***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: Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus . Design Prospect i ve r and omised controlled trial of self monitoring versus no monitoring ( control ) . Setting Hospital diabetes clinics . Participants 184 ( 111 men ) people aged < 70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics . Major exclusion criteria were secondary diabetes , insulin treatment , previous self monitoring of blood glucose . Interventions Participants were r and omised to self monitoring or no monitoring ( control ) groups for one year with follow-up at three monthly intervals . Both groups underwent an identical structured core education programme . The self monitoring group received additional education on monitoring . Main outcome measures Between group differences in HbA1c , psychological indices , use of oral hypoglycaemic drugs , body mass index ( BMI ) , and reported hypoglycaemia rates . Results 96 patients ( 55 men ) were r and omised to monitoring and 88 ( 56 men ) to control . There were no baseline differences in mean ( SD ) age ( 57.7 ( 11.0 ) in monitoring group v 60.9 ( 11.5 ) in control group ) or HbA1c ( 8.8 (2.1)% v 8.6 (2.3)% , respectively ) . Those in the monitoring group had a higher baseline BMI ( 34 ( 7 ) v 32 ( 6.2 ) ) . There were no significant differences between groups at any time point ( 12 months values given ) in HbA1c ( 6.9 (0.8)% v 6.9 (1.2)% , P=0.69 ; 95 % confidence interval for difference −0.25 % to 0.38 % ) , BMI ( 33.1 ( 6.4 ) v 31.8 ( 6.0 ) ; adjusted for baseline BMI , P=0.32 ) , use of oral hypoglycaemic drugs , or reported incidence of hypoglycaemia . Monitoring was associated with a 6 % higher score on the depression subscale of the well-being question naire ( P=0.01 ) . Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale . Trial registration IS RCT N 49814766 OBJECTIVE Given the urgent need to develop effective programs that improve the ability for adolescents to achieve metabolic control equivalent to programs studied in the Diabetes . Control and Complications Trial , we have undertaken a clinical trial to determine if a behavioral intervention ( coping skills training [ CST ] ) combined with intensive diabetes management can improve metabolic control and quality of life in adolescents implementing intensive therapy regimens . RESEARCH DESIGN AND METHODS A total of 65 youths between the ages of 13 and 20 years , who elected to initiate intensive insulin therapy  , were r and omly assigned to one of two groups : the intensive management with CST group and the intensive management without CST group . CST consists of a series of small group efforts design ed to teach adolescents the coping skills of social problem-solving , social skills training , cognitive behavior modification , and conflict resolution . Data were collected at pre-intervention and at 3 months following the use of the Self-Efficacy for Diabetes scale , Children 's Depression Inventory , Issues in Coping with IDDM scale , and the Diabetes Quality of Life : Youth scale . Clinical data ( HbA1c , adverse effects ) were collected monthly . RESULTS The experimental and control groups were comparable on all measures at baseline . Results show that adolescents who received CST had lower HbA1c and better diabetes self-efficacy and were less upset about coping with diabetes than adolescents receiving intensive management alone . In addition , adolescents who received the CST found it easier to cope with diabetes and experienced less of a negative impact of diabetes on quality of life than those who did not receive CST . CONCLUSIONS CST is useful in improving not only an adolescent 's metabolic control , but also their quality of life . As more pediatric providers aim for improved control , in adolescents with diabetes , the addition of this behavioral intervention may be helpful in achieving metabolic and life goals OBJECTIVE To investigate whether monitoring and discussing psychological well-being in out patients with diabetes improves mood , glycemic control , and the patient 's evaluation of the quality of diabetes care . RESEARCH DESIGN AND METHODS This study was a r and omized controlled trial of 461 out patients with diabetes who were r and omly assigned to st and ard care or to the monitoring condition .  In the latter group , the diabetes nurse specialist assessed and discussed psychological well-being with the patient ( with an interval of 6 months ) in addition to st and ard care . The computerized Well-being Question naire was used for this purpose . Primary outcomes were mood , HbA(1c ) , and the patient 's evaluation of the quality of diabetes care at 1-year follow-up . The number of referrals to the psychologist was analyzed as a secondary outcome . Intention-to-treat analysis was used . RESULTS The monitoring group reported better mood compared with the st and ard care group , as indicated by significantly lower negative well-being and significantly higher levels of energy , higher general well-being , better mental health , and a more positive evaluation of the quality of the emotional support received from the diabetes nurse . The two groups did not differ for HbA(1c ) or in their overall evaluation of the quality of diabetes care . In the monitoring condition , significantly more subjects were referred to the psychologist . CONCLUSIONS Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c ) . Our results support the recommendation to monitor psychological well-being in patients with diabetes BACKGROUND Previous findings are unclear regarding the possible glycemic benefits of applying behavioral relaxation training in non-insulin-dependent diabetes mellitus ( NIDDM ) . METHODS Subjects with NIDDM were r and omized to relaxation training ( 6 sessions of progressive muscle relaxation and imagery , n = 12 ) or control treatment ( routine medical care , n = 10 ) . Physiological measures were total glycosylated hemoglobin ( GHb ) and area under the 2-hour oral-glucose-tolerance curve ( AUC ) . Psychological measures of generalized distress , anxiety and daily stress were also administered . All subjects were assessed before and after the 8-week intervention , and again at 16 weeks of long-term follow-up . RESULTS There were no postintervention group differences in physiological variables . Highly distressed subjects and those who rated their glucose as more stress responsive tended to practice relaxation less between sessions . Within the treated group only , lower preintervention stress responsivity was associated with greater improvement in GHb , and lower anxiety and distress levels predicted long-term improvement in AUC . CONCLUSIONS It remains unclear whether relaxation training produces glycemic benefits in NIDDM . Perhaps the least anxious and stress-responsive patients only benefit from group-based relaxation training , whereas anxious individuals require intensive individually administered interventions Background It is generally believed that exhaustive search es of bibliographic data bases are needed for systematic review s of health care interventions . The CENTRAL data base of controlled trials ( RCTs ) has been built up by exhaustive search ing . The CONSORT statement aims to encourage better reporting , and hence indexing , of RCTs . Our aim was to assess whether developments in the CENTRAL data base , and the CONSORT statement , mean that a simplified RCT search strategy for identifying RCTs now suffices for systematic review s of health care interventions . Methods RCTs used in the Cochrane review s were identified . A brief RCT search strategy ( BRSS ) , consisting of a search of CENTRAL , and then for variants of the word r and om across all fields ( r and om$.af . ) in MEDLINE and EMBASE , was devised and run . Any trials included in the meta-analyses , but missed by the BRSS , were identified . The meta-analyses were then re-run , with and without the missed RCTs , and the differences quantified . The proportion of trials with variants of the word r and om in the title or abstract was calculated for each year . The number of RCTs retrieved by search ing with " r and om$.af . " was compared to the highly sensitive search strategy ( HSSS ) . Results The BRSS had a sensitivity of 94 % . It found all journal RCTs in 47 of the 57 review s. The missing RCTs made some significant differences to a small proportion of the total outcomes in only five review s , but no important differences in conclusions result ed . In the post-CONSORT years , 1997–2003 , the percentage of RCTs with r and om in the title or abstract was 85 % , a mean increase of 17 % compared to the seven years pre-CONSORT ( 95 % CI , 8.3 % to 25.9 % ) . The search using r and om$.af . reduced the MEDLINE retrieval by 84 % , compared to the HSSS , thereby reducing the workload of checking retrievals . Conclusion A brief RCT search strategy is now sufficient to locate RCTs for systematic review s in most cases . Exhaustive search ing is no longer cost-effective , because in effect it has already been done for CENTRAL Background Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors , psychosocial factors , and the social environment . This report examines the long-term effects of a multiple-risk-factor intervention . Methods Postmenopausal women ( N = 279 ) with type 2 diabetes participated in the  Mediterranean Lifestyle Program ( MLP ) , a r and omized , comprehensive lifestyle intervention study . The intervention targeted healthful eating , physical activity , stress management , smoking cessation , and social support . Outcomes included lifestyle behaviors ( i.e. , dietary intake , physical activity , stress management , smoking cessation ) , psychosocial variables ( e.g. , social support , problem solving , self-efficacy , depression , quality of life ) , and cost analyses at baseline , and 6 , 12 , and 24 months . Results MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception ( there were too few smokers to analyze tobacco use effects ) , and in psychosocial measures of use of supportive re sources , problem solving , self-efficacy , and quality of life . Conclusion The MLP was more effective than usual care over 24 months in producing improvements on behavioral and psychosocial outcomes . Directions for future research include replication with other population BACKGROUND A growing body of evidence suggests that earlier diagnosis and treatment of diabetes may be beneficial ; however , definitive evidence is lacking . AIM To evaluate the effectiveness of an intensified multifactorial treatment on cardiovascular risk factors in patients with screen-detected type 2 diabetes . DESIGN OF STUDY R and omised controlled trial . SETTING Seventy-nine general practice s in the southwestern region of the Netherl and s. METHOD In this r and omised trial , patients diagnosed with diabetes by screen-detection were assigned to intensified ( n = 255 ) or routine treatment ( n = 243 ) , and followed over 1 year . Intensified treatment consisted of pharmacological treatment combined with lifestyle education to achieve haemoglobin A1c ( HbA1c ) < 7.0 % , blood pressure < 135/85 mmHg , and cholesterol < 5.0 mmol/l ( 4.5 mmol/l if cardiovascular disease was present ) . Health-related quality of life ( HRQoL ) was assessed using the Short Form (SF)-36 . Analyses were performed using generalised estimating equations models . RESULTS Changes in body mass index were 0.2 ( routine care ) versus -1.4 kg/m(2 ) ( intensified treatment ) , P<0.001 ; systolic blood pressure -19 versus -33 mmHg , P<0.001 ; diastolic blood pressure -7 versus -12 mmHg , P<0.001 ; HbA1c -0.9 % versus -1.1 % , P = 0.03 ; cholesterol -0.5 versus -1.2 mmol/l , P<0.001 ; high-density lipoprotein cholesterol 0.1 versus 0.1 mmol/l , P = 0.26 ; low-density lipoprotein cholesterol -0.5 versus -1.0 mmol/l , P<0.001 ; triglycerides -0.3 versus -0.4 mmol/l , P = 0.71 . No difference in HRQoL between the two groups was reported . CONCLUSION Intensified multifactorial treatment of patients with screen-detected diabetes in general practice reduces cardiovascular risk factor levels significantly without worsening In r and omised controlled trials , allocation concealment ( separating the process of r and omisation from the recruitment of participants ) is important for rigorously design ed trials.1–4 In 1996 many major medical journals adopted the CONSORT statement ( whereby research ers have to include a short checklist of essential items and a flow diagram when reporting trials),5 and this move encouraged the reporting of allocation concealment . We review ed the prevalence of adequate allocation concealment and its association with the statistical significance of trial results . We search ed by h and four general medical journals ( the BMJ , JAMA , the Lancet , and the New Engl and Journal of Medicine ) to identify 
    Output:
    
However , there was a limited association between the effects on A1C and mental health , and no intervention characteristics predicted benefit on both outcomes .
Managing physical and mental health in long-term conditions are increasingly important .
The review did not identify types of interventions that consistently provide benefits for both physical and mental health .