diabetes Passport , in isolation , was not associated with improvements in either diabetes knowledge or self-empowerment . While a small improvement in glycaemic control occurred , this was probably due to changes in insulin therapy in the intervention group . It is possible that linking the use of the Passport with other behavioural and educational interventions may make the Passport more useful . Further study is required to confirm the effect of such multifaceted interventions OBJECTIVE To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes . MATERIAL S AND METHODS Engaging and Motivating Patients Online With Enhanced Re sources for Diabetes was a 12-month parallel r and omized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin ( A1C ) values ≥7.5 % from primary care sites sharing an electronic health record . The intervention included : ( 1 ) wirelessly uploaded home glucometer readings with graphical feedback ; ( 2 ) comprehensive patient-specific diabetes summary status report ; ( 3 ) nutrition and exercise logs ; ( 4 ) insulin record ; ( 5 ) online messaging with the patient 's health team ; ( 6 ) nurse care manager and dietitian providing advice and medication management ; and ( 7 ) personalized text and video educational ' nuggets ' dispensed electronically by the care team . A1C was the primary outcome variable . RESULTS Compared with usual care ( UC , n=189 ) , patients in the intervention ( INT , n=193 ) group had significantly reduced A1C at 6 months ( -1.32 % INT vs -0.66 % UC ; p<0.001 ) . At 12 months , the differences were not significant ( -1.14 % INT vs -0.95 % UC ; p=0.133 ) . In post hoc analysis , significantly more INT patients had improved diabetes control ( > 0.5 % reduction in A1C ) than UC patients at 12 months ( 69.9 ( 95 % CI 63.2 to 76.5 ) vs 55.4 ( 95 % CI 48.4 to 62.5 ) ; p=0.006 ) . CONCLUSIONS A nurse-led , multidisciplinary health team can manage a population of diabetic patients in an online disease management program . INT patients achieved greater decreases in A1C at 6 months than UC patients , but the differences were not sustained at 12 months . More INT than UC patients achieved improvement in A1C ( > 0.5 % decrease ) . Trial registered in clinical trials.gov : # NCT00542204 Summary Background Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes . We investigated the effect of early multifactorial treatment after diagnosis by screening . Methods In a pragmatic , cluster-r and omised , parallel-group trial done in Denmark , the Netherl and s , and the UK , 343 general practice s were r and omly assigned screening of registered patients aged 40–69 years without known diabetes followed by routine care of diabetes or screening followed by intensive treatment of multiple risk factors .  The primary endpoint was first cardiovascular event , including cardiovascular mortality and morbidity , revascularisation , and non-traumatic amputation within 5 years . Patients and staff assessing outcomes were unaware of the practice 's study group assignment . Analysis was done by intention to treat . This study is registered with Clinical Trials.gov , number NCT00237549 . Findings Primary endpoint data were available for 3055 ( 99·9 % ) of 3057 screen-detected patients . The mean age was 60·3 ( SD 6·9 ) years and the mean duration of follow-up was 5·3 ( SD 1·6 ) years .  Improvements in cardiovascular risk factors ( HbA1c and cholesterol concentrations and blood pressure ) were slightly but significantly better in the intensive treatment group . The incidence of first cardiovascular event was 7·2 % ( 13·5 per 1000 person-years ) in the intensive treatment group and 8·5 % ( 15·9 per 1000 person-years ) in the routine care group ( hazard ratio 0·83 , 95 % CI 0·65–1·05 ) , and of all-cause mortality 6·2 % ( 11·6 per 1000 person-years ) and 6·7 % ( 12·5 per 1000 person-years ; 0·91 , 0·69–1·21 ) , respectively . Interpretation An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small , non-significant reduction in the incidence of cardiovascular events and death . Funding National Health Service Denmark , Danish Council for Strategic Research , Danish Research Foundation for General Practice , Danish Centre for Evaluation and Health Technology Assessment , Danish National Board of Health , Danish Medical Research Council , Aarhus University Research Foundation , Wellcome Trust , UK Medical Research Council , UK NIHR Health Technology Assessment Programme , UK National Health Service R&D , UK National Institute for Health Research , Julius Center for Health Sciences and Primary Care , University Medical Center , Utrecht , Novo Nordisk , Astra , Pfizer , GlaxoSmithKline , Servier , HemoCue , Merck Background Providing care for adolescents with type 1 diabetes is complex , dem and ing , and often unsuccessful . Guided self-determination ( GSD ) is a life skills approach that has been proven effective in caring for adults with type 1 diabetes . To improve care , GSD was revised for adolescents , their parents , and interdisciplinary healthcare providers ( HCP ) to create GSD-Youth ( GSD-Y ) . We evaluated the impact of GSD-Y after 
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However , after meta- analysis , no statistically significant improvement was found for HbA1c .
CONCLUSION This systematic review showed that individual strategies for DM empowerment were not effective in reducing HbA1c , despite contributing to improvements in psychosocial parameters .