***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: OBJECTIVE To assess the effectiveness of structured blood glucose testing in poorly controlled , noninsulin-treated type 2 diabetes . RESEARCH DESIGN AND METHODS This 12-month , prospect i ve , cluster-r and omized , multicenter study recruited 483 poorly controlled ( A1C ≥7.5 % ) , insulin-naïve type 2 diabetic subjects from 34 primary care practice s in the U.S. Practice s were r and omized to an active control group ( ACG ) with enhanced usual care or a structured testing group ( STG ) with enhanced usual care and at least quarterly use of structured self-monitoring of blood glucose ( SMBG ) . STG patients and physicians were trained to use a paper tool to collect/interpret 7-point glucose profiles over 3 consecutive days . The primary end point was A1C level measured at 12 months . RESULTS The 12-month intent-to-treat analysis ( ACG , n = 227 ; STG , n = 256 ) showed significantly greater reductions in mean ( SE ) A1C in the STG compared with the ACG : −1.2 % ( 0.09 ) vs. −0.9 % ( 0.10 ) ; Δ = −0.3 % ; P = 0.04 . Per protocol analysis ( ACG , n = 161 ; STG , n = 130 ) showed even greater mean ( SE ) A1C reductions in the STG compared with the ACG : −1.3 % ( 0.11 ) vs. −0.8 % ( 0.11 ) ; Δ = −0.5 % ; P < 0.003 . Significantly more STG patients received a treatment change recommendation at the month 1 visit compared with ACG patients , regardless of the patient ’s initial baseline A1C level : 179 ( 75.5 % ) vs. 61 ( 28.0 % ) ; < 0.0001 . Both STG and ACG patients displayed significant ( P < 0.0001 ) improvements in general well-being ( GWB ) . CONCLUSIONS Appropriate use of structured SMBG significantly improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing GWB Background Despite the efforts of the healthcare community to improve the quality of diabetes care , about 50 % of people with type 2 diabetes do not reach their treatment targets , increasing the risk of future micro- and macro-vascular complications . Diabetes self-management education has been shown to contribute to better disease control . However , it is not known which strategies involving educational programs are cost-effective . Telehealth applications might support chronic disease management . Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high method ological quality . “ The COACH Program ” was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions . It proved to be effective in patients with coronary heart disease after hospitalization . Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes in Belgium needs to be assessed . Methods / Design R and omized controlled trial in patients with type 2 diabetes . Patients were selected based on their medication consumption data and were recruited by their sickness fund . They were r and omized to receive either usual care plus “ The COACH Program ” or usual care alone . The study will assess the difference in outcomes between groups . The primary outcome measure is the level of HbA1c . The secondary outcomes are : Total Cholesterol , LDL-Cholesterol , HDL-Cholesterol , Triglycerides , Blood Pressure , body mass index , smoking status ; proportion of people at target for HbA1c , LDL-Cholesterol and Blood Pressure ; self-perceived health status , diabetes-specific emotional distress and satisfaction with diabetes care . The follow-up period is 18 months . Within-trial and modeled cost-utility analyses , to project effects over life-time horizon beyond the trial duration , will be undertaken from the perspective of the health care system if the intervention is effective . Discussion The study will enhance our underst and ing of the potential of telehealth in diabetes management in Belgium . Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions . Trial registration Belgian number : B322201213625 . Clinical Trials.gov Identifier : PURPOSE We compared a 3-month diabetes self-management education ( DSME ) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin ( HbA1c ) . Secondary outcomes were risk factors for cardiovascular disease ( CVD ) , diabetes distress , and social support . METHODS We r and omized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support . Assessment s were conducted at baseline , 3 , 9 , and 15 months . RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group . The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months . At 15 months , the peer-support group had significantly lower low-density lipoprotein cholesterol levels ( −15 mg/dL , P = .03 ) , systolic blood pressure ( −10 mm Hg , P = .01 ) , diastolic blood pressure ( −8.3 mm Hg , P = .001 ) , and body mass index ( −0.8 kg/m2 , P = .032 ) than the DSME-alone group . CONCLUSIONS In this population of African American adults , an initial DSME program , whether or not followed by 12 months of peer support , had no effect on glycemic control . Participants in the peer-support arm of the trial did , however , experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined PURPOSE It is unclear whether peer coaching is effective in minority population s living with diabetes in hard-to-reach , under-re source d areas such as the rural South . We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes . METHODS This was a community-engaged , cluster-r and omized , controlled trial with primary care practice s and their surrounding communities serving as clusters . The trial enrolled 424 participants , with 360 completing baseline and follow-up data collection ( 84.9 % retention ) . The primary outcomes were change in glycated hemoglobin ( HbA1c ) , systolic blood pressure ( BP ) , low density lipoprotein cholesterol ( LDL-C ) , body mass index ( BMI ) , and quality of life , with diabetes distress and patient activation as secondary outcomes . Peer coaches were trained for 2 days in community setting s ; the training emphasized motivational interviewing skills , diabetes basics , and goal setting . All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline . Intervention arm participants were also paired with peer coaches ; the protocol called for telephone interactions weekly for the first 8 weeks , then monthly for a total of 10 months . RESULTS Due to real-world constraints , follow-up was protracted , and intervention effects varied over time . The analysis that included the 68 % of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group . The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP ( P = .047 ) , BMI ( P = .02 ) , quality of life ( P = .003 ) , diabetes distress ( P = .004 ) , and patient activation ( P = .03 ) , but not in HbA1c ( P = .14 ) or LDL-C ( P = .97 ) . CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-re source d areas Background The prevalence of mood difficulties in persons with diabetes is approximately twice that in the general population , affecting the health outcomes and patients ' quality of life in an undesirable way . Although subsyndromal depression is an important predictor of a more serious clinical depression , it is often overlooked . This study aims to compare the effects of two non-pharmacological interventions for subsyndromal depression , psychoeducation and physical exercise , with diabetes treatment as usual on mood- and diabetes-related outcomes . Methods and Design Type 2 diabetic patients aged 18 - 65 yrs . who report mood difficulties and the related need for help in a mail survey will be potential participants . After giving informed consent , they will be r and omly assigned to one of the three groups ( psychoeducation , physical activity , treatment as usual ) . Depressive symptoms , diabetes distress , health-related quality of life and diabetes self-care activities will be assessed at baseline , at 6 weeks , 6 months and 12 months . A structured clinical interview for DSM-IV Axis I Disorders ( SCID-I ) will be performed at baseline and at one-year follow-up in order to determine the clinical significance of the patients ' depressive symptoms . Disease-related data will be collected from patients ' files and from additional physical examinations and laboratory tests . The two interventions will be comparable in terms of format ( small group work ) , duration ( six sessions ) and approach ( interactive learning ; supporting the participants ' active roles ) . The group treated as usual will be informed about their screening results and about the importance of treating depression . They will be provided with brief re-education on diabetes and written self-help instructions to cope with mood difficulties . Primary outcomes will be depressive symptoms . Secondary outcomes will be glycaemic control , diabetes-related distress , self-management of diabetes and health-related quality of life . Tertiary outcomes will be biochemical markers reflecting common pathophysiological processes of insulin resistance , inflammation and oxidative damage that are assumed to be intertwined in both diabetes and depression . The mixed-effect linear model will be used to compare the outcome variables . Power analysis has indicated that the two intervention groups and the control group should comprise 59 patients to enable detection of clinical ly meaningful differences in depressive symptoms with a power of 80 % and alpha = 0.05 . Outcomes will be analysed on an intention-to-treat basis . Trial Registration IS RCT N : IS RCT Adults with type 2 diabetes mellitus often struggle with their antihyperglycemic medication regimens . To improve medication management , providers must ensure that their patients underst and potential benefits , harms , and burdens of available options and elicit patients ' preferences and barriers to taking medications . Patients who are actively involved in treatment decision making tend to be more satisfied with their health care , be more adherent to treatment , and have improved clinical outcomes ( 13 ) . Such discussion s , however , can be too time-consuming for clinic visits . For inner-city low-income African American and Latino adults , low health literacy and limited English proficiency are often additional barriers ( 4 ) that reduce the exchange of information and decrease patient participation during primary care visits ( 58 ) . This contributes to less optimal treatment decisions and lower patient satisfaction , leading to poor medication adherence and outcomes ( 3 , 911 ) . There is therefore an urgent need for cost-effective approaches to enable low-re source health systems to help these high-risk population s gain information and decision support so that they can more actively participate in and improve satisfaction with their treatment decision making . Since 2000 , the REACH ( Racial and Ethnic Approaches to Community Health 2010 ) Detroit Partnership , a coalition of community , health system , and academic partners , has used community-based participatory research principles to guide development , implementation , and evaluation of interventions to meet this need among African American and Latino adults with diabetes in Detroit , Michigan . These interventions have built on evidence that community health workers ( CHWs ) are effective in improving diabetes outcomes , particularly among racial and ethnic minority communities ( 12 ) . CHW interventions train community members to work as bridges between their ethnic , cultural , or geographic communities and health care providers ( 13 ) . Two cohorts of participants in our previous CHW-led diabetes self-management support interventions  improved hemoglobin A1c ( HbA1c ) levels and diabetes distress compared with usual care ( 14 , 15 ) . An important next step in increasing the potential effect of CHWs and other lay health care workers is to develop and test effective tools they can use to better present evidence -based information to patients and to help patients make better self-management decisions ( 16 ) . Little is known about the effectiveness of different approaches for nontraditional care providers , such as CHWs , to deliver health information to ethnic minority and low-literacy population s ( 17 ) . By definition , CHWs and other lay workers do not have medical expertise and thus rely on effectively sharing printed educational and support material s with patients as part of their coaching and counseling efforts . Decision aids can increase satisfaction with treatment decisions and result in treatments that better reflect patients ' preferences ( 18 , 19 ) . There is also evidence that tailored health messages are more effective than generic group messages ( 20 , 21 ) , including for patients with diabetes ( 22 , 23 ) . Tailoring individualizes information and behavior change strategies to reach each person based on characteristics unique to that person derived from an individual assessment and related to the outcome of interest ( 24 ) 
    Output:
    
AUTHORS ' CONCLUSIONS Low- quality evidence showed that none of the psychological interventions would improve DRD more than usual care .
Low- quality evidence is available for improved self-efficacy and HbA1c after psychological interventions .
This means that we are uncertain about the effects of psychological interventions on these outcomes .
However , psychological interventions probably have no substantial adverse events compared to usual care .