***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 evaluate adherence to self-care and glycemic control and empowerment of people with diabetes mellitus in group education . METHOD Cluster-r and omized clinical trial , with participants with type 2 diabetes mellitus . All people in the sample were linked to Family Health Strategy Units from Divinópolis , state of Minas Gerais , Brazil , during 2014 and 2015 . Data regarding adherence to self-care practice s , empowerment and glycated hemoglobin were collected for comparison of groups in the baseline and of intergroup results before and after interventions . The chosen level of significance was 0.05 . RESULTS The sample had 183 people , with 72 in the intervention group and 111 in the control group . A statistically significant decrease ( < 0.001 ) in the value of glycated hemoglobin and an increase in the scores of adherence to self-care and empowerment scales were found for participants in the intervention group ( < 0.001 ) . CONCLUSION Group education caused an increase in the scores of the scales of adherence to self-care practice s and empowerment , in addition to an improvement in glycemic levels , as shown by glycated hemoglobin results . Brazilian Registry of Clinical Trials : RBR-92j38 t 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 Background The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world . One such national education programme in the United Kingdom is the DESMOND Programme , which has been shown to be robust and effective for patients in general . However , these programmes are not generally targeted to people with intellectual disabilities ( ID ) , and robust evidence on their effects for this population is lacking . We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID.This protocol is for a pilot trial to determine whether a large-scale r and omised trial is feasible , to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes , in particular as a means to reduce glycated haemoglobin ( Hb1Ac ) , improve psychological wellbeing and quality of life and promote a healthier lifestyle . This protocol describes the rationale , methods , proposed analysis plan and organisational and administrative details . Methods / Design This trial is a two arm , individually r and omised , pilot trial for adults with ID and type 2 diabetes , and their family and /or paid carers . It compares the DESMOND-ID programme with usual care .  Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom . Family and /or paid carers may also participate in the study . Participants will be r and omly assigned to one of two conditions using a secure computerised system with robust allocation concealment . A range of data will be collected from the adults with ID ( biomedical , psychosocial and self-management strategies ) and from their carers . Focus groups with all the participants will assess the acceptability of the intervention and the trial . Discussion The lack of appropriate structured education programmes and educational material s for this population leads to secondary health conditions and may lead to premature deaths . There are significant benefits to be gained globally , if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments . Trial registration Registered with International St and ard R and omised Controlled Trial ( identifier : IS RCT N93185560 ) on 10 November 2014 Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Background We report on the development of the ' STOP Diabetes ' education programme , a multi-component lifestyle behaviour change intervention for the prevention of type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities ( ID ) . Methods We combined qualitative stakeholder interviews with evidence review s to develop the intervention , guided by the MRC Framework and informed by intervention mapping and two existing diabetes prevention programmes . We conducted two pilot cycles drawing on additional stakeholder interviews to inform and refine the intervention . Results The STOP Diabetes education programme employed a theoretical framework , using sound learning and behavioural principles and concrete kinaesthetic methods , to provide the grounding for innovative games and activities to promote health behaviour change in adults with ID . Qualitative data also suggested that two educators and one support person delivering a programme of one carer session followed by seven 2.5-h sessions over 7 weeks was acceptable to service users , carers and educators and appeared to benefit the participants . Conclusions The STOP Diabetes education programme was successfully developed and is suitable for a definitive r and omized controlled trial PURPOSE The purpose of this r and omized clinical study was to test the efficacy of a resiliency training approach for people with diabetes who have previously received st and ard diabetes self-education . METHODS A single-blinded , r and omized design was employed with repeated measures ( baseline , 3 months , 6 months ) with 67 participants assigned to either  treatment as usual ( n = 37 ) or the resiliency classes ( n = 30 ) . Outcome variables included physiological measures ( glycosylated hemoglobin , waist measurement , eating and exercise habits ) and psychosocial measures ( self-efficacy , locus of control , social support , and purpose in life ) . RESULTS Analyses of variance indicated that the intervention group had higher levels of resiliency as reported by knowing positive ways of coping with diabetes-related stress , knowing enough about themselves to make right diabetes choices , having fun in life , eating healthier , and increasing physical activity compared with the control group at 3 months ( P < .05 ) . Glycosylated hemoglobin and waist measurement improved but not significantly . CONCLUSIONS Interventions to foster resilience among people with diabetes have the potential to make an important contribution to increasing positive life outcomes . Diabetes educators using the resiliency approach in t and em with st and ard diabetes education programs can assist their patients to become more self-directed in their diabetes care Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans . Social Cognitive Theory provided the framework for the study . Methods Twenty-two participants were recruited and r and omly assigned to either Group or Individual diabetes self-management ( DSME ) . Group DSME included story-telling , h and s-on activities , and problem-solving exercises . Individual DSME sessions focused on goal - setting and problem-solving strategies . Sessions were offered in an accessible community center over a 10-week period . Results Outcomes included glycosylated hemoglobin ( A1C ) , self-care actions , self-efficacy level , goal attainment , and satisfaction with DSME . Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities , A1C level , and goal attainment . Although differences were not statistically significant , trends indicate improved scores on dietary actions , foot care , goal attainment , and empowerment for those experiencing Group DSME . Conclusions The culturally tailored approach was well received by all participants . Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control . Additional testing among more participants over a longer time period is recommended The S and y Lake school-based diabetes prevention program is a culturally appropriate intervention for Ojibway-Cree students in the 3rd , 4th , and 5th grade s. This paper reports the results of the program in changing dietary intake behaviors and related psychosocial factors . Physical activity results are not included . The study was a pretest/post-test , single- sample design conducted during the 1998 - 1999 school year . A total of 122 students completed all 4 measurements ( anthropometry , 24-h dietary recall , and 2 question naires ) , at baseline and follow-up . There were significant increases ( P < 0.0001 ) in dietary intention , dietary preference , knowledge , and dietary self-efficacy , and in the curriculum knowledge scale between baseline and follow-up . Intervention exposure was significantly associated with being in the highest category for knowledge about foods that were low in dietary fat [ Medium Exposure odds ratio ( OR ) : 3.4 ; P < 0.05 ; High Exposure OR : 6.4 ; P < 0.05 ] , being in the highest category for dietary self-efficacy ( Medium Exposure OR : 3.7 ; P < 0.05 ; High Exposure OR : 3.9 ; P < 0.1 ) , being in the highest category for knowledge about curriculum concepts ( Medium Exposure OR : 3.4 ; P < 0.05 ; High Exposure OR : 9.4 : P < 0.01 ) , and for having met the age + 5 g dietary fiber intake/d ( Medium Exposure OR : 2.9 ; P < 0.1 ; High Exposure OR : 11.0 ; P < 0.01 ) . Exposure to the intervention was not associated with dietary intent or the percentage of energy from dietary fat . This program was associated with improved knowledge and the psychosocial factors related to healthy eating and dietary fiber intake of students in a remote First Nations community Background Individuals with a learning disability ( LD ) are at higher risk of developing type 2 diabetes , but LD is not straightforward to define or identify , especially at the milder end of the spectrum , which makes case finding difficult . While supported self-management of health problems is now established , current material is largely educational and didactic with little that facilitates behavioural change . The interaction between the 
    Output:
    
RESULTS Successful components of programs align to the needs of people with ID .