***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: AIMS To assess the effect of regular diabetic health education on cardiovascular risk factors in Chinese Type 2 diabetic patients . METHODS This was a 1-year prospect i ve r and omized study . One hundred and eighty Type 2 diabetic subjects were recruited from three regional diabetic centres in Hong Kong . Ninety received additional structured reinforcement of diabetic health education by a trained nurse after the doctors ' consultations every 3 months ( intervention group ) . The others received the same medical care except no nursing reinforcement ( control group ) . Outcome measures included fasting plasma glucose , HbA(1c ) , body mass index , waist circumference , blood pressure and lipid profiles , which were assessed before the study and after 1 year . RESULTS Two of the controls defaulted follow-up . The intervention group and controls had similar age and sex distribution . At the end of study , the intervention group had reducted their waist circumference , diastolic blood pressure , HbA(1c ) , total cholesterol and low-density lipoprotein cholesterol levels . The controls had reduced their total cholesterol and low-density lipoprotein cholesterol levels . Other cardiovascular risk factors were not significantly changed in the controls . Addition of drugs and /or dosage increment of anti-diabetic drugs , lipid-lowering agents and anti-hypertensive agents were similar between the two groups . CONCLUSIONS Regular structured reinforcement with diabetic health education is useful . It helps to control more successfully some of the cardiovascular risk factors in Chinese Type 2 diabetic patients OBJECTIVE To test the effects of two Mediterranean diet ( MedDiet ) interventions versus a low-fat diet on incidence of diabetes . RESEARCH DESIGN AND METHODS This was a three-arm r and omized trial in 418 nondiabetic subjects aged 55–80 years recruited in one center ( PREDIMED-Reus , northeastern Spain ) of the Prevención con Dieta Mediterránea [ PREDIMED ] study , a large nutrition intervention trial for primary cardiovascular prevention in individuals at high cardiovascular risk . Participants were r and omly assigned to education on a low-fat diet ( control group ) or to one of two MedDiets , supplemented with either free virgin olive oil ( 1 liter/week ) or nuts ( 30 g/day ) . Diets were ad libitum , and no advice on physical activity was given . The main outcome was diabetes incidence diagnosed by the 2009 American Diabetes Association criteria . RESULTS After a median follow-up of 4.0 years , diabetes incidence was 10.1 % ( 95 % CI 5.1–15.1 ) , 11.0 % ( 5.9–16.1 ) , and 17.9 % ( 11.4–24.4 ) in the MedDiet with olive oil group , the MedDiet with nuts group , and the control group , respectively . Multivariable adjusted hazard ratios of diabetes were 0.49 ( 0.25–0.97 ) and 0.48 ( 0.24–0.96 ) in the MedDiet supplemented with olive oil and nuts groups , respectively , compared with the control group . When the two MedDiet groups were pooled and compared with the control group , diabetes incidence was reduced by 52 % ( 27–86 ) . In all study arms , increased adherence to the MedDiet was inversely associated with diabetes incidence . Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity . CONCLUSIONS MedDiets without calorie restriction seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk Objectives Our objective was to evaluate the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes in a low-income country ( Mali ) . Methods We conducted an open-label r and omised controlled trial . A total of 151 adults ( 76 % women , mean age 52.5 ) with type 2 diabetes ( HbA1c≥8 % ) , treated in the diabetes consultation units of two secondary health centres in Bamako , were allocated to peer-led structured patient education ( n = 76 ) or conventional care alone ( n = 75 ) . The intervention group received 1 year of culturally tailored structured patient education ( 3 courses of 4 sessions ) delivered in the community by five trained peer educators . Both groups underwent conventional diabetes monitoring and follow-up . Primary outcome was the mean absolute change in HbA1c from baseline to 12 months . Results 177 education sessions were delivered to the intervention group . Patient attrition was 8 % . From baseline to 12 months , the decrease in HbA1c levels was 1.05 % ( SD = 2.0 ; CI95 % : 1.54;-0.56 ) in the intervention group compared with 0.15 % ( SD = 1.7 ; CI95 % : -0.56 ; 0.26 ) in the control group , p = 0.006 . Mean BMI change was -1.65 kg/m2 ( SD = 2.5 ; CI95 % : -2.25 ; -1.06 ) in the intervention group and + 0.05 kg/m2 ( SD = 3.2 ; CI95 % : -0.71 ; 0.81 ) in the control group , p = 0.0005 . Mean waist circumference decreased by 3.34 cm ( SD = 9.3 ; CI95 % : -5.56;-1.13 ) in the intervention group and increased by 2.65 cm ( SD = 10.3 ; CI95 % : 0.20 ; 5.09 ) in the control group , p = 0.0003 . Conclusions Peer-led structured patient education delivered over 1 year to patients with poorly controlled type 2 diabetes in Mali  yielded substantial improvements in glycaemic control and anthropometric parameters . This is of importance for the scaling up of efficient interventions in low-re source setting s in the future . Trial registration Clinical Trials.gov Abstract We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population -based primary care data base through a retrospective analysis of economic impact during 2011 , including 126,811 patients with type 2 diabetes in Catalonia , Spain . Total annual costs included primary care visits , hospitalizations , referrals , diagnostic tests , self-monitoring test strips , medication , and dialysis .  For each patient , one control matched for age , gender and managing physician was r and omly selected from a population data base . The annual average cost per patient was € 3110.1 and € 1803.6 for diabetic and non-diabetic subjects , respectively ( difference € 1306.6 ; i.e. , 72.4 % increased cost ) . The costs of hospitalizations were € 1303.1 and € 801.6 ( 62.0 % increase ) , and medication costs were € 925.0 and € 489.2 ( 89.1 % increase ) in diabetic and non-diabetic subjects , respectively . In type 2 diabetic patients , hospitalizations and medications had the greatest impact on the overall cost ( 41.9 and 29.7 % , respectively ) , generating approximately 70 % of the difference between diabetic and non-diabetic subjects . Patients with poor glycaemic control ( glycated haemoglobin > 7 % ; > 53 mmol/mol ) had average costs of € 3296.5 versus € 2848.5 for patients with good control . In the absence of macrovascular complications , average costs were € 3008.1 for diabetic and € 1612.4 for non-diabetic subjects , while its presence increased costs to € 4814.6 and € 3306.8 , respectively . In conclusion , the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications , and are higher among diabetic patients with poor glycaemic control and macrovascular complications OBJECTIVE To evaluate the effect of a participant-customised nutrition education programme on glycated Hb ( HbA(1c ) ) , blood lipids , blood pressure , BMI and dietary behaviours in patients with type 2 diabetes mellitus . DESIGN A r and omised controlled trial . The control group ( n 41 ) received education material s. The intervention group ( n 41 ) received the same education material s and participated in eight weekly ( 2 - 2·5 h ) group nutrition education sessions and follow-up sessions . Outcomes were assessed at 6 and 12 months . An intention-to-treat analysis was conducted . ANCOVA compared the groups ( adjustments for baseline values , age , sex and clinic ) . SETTING Two community health centres , Moretele sub-district ( North West Province ) , South Africa . SUBJECTS Adults ( aged 40 - 70 years ) with type 2 diabetes , HbA(1c ) ≥8 % .  RESULTS Differences in HbA(1c ) ( primary outcome ) were -0·64 % ( P=0·15 ) at 6 months and -0·63 % ( P=0·16 ) at 12 months in favour of the intervention group . Starchy-food intake was significantly lower in the intervention group , 9·3 v. 10·8 servings/d ( P=0·005 ) at 6 months and 9·9 v. 11·9 servings/d ( P=0·017 ) at 12 months . Median energy intake was significantly lower in the intervention group at 12 months ( 5988 v. 6946 kJ/d , P=0·017 ) . No significant group differences in BMI , lipid profile , blood pressure and intakes of macronutrients , vegetables and fruits were observed . CONCLUSIONS Nutrition education was not efficacious on HbA(1c ) ; however , it improved specific dietary behaviours . Group education and h and s-on activities appeared to contribute to the improvement . Optimal goal setting and self-efficacy training/ assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in re source -limited setting BACKGROUND Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus , but no large trials have compared interventions . We investigated the effects of diet and physical activity on blood pressure and glucose concentrations . METHODS We did a r and omised , controlled trial in southwest Engl and in adults aged 30 - 80 years in whom type 2 diabetes had been diagnosed 5 - 8 months previously . Participants were assigned usual care ( initial dietary consultation and follow-up every 6 months ; control group ) , an intensive diet intervention ( dietary consultation every 3 months with monthly nurse support ) , or the latter plus a pedometer-based activity programme , in a 2:5:5 ratio . The primary endpoint was improvement in glycated haemoglobin A(1c)(HbA(1c ) ) concentration and blood pressure at 6 months . Analysis was done by intention to treat . This study is registered , number IS RCT N92162869 . FINDINGS Of 593 eligible individuals , 99 were assigned usual care , 248 the diet regimen , and 246 diet plus activity . Outcome data were available for 587 ( 99 % ) and 579 ( 98 % ) participants at 6 and 12 months , respectively . At 6 months , glycaemic control had worsened in the control group ( mean baseline HbA(1c ) percentage 6·72 , SD 1·02 , and at 6 months 6·86 , 1·02 ) but improved in the diet group ( baseline-adjusted difference in percentage of HbA(1c ) -0·28 % , 95 % CI -0·46 to -0·10 ; p=0·005 ) and diet plus activity group ( -0·33 % , -0·51 to -0·14 ; p<0·001 ) . These differences persisted to 12 months , despite less use of diabetes drugs . Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups . Blood pressure was similar in all groups . INTERPRETATION An intensive diet intervention soon after diagnosis can improve glycaemic control . The addition of an activity intervention conferred no additional benefit . FUNDING Diabetes UK and the UK Department of Health Background : National guidelines for managing diabetes set st and ards for care . We sought to determine whether a 1-year intensive multitherapy program result ed in greater goal attainment than usual care among patients with poorly controlled type 2 diabetes mellitus . Methods : We identified patients with poorly controlled type 2 diabetes receiving outpatient care in the community or at our hospital . Patients 30–70 years of age with a hemoglobin A1c concentration of 8 % or greater were r and omly assigned to receive intensive multitherapy  ( n = 36 ) or usual care ( n = 36 ) . Results : The average hemoglobin A1c concentration at entry was 9.1 % ( st and ard deviation [ SD ] 1 % ) in the intensive therapy group and 9.3 % ( SD 1 % ) in the usual therapy group . By 12 months , a higher proportion of patients in the intensive therapy group than in the control group had achieved Canadian Diabetes Association ( CDA ) goals for hemoglobin A1c concentrations 
    Output:
    
Most of stratified analyses did not totally resolve heterogeneity , but improvement in HbA1c levels has been consistently observed .
The available evidence from RCTs shows that lifestyle intervention  is more effective than the st and ard care regarding the glycaemic control of type 2 diabetic patients  , particularly when there is a weight loss .