***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: Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed , using IT technology . But all of them allow only limited-or no-real-time interaction between patients and the system in terms of system response to patient input ; few studies have effectively assessed the systems ' usability and feasibility to determine how well patients underst and and can adopt the technology involved . DialBetics is composed of 4 modules : ( 1 ) data transmission module , ( 2 ) evaluation module , ( 3 ) communication module , and ( 4 ) dietary evaluation module . A 3-month r and omized study was design ed to assess the safety and usability of a remote health- data monitoring system , and especially its impact on modifying patient lifestyles to improve diabetes self-management and , thus , clinical outcomes .  Fifty-four type 2 diabetes patients were r and omly divided into 2 groups , 27 in the DialBetics group and 27 in the non-DialBetics control group .  HbA1c and fasting blood sugar ( FBS ) values declined significantly in the DialBetics group : HbA1c decreased an average of 0.4 % ( from 7.1 ± 1.0 % to 6.7 ± 0.7 % ) compared with an average increase of 0.1 % in the non-DialBetics group ( from 7.0 ± 0.9 % to 7.1 ± 1.1 % ) ( P = .015 ) ; The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl ( P = .019 ) . BMI improvement-although not statistically significant because of the small sample size-was greater in the DialBetics group . DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs Background Self-management is crucial in the daily management of type 2 diabetes . It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling . Objective The objective of this study was to test whether the use of a mobile phone – based self-management system used for 1 year , with or without telephone health counseling by a diabetes specialist nurse for the first 4 months , could improve glycated hemoglobin A1c ( HbA1c ) level , self-management , and health-related quality of life compared with usual care . Methods We conducted a 3-arm prospect i ve r and omized controlled trial involving 2 intervention groups and 1 control group . Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1 % ( ≥54.1 mmol/mol ) and aged ≥18 years . Both intervention groups received the mobile phone – based self-management system Few Touch Application ( FTA ) . The FTA consisted of a blood glucose – measuring system with automatic wireless data transfer , diet manual , physical activity registration , and management of personal goals , all recorded and operated using a diabetes diary app on the mobile phone . In addition , one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after r and omization . All groups received usual care by their general practitioner . The primary outcome was HbA1c level . Secondary outcomes were self-management ( heiQ ) , health-related quality of life ( SF-36 ) , depressive symptoms ( CES-D ) , and lifestyle changes ( dietary habits and physical activity ) . Data were analyzed using univariate methods ( t test , ANOVA ) and multivariate linear and logistic regression . Results A total of 151 participants were r and omized : 51 to the FTA group , 50 to the FTA-health counseling ( FTA-HC )  group , and 50 to the  control group . Follow-up data after 1 year were available for 120 participants ( 79 % ) . HbA1c level decreased in all groups , but did not differ between groups after 1 year . The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age , gender , and education ( P=.04 ) . Other secondary outcomes did not differ between groups after 1 year . In the FTA group , 39 % were substantial users of the app ; 34 % of the FTA-HC group were substantial users . Those aged ≥63 years used the app more than their younger counterparts did ( OR 2.7 ; 95 % CI 1.02 - 7.12 ; P=.045 ) . Conclusions The change in HbA1c level did not differ between groups after the 1-year intervention . Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group . Older participants used the app more than the younger participants did Background We developed a patient-centered , smartphone-based , diabetes care system ( PSDCS ) . This study aims to test the feasibility of glycosylated hemoglobin ( HbA1c ) reduction with the PSDCS . Methods This study was a single-arm pilot study . The participants with type 2 diabetes mellitus were instructed to use the PSDCS , which integrates a Bluetooth-connected glucometer , digital food diary , and wearable physical activity monitoring device . The primary end point was the change in HbA1c from baseline after a 12-week intervention . Results Twenty-nine patients aged 53.9±9.1 years completed the study . HbA1c and fasting plasma glucose levels decreased significantly from baseline ( 7.7%±0.7 % to 7.1%±0.6 % , P<0.0001 ; 140.9±39.1 to 120.1±31.0 mg/dL , P=0.0088 , respectively ) . The frequency of glucose monitoring correlated with the magnitude of HbA1c reduction ( r=–0.57 , P=0.0013 ) . The components of the diabetes self-care activities , including diet , exercise , and glucose monitoring , were significantly improved , particularly in the upper tertile of HbA1c reduction . There were no severe adverse events during the intervention . Conclusion A 12-week application of the PSDCS to patients with inadequately controlled type 2 diabetes result ed in a significant HbA1c reduction with tolerable safety profiles ; these findings require confirmation in a future r and omized controlled trial Background Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs . We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population . We also explored whether reductions in glycated hemoglobin ( HbA1c ) will be more marked in minority persons . Methods We conducted an open-label r and omized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5 % ( ≥58 mmol/mol ) . Participants were r and omized to : 1 ) a Chronic Disease Self-Management Program ( CDSMP ; n = 101 ) ; 2 ) a diabetes self-care software on a personal digital assistant ( PDA ; n = 81 ) ; 3 ) a combination of interventions ( CDSMP + PDA ; n = 99 ) ; or 4 ) usual care ( control ; n = 95 ) . Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice . The primary outcome was change in HbA1c from r and omization to 12 months . Data were analyzed using a multilevel statistical model . Results Average baseline HbA1c in the CDSMP , PDA , CDSMP + PDA , and control arms were 9.4 % , 9.3 % , 9.2 % , and 9.2 % , respectively . HbA1c reductions at 12 months for the groups averaged 1.1 % , 0.7 % , 1.1 % , and 0.7 % , respectively and did not differ significantly from baseline based on the model ( P = .771 ) . Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts ( P < .004 ) , no other significant differences were observed in participants ’ diabetes self-care activities . Exploratory sub- analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups . Conclusions Although behavioral and technological interventions can result in some modest improvements in glycemic control , these interventions did not fare significantly better than usual care in achieving glycemic control . More research is needed to underst and how these interventions can be most effective in clinical practice . The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control . Trial registration Clinical trials.gov Identifier : NCT01221090 Introduction The expansion of mobile health technologies , particularly for diabetes-related applications ( apps ) , grew exponentially in the past decade . This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost ( free or not ) . Methods We used diabetes-related keywords to identify  diabetes-related apps for iOS devices . A r and om sample of 110 apps ( 24 % of total number of apps identified ) was selected for coding . The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable . Results Most diabetes apps in this sample addressed diabetes management and therapeutics , and paid apps were more likely than free apps to use plain language strategies , to label links clearly , and to have at least 1 feature ( a “ back ” button ) that helps with the organization . Conclusion Paid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy . Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible In a pilot r and omized controlled trial involving overweight or obese participants with type 2 diabetes , we find that  smartphone users have sharply higher adherence to self-monitoring of diet , physical activity , blood glucose , and body weight  , as compared to paper diary users . By characterizing the pattern of adherence with the probability of continuation of active and inactive sequences of self-monitoring , we find that smartphone users have longer active sequences of self-monitoring of all four behaviors that were being monitored . Smartphone users are also quicker to resume  self-monitoring of diet and physical activity after a lapse in self-monitoring , whereas paper diary users have shorter inactive sequences for monitoring blood glucose and body weight . The findings are informative for data collection methodology in this burgeoning area of research OBJECTIVE We applied the self-determination theory of human motivation to examine whether patient perceptions of autonomy supportiveness ( i.e. , patient centeredness ) from their diabetes care providers related to improved glucose control over a 12-month period . RESEARCH DESIGN AND METHODS We conducted a prospect i ve cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated community hospital . Participants were 128 patients between 18 and 80 years of age who took medication for diabetes , had no other major medical illnesses , and were responsible for monitoring their glucose and taking their medications . The main outcome measure was a change in HbA1c values over the 12 months of the study . RESULTS Patient perception of autonomy support from a health care provider related to a change in HbA1c values at 12 months ( P < 0.05 ) . Further analyses showed that perceived autonomy support from the staff related to significant increases in patient autonomous motivation at 12 months ( P < 0.05 ) ; that increases in autonomous motivation related to significant increases in perceived competence ( P < 0.05 ) ; and that increases in a patient 's perceived competence related to significant reductions in their HbA1c values over 12 months ( P < 0.001 ) . CONCLUSIONS The findings support the prediction of the self-determination theory that patients with diabetes whose health care providers are autonomy supportive will become more motivated to regulate their glucose levels , feel more able to regulate their glucose , and show improvements in their HbA1c values OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index 
    Output:
    
Despite meager satisfaction ratings and major usability problems , there is some limited evidence supporting the effectiveness of diabetes apps to improve glycemic control for adults with type 2 diabetes .
Findings strongly suggest that efforts to improve user satisfaction , incorporate established principles of health behavior change , and match apps to user characteristics will increase the therapeutic impact of diabetes apps