***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: The current r and omized controlled study evaluated the effects of a health literacy-considered diabetes self-management program on diabetes-related parameters : diabetes self-management knowledge ( DSK ) , diabetes health beliefs ( DHB ) , diabetes self-efficacy ( DSE ) , diabetes self-management behavior ( DSMB ) , and diabetes biomarkers .  Fifty-one Korean older adults with diabetes completed 12 weekly sessions that were developed based on their health literacy and health-related characteristics . The results indicate significant posttest differences between groups in DSK ( p = 0.046 ) , DSE ( p = 0.046 ) , DSMB ( p = 0.012 ) , and the DSMB self-monitored blood glucose subscale ( p = 0.002 ) . Significant pre-post changes between groups were observed in the DHB benefit subscale ( p = 0.043 ) , DSE ( p = 0.006 ) , DSMB ( p = 0.008 ) , DSMB diet ( p = 0.029 ) , and the self-monitored blood glucose subscale ( p < 0.001 ) . A significant pre-post difference was observed in the intervention group 's HbA1c levels ( p = 0.008 ) . The program effectively improved participants ' DSK , DHB , DSE , and DSMB values , which may be helpful for improving HbA1c levels . [ Res Gerontol Nurs . 2017 ; 10(5):215 - 225 . ] Background Developing accessible Web-based material s to support diabetes self-management in people with lower levels of health literacy is a continuing challenge . Objective The objective of this international study was to develop a Web-based intervention promoting physical activity among people with type 2 diabetes to determine whether audiovisual presentation and interactivity ( quizzes , planners , tailoring ) could help to overcome the digital divide by making digital interventions accessible and effective for people with all levels of health literacy . This study also aim ed to determine whether these material s can improve health literacy outcomes for people with lower levels of health literacy and also be effective for people with higher levels of health literacy . Methods To assess the impact of interactivity and audiovisual features on usage , engagement , and health literacy outcomes , we design ed two versions of a Web-based intervention ( one interactive and one plain-text version of the same content ) to promote physical activity in people with type 2 diabetes . We r and omly assigned participants from the United Kingdom , Austria , Germany , Irel and , and Taiwan to either an interactive or plain-text version of the intervention in English , German , or M and arin . Intervention usage was objective ly recorded by the intervention software .  Self-report measures were taken at baseline and follow-up ( immediately after participants viewed the intervention ) and included measures of health literacy , engagement ( website satisfaction and willingness to recommend the intervention to others ) , and health literacy outcomes ( diabetes knowledge , enablement , attitude , perceived behavioral control , and intention to undertake physical activity ) . Results In total , 1041 people took part in this study . Of the 1005 who completed health literacy information , 268 ( 26.67 % ) had intermediate or low levels of health literacy . The interactive intervention overall did not produce better outcomes than did the plain-text version . Participants in the plain-text intervention group looked at significantly more sections of the intervention ( mean difference –0.47 , 95 % CI –0.64 to –0.30 , P<.001 ) , but this did not lead to better outcomes . Health literacy outcomes , including attitudes and intentions to engage in physical activity , significantly improved following the intervention for participants in both intervention groups . These improvements were similar across higher and lower health literacy levels and in all countries . Participants in the interactive intervention group had acquired more diabetes knowledge ( mean difference 0.80 , 95 % CI 0.65 - 0.94 , P<.001 ) . Participants from both groups reported high levels of website satisfaction and would recommend the website to others . Conclusions Following established practice for simple , clear design and presentation and using a person-based approach to intervention development , with in-depth iterative feedback from users , may be more important than interactivity and audiovisual presentations when developing accessible digital health interventions to improve health literacy outcomes . Clinical Trial International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 43587048 ; http://www.is rct n.com/IS RCT N43587048 . ( Archived by WebCite at http://www.webcitation.org/6nGhaP9bv OBJECTIVE To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support ( DSME/S ) . METHODS We r and omized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education . The primary outcome was change in HbA1C over 6 months . RESULTS At 6 months , HbA1C improved within the plate method [ -0.83 % ( -1.29 , -0.33 ) , P<0.001 ] and carbohydrate counting [ -0.63 % ( -1.03 , -0.18 ) , P=0.04 ] groups but not the control group [ P=0.34 ] . Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months ( carbohydrate counting , P=0.36 ; modified plate method , P=0.08 ) . In a pre-specified subgroup analysis of patients with a baseline HbA1C 7 - 10 % , change in HbA1C from baseline improved in the carbohydrate counting [ -0.86 % ( -1.47 , -0.26 ) , P=0.006 ] and plate method groups [ -0.76 % ( -1.33 , -0.19 ) , P=0.01 ] compared to controls . CONCLUSION CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10 % . PRACTICE IMPLICATION S Both carbohydrate counting and the modified plate method improve glycemic control as part of Background The prevalence of type 2 diabetes mellitus is increasing substantially worldwide , leading to serious economic effects , complications and deaths . This study evaluated the effectiveness of an empowerment program providing support for psychosocial , behavioral , and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition . Methods In this cluster r and omized trial , participants aged 30–80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015 . Five units were r and omly assigned to receive the empowerment program based on a behavior change protocol , and five continued to receive only conventional treatment . The primary outcome was the biochemical and anthropometric parameters , and the secondary outcomes were self-care , attitude , knowledge and empowerment related to diabetes . The effect of the experiment was defined as the percentage variation between the values at the initial and final periods . To evaluate this effect and to compare it in the two groups , tests were used for paired and independent sample s , respectively . Results There were 238 participants : 127 and 111 in the intervention and control group , respectively .  For glycated hemoglobin , the mean effect in the control and intervention groups was 3.93 and −5.13 , respectively ( p < 0.001 ) . Levels of glycated hemoglobin and other metabolic indicators , as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group . Conclusions The empowerment program improved metabolic control of type 2 diabetes in Brazilian users . Trial registration NCT02132338 - April 22 , 2014 BACKGROUND Despite extensive efforts and advances in evidence -based diabetes management , poor glycaemic control still remains a challenge in many countries . There is a paucity of research addressing the needs of patients with poorly controlled type 2 diabetes , or exploring the effectiveness of empowerment-based interventions in this vulnerable population . OBJECTIVES To evaluate the effectiveness of a patient-centred , empowerment-based programme on  glycaemic control and self-management behaviours among patients with poorly controlled type 2 diabetes . DESIGN A prospect i ve multi-centre , single-blind , r and omised controlled trial . SETTING S AND PARTICIPANTS Adult patients with poorly controlled type 2 diabetes [ Haemoglobin A1c ( HbA1c ) ≥7.5 % in the recent six months ] were recruited from two tertiary hospitals in Xi'an city , China . METHODS A total of 242 eligible patients were recruited and r and omly assigned to the intervention or attentional control groups after baseline measurement . Participants in the intervention group received a 6-week patient-centred , empowerment-based self-management programme , which is theoretically grounded on the principles of the Empowerment Process Model- setting personally meaningful goals , taking action towards goals and reflecting on the impact of action plans . Those in the attentional control group received health education classes and post-discharge follow-up . Outcome measures included glycaemic control ( measured by HbA1c ) and self-management behaviours . Data were collected at baseline , and at 8th and 20th week after enrolment . Intervention effect were analysed using the generalised estimating equation model on the basis of the intention-to-treat principle . RESULTS Compared with the attention control group , the intervention group showed a non-significant HbA1c reduction of 0 . 476 % ( Cohen 's d effect size=0.31 , p=0.162 ) . The intervention group exhibited significant improvements in general diet management at the 8th-week ( β=0.740 ; p=0.013 ) , specific diet management at 8th-week ( β=0.646 ; p=0.022 ) and 20th-week ( β=0.517 ; p=0.043 ) , and blood glucose self-monitoring at both the 8th- ( β=0.793 ; p=0.009 ) and 20th-week ( β=0.739 ; p=0.017 ) follow-ups . No intervention-related adverse events were observed . CONCLUSIONS Findings indicate that the patient-centred , empowerment-based self-management intervention program did not induce a significant HbA1c reduction . Whereas this intervention yields improvements in diet management and blood glucose self-monitoring among patients with poorly controlled type 2 diabetes AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention Background Lower socioeconomic status is associated with excess disease burden from diabetes .  Diabetes self-management support interventions are needed that are effective in engaging lower income patients , addressing competing life priorities and barriers to self-care , and facilitating behavior change . Objective To pilot test feasibility , acceptability , and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility . Design Two-arm r and omized controlled trial powered to detect a 0.50 % change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis . Participants Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar , blood pressure , or cholesterol control recruited from a diabetes registry within a university-affiliated managed 
    Output:
    
Our findings showed that HL was instrumental in improving diabetes knowledge , physical activity , self-efficacy and quality of life ; however , its associations with glycaemic control , self-monitoring of blood glucose , foot care and medication adherence was inconclusive .
Customized and community-based HL interventions were more efficient compared to patient-focused HL interventions .
This review concludes that HL is key for T2DM self-management , but customised , structured and community-based interventions are more likely to yield better outcomes