***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 Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression . This study was aim ed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms . Methods A r and omized controlled study design with a one-year follow-up was used . Fifty patients with mild to moderate depressive symptoms ( 74 % female , aged 57 ± 9 yrs , diabetes duration of 10 ± 8 yrs , BMI 31 ± 6 kg/m2 , HbA1C 7.7 % ± 1.4 , 53 % insulin treated ) were r and omly assigned to either an intervention or a control group . The intervention group underwent four psycho-educational sessions aim ed at enabling self-management of depressive symptoms . The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual . Both groups were contacted by phone in 2–3-month intervals , and re-assessed for depression after 6 and 12 months . Changes in depressive symptoms and glycaemic control were considered primary outcomes . Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups . Results Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale ( Friedman ANOVA χ2 = 10.8 p = .004 and χ2 = 7.3 p = 0.03 , respectively ) . The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups ( χ2 = 11.6 p = 0.003 and χ2 = 17.1 p = 0.0002 , respectively ) . Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up ( all p > 0.05 ) . Conclusion Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms  , but its effects are comparable with the non-specific support given to the subjects in the control group . Trial registration Current Controlled Trials IS RCT Background R and omised controlled trials demonstrate a 60 % reduction in  type 2 diabetes incidence through lifestyle modification programmes . The aim of this study is to determine whether such programmes are feasible in primary health care . Methods An intervention study including 237 individuals 40–75 years of age with moderate or high risk of developing type 2 diabetes . A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004–2006 . Main outcome measures taken at baseline , three , and 12 months included weight , height , waist circumference , fasting plasma glucose and lipids , plasma glucose two hours after oral glucose challenge , blood pressure , measures of psychological distress and general health outcomes . To test differences between baseline and follow-up , paired t-tests and Wilcoxon rank sum tests were performed . Results At twelve months participants ' mean weight reduced by 2.52 kg ( 95 % confidence interval 1.85 to 3.19 ) and waist circumference by 4.17 cm ( 3.48 to 4.87 ) . Mean fasting glucose reduced by 0.14 mmol/l ( 0.07 to 0.20 ) , plasma glucose two hours after oral glucose challenge by 0.58 mmol/l ( 0.36 to 0.79 ) , total cholesterol by 0.29 mmol/l ( 0.18 to 0.40 ) , low density lipoprotein cholesterol by 0.25 mmol/l ( 0.16 to 0.34 ) , triglycerides by 0.15 mmol/l ( 0.05 to 0.24 ) and diastolic blood pressure by 2.14 mmHg ( 0.94 to 3.33 ) . Significant improvements were also found in most psychological measures . Conclusion This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care setting s , with reductions in risk factors approaching those observed in clinical trials . Trial NumberCurrent Controlled Trials IS RCT Abstract OBJECTIVE : There is a well-documented gap between diabetes care guidelines and the services received by patients in almost all health care setting s. This project reports initial results from a computer-assisted , patient-centered intervention to improve the level of recommended services received by patients from a wide variety of primary care providers . DESIGN AND SETTING S : Eight hundred eighty-six patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program . Physicians were stratified and r and omized to intervention or control conditions and evaluated on 2 primary outcomes : number of recommended laboratory screenings and recommended patient-centered care activities completed . Secondary outcomes were evaluated using the Problem Areas in Diabetes scale and the Patient Health Question naire (PHQ)-9 depression scale , and the RE- AIM framework was used to evaluate potential for dissemination . RESULTS : The program was well-implemented and significantly improved both number of recommended laboratory assays ( 3.4 vs 3.1 ; P<.001 ) and patient-centered aspects of diabetes care patients received ( 3.6 vs 3.2 ; P<.001 ) compared to those in r and omized control practice s. Activities that were increased most were foot exams ( follow-up rates of 80 % vs 52 % ; P<.003 ) and nutrition counseling ( 76 % vs 52 % ; P<.001 ) . CONCLUSIONS : Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality of diabetes care . Staff in primary care offices can consistently deliver an intervention of this nature , but most physicians were unwilling to participate in this translation research study OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year Background : The prevalence of type 2 diabetes and diabetesrelated morbidity and mortality is higher among low-income Hispanics when compared to that of Whites . However , little is known about how to effectively promote self-management in this population . Purpose : The objectives were first to determine the feasibility of conducting a r and omized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects . Methods : Participants for this pilot study were recruited from a community health center , an elder program , and a community-wide data base developed by the community health center , in collaboration with other agencies serving the community , by surveying households in the entire community . Participants were r and omly assigned to an intervention  ( n = 15 ) or a control ( n = 10 ) condition . Assessment s were conducted at baseline and at 3 months and 6 months postr and omization . The intervention consisted of 10 group sessions that targeted diabetes knowledge , attitudes , and self-management skills through culturally specific and literacysensitive strategies . The intervention used a cognitivebehavioral theoretical framework . Results : Recruitment rates at the community health center , elder program , and community registry were 48 % , 69 % , and 8 % , respectively . Completion rates for baseline , 3-month , and 6-month assessment s were 100 % , 92 % , and 92 % , respectively . Each intervention participant attended an average of 7.8 out of 10 sessions , and as a group the participants showed high adherence to intervention activities ( 93 % turned in daily logs , and 80 % self-monitored glucose levels at least daily ) . There was an overall Group × Time interaction ( p = .02 ) indicating group differences in glycosylated hemoglobin over time . The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was −0.8 % ( 95 % confidence intervals = −1.1 % , −0.5 % ) compared with the change in the control group ( p = .02 ) . At 6 months , the decrease in the intervention group remained significant , −0.85 % ( 95 % confidence intervals = −1.2 , −0.5 ) , and the decrease was still significantly different from that of the controls ( p = .005 ) . There was a trend toward increased physical activity in the intervention group as compared to that of the control group ( p = .11 ) and some evidence ( nonsignificant ) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants . Adjusting for baseline depressive scores , we oberved a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment ( p = .02 ) . Conclusions : Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research . This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a r and omized clinical trial Purpose The purpose of this pilot study was to determine the feasibility of offering the authors ' Diabetes Coaching Program ( DCP ) , adapted for African Americans , in a sample of African American adults with type 2 diabetes . Methods The study used a 1-group , pretest-posttest design to test the acceptance and potential effectiveness of the DCP .  Subjects were a convenience sample of 16 African Americans ( 8 women , 8 men ) with type 2 diabetes ; 12 subjects ( 6 women , 6 men ) completed the program . The DCP included 4 weekly class sessions devoted to resilience education and diabetes self-management , followed by 8 biweekly support group meetings .  Psychosocial process variables ( resilience , coping strategies , diabetes empowerment ) and proximal ( perceived stress , depressive symptoms , diabetes self-management ) and distal outcomes ( body mass index [ BMI ] , fasting blood glucose , HbA1C , lipidemia , blood pressure ) were assessed at baseline and at 6 months after study entry . Qualitative data were collected at 8 months via a focus group conducted to examine the acceptability of the DCP . Results Preliminary paired t tests indicated statistically significant improvements in diabetes empowerment , diabetes self-management , BMI , HbA1c , total cholesterol , low-density lipoprotein cholesterol , and systolic and diastolic blood pressure . Medium to large effect sizes were reported . Resilience , perceived stress , fasting blood glucose , and high-density lipoprotein cholesterol improved , but changes were not statistically significant . Focus group data confirmed that participants held positive opinions regarding the DCP and follow-up support group sessions , although they suggested an increase in program length from 4 to 8 weeks . Conclusions The pilot study documented the feasibility and potential effectiveness of the DCP to enhance diabetes empowerment , diabetes self-management , and reductions in the progression of obesity , type 2 diabetes , and cardiovascular disease in the African American community . R and omized experimental design s are needed to confirm these findings Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . 
    Output:
    
CONCLUSIONS Lifestyle interventions were effective in improving depression among people with T2DM