***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 Diabetes is a leading cause of morbidity and mortality . The purpose of this study is to assess the associations between diabetes complications and mortality in the Early Treatment Diabetic Retinopathy Study ( ETDRS ) . RESEARCH DESIGN AND METHODS We examined demographic , clinical , and laboratory characteristics of the 3,711 subjects enrolled in the ETDRS , a r and omized controlled clinical trial design ed to evaluate the role of laser photocoagulation and aspirin therapy for diabetic retinopathy . The outcome assessed was all-cause mortality . Multivariable Cox proportional hazards regression was used to assess associations between diabetes complications and mortality for type 1 and type 2 diabetes separately . RESULTS The 5-year estimates of all-cause mortality were 5.5 and 18.9 % for patients with type 1 and type 2 diabetes , respectively . In patients with type 1 diabetes , amputation ( hazard ratio [ HR ] 5.08 [ 95 % CI 2.06 - 12.54 ] ) and poor visual acuity ( 1.74 [ 1.10 - 2.75 ] ) remained significantly associated with mortality , after adjusting for other diabetes complications and baseline characteristics . In patients with type 2 diabetes , macrovascular disease  and worsening levels of nephropathy , neuropathy , retinopathy , and visual acuity are associated with progressively increasing risks of mortality , after controlling for other baseline risk factors . CONCLUSIONS Amputation is the strongest predictor for mortality in patients with type 1 diabetes . All complications independently predict mortality in patients with type 2 diabetes . There is an increased risk for mortality as the degree of each complication worsens . Additional studies are needed to investigate the effectiveness of tertiary prevention to decrease mortality in these patients AIMS Despite the known benefits , 60 % of individuals with diabetes do not engage in regular physical activity ( PA ) . This pilot study tested the effects of a counseling intervention using continuous glucose monitoring system ( CGMS ) feedback on PA self-efficacy , PA levels , and physiological variables . METHODS Adults ( N=52 ) with type 2 diabetes ( non-insulin requiring , inactive ) were r and omized to intervention ( n=27 ) or control ( n=25 ) groups . Both groups received 90min of diabetes education with a follow-up phone call 4 weeks later . The intervention group also received counseling derived from self-efficacy theory . This intervention included feedback on each participant 's CGMS graph and used role model CGMS graphs to clearly depict glucose reductions in response to PA . Outcomes were assessed at baseline and 8 weeks . RESULTS Participants receiving the intervention had higher self-efficacy scores than the control group for sticking to activity/resisting relapse at 8 weeks ( p<0.05 ) , indicating more confidence in maintaining a PA program . Intervention group participants light/sedentary activity minutes decreased significantly ( p<0.05 ) , moderate activity minutes increased significantly ( p<0.05 ) , and , HbA1c and BMI decreased significantly ( p<0.05 ) . CONCLUSIONS These data suggest that PA counseling interventions using CGMS feedback for individuals with type 2 diabetes may improve PA levels and reduce risk factors for diabetes-related complications OBJECTIVE The benefits of real-time continuous glucose monitoring ( CGM ) have been demonstrated in patients with type 1 diabetes . Our aim was to compare the effect of two modes of use of CGM , patient led or physician driven , for 1 year in subjects with poorly controlled type 1 diabetes . RESEARCH DESIGN AND METHODS Patients with type 1 diabetes aged 8–60 years with HbA1c ≥8 % were r and omly assigned to three groups ( 1:1:1 ) . Outcomes for glucose control were assessed at 1 year for two modes of CGM ( group 1 : patient led ; group 2 : physician driven ) versus conventional self-monitoring of blood glucose ( group 3 : control ) . RESULTS A total of 257 subjects with type 1 diabetes underwent screening . Of these , 197 were r and omized , with 178 patients completing the study ( age : 36 ± 14 years ; HbA1c : 8.9 ± 0.9 % ) . HbA1c improved similarly in both CGM groups and was reduced compared with the control group ( group 1 vs. group 3 : −0.52 % , P = 0.0006 ; group 2 vs. group 3 : −0.47 % , P = 0.0008 ; groups 1 + 2 vs. group 3 : −0.50 % , P < 0.0001 ) . The incidence of hypoglycemia was similar in the three groups . Patient SF-36 question naire physical health score improved in both experimental CGM groups ( P = 0.004 ) . Sensor consumption was 34 % lower in group 2 than in group 1 ( median [ Q1–Q3 ] consumption : group 1 : 3.42/month [ 2.20–3.91 ] vs. group 2 : 2.25/month [ 1.27–2.99 ] , P = 0.001 ) . CONCLUSIONS Both patient-led and physician-driven CGM provide similar long-term improvement in glucose control in patients with poorly controlled type 1 diabetes , but the physician-driven CGM mode used fewer sensors BACKGROUND Continuous glucose monitoring ( CGM ) has been shown to be a valuable tool to improve glycemic control in patients with diabetes . The objective of this pilot study was to develop and implement CGM in an existing diabetes clinic for low-income patients on multiple daily injections . SUBJECTS AND METHODS This was a single-center , prospect i ve , r and omized controlled , crossover pilot study . Initial focus groups were held to create low-literacy , Spanish and English guides to the use of carbohydrate counting and CGM . These tools were implemented to train participants on carbohydrate counting and insulin adjustments participants . Subjects were then r and omized to start in Group A ( CGM ) or Group B ( self-monitoring blood glucose and then switched after 28 weeks ) . Hemoglobin A1c ( HbA1c ) was obtained at baseline and at the end of both study phases . RESULTS Twenty-five economically challenged , primarily Latino participants with minimal prior education on intensive diabetes management completed the study . No significant reduction in HbA1c or decrease in time spent in parameters of low and high blood glucose was shown . However , eighty percent of participants who completed the study wanted to continue to use  CGM  once the research study was over . The participants also felt that the CGM made adjusting insulin easier . CONCLUSIONS CGM can be implemented in patients from a low-income public clinic ; however , HbA1c reduction was not achieved . Given the underlying lack of baseline self-management knowledge , a longer trial might be necessary to see benefit with CGM in this population OBJECTIVE To assess the cost-effectiveness of sensor-augmented insulin pump therapy with " Low Glucose Suspend " ( LGS ) functionality versus st and ard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia . METHODS A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio ( ICER ) . The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study . Quality -of-life utility scores were calculated using the three-level EuroQol five-dimensional question naire . Re source use costs were estimated using public sources . RESULTS After 6 months , the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with st and ard pump therapy ( incident rate difference 1.85 [ 0.17 - 3.53 ] ; P = 0.037 ) . Based on a primary r and omized study , the ICER per severe hypoglycemic event avoided was $ 18,257 for all patients and $ 14,944 for those aged 12 years and older . Including all major medical re source costs ( e.g. , hospital admissions ) , the ICERs were $ 17,602 and $ 14,289 , respectively . Over the 6-month period , the cost per quality -adjusted life-year gained was $ 40,803 for patients aged 12 years and older . CONCLUSIONS Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas , sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to st and ard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes OBJECTIVE To assess the impact of continuous glucose monitoring on hypoglycemia in people with type 1 diabetes . RESEARCH DESIGN AND METHODS In this r and omized , controlled , multicenter study , 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glycated hemoglobin A1c ( HbA1c ) < 7.5 % were r and omly assigned to a control group performing conventional home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring . The primary outcome was the time spent in hypoglycemia ( interstitial glucose concentration < 63 mg/dL ) over a period of 26 weeks . Analysis was by intention to treat for all r and omized patients . RESULTS The time per day spent in hypoglycemia was significantly shorter in the continuous monitoring group than in the control group ( mean ± SD 0.48 ± 0.57 and 0.97 ± 1.55 h/day , respectively ; ratio of means 0.49 ; 95 % CI 0.26–0.76 ; P = 0.03 ) . HbA1c at 26 weeks was lower in the continuous monitoring group than in the control group ( difference −0.27 % ; 95 % CI −0.47 to −0.07 ; P = 0.008 ) . Time spent in 70 to 180 mg/dL normoglycemia was significantly longer in the continuous glucose monitoring group compared with the control group ( mean hours per day , 17.6 vs. 16.0 , P = 0.009 ) . CONCLUSIONS Continuous glucose monitoring was associated with reduced time spent in hypoglycemia and a concomitant decrease in HbA1c in children and adults with type 1 diabetes Aims /hypothesisThe value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined . Methods A total of 160 children ( aged 1–16 years , mean ± SD : 8.7 ± 4.4 years ; 47.5 % girls ) were r and omised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements . The primary outcome was the level of HbA1c after 12 months . Other analyses included fasting C-peptide , glycaemic variability , sensor usage , adverse events , children ’s health-related quality of life and parent ’s wellbeing . Results HbA1c was not significantly different between the two groups , but patients with regular sensor use had lower values ( mean 7.1 % , 95 % CI 6.8–7.4 % ) compared with the combined group with no or low sensor usage ( mean 7.6 % , 95 % CI 7.3–7.9 % ; p = 0.032 ) . At 12 months , glycaemic variability was lower in the sensor group ( mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7 ; p = 0.037 ) . Higher C-peptide concentrations were seen in sensor-treated 12- to 16-year-old patients ( 0.25 ± 0.12 nmol/l ) compared with those treated with insulin pump alone ( 0.19 ± 0.07 nmol/l ; p = 0.033 ) . Severe hypoglycaemia was reported only in the group without sensors ( four episodes ) . Conclusion /interpretationSensor-augmented pump therapy starting from the diagnosis of type 1 diabetes can be associated with less decline in fasting C-peptide particularly in older children , although regular sensor use is a prerequisite for improved glycaemic control . Trial registration IS RCT N.org IS RCT N05450731 Funding Medtronic International Trading Sàrl , Tolochenaz , Switzerl Aims /hypothesisThe aim of this multicentre , r and omised , controlled crossover study was to determine the efficacy of adding continuous glucose monitoring ( CGM ) to insulin pump therapy ( CSII ) in type 1 diabetes . Methods Children and adults ( n = 153 ) on CSII with HbA1c 7.5–9.5 % ( 58.5–80.3 mmol/mol ) were r and omised to ( CGM ) a Sensor On or Sensor Off arm for 6 months . After 4 months ’ washout , participants crossed over to the other 
    Output:
    
Real-time continuous glucose monitoring is not a cost-effective technology when compared to SMBG in Spain