***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 
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    ***EXAMPLES*** 
    Input: A cross-sectional study to assess home glucose monitoring practice s was conducted in 200 non-insulin-treated diabetic patients consecutively attending our hospital clinic . Of the 200 , 97 ( 48 % ) patients ( Group 1 ) regularly monitored urine ( n = 74 ) , blood ( n = 19 ) or both ( n = 4 ) ; 103 ( 52 % ) patients ( Group 2 ) performed no home monitoring . The two groups were similar in terms of age , sex , duration of diabetes and type of treatment . The prevalence of diabetic complications was also closely comparable and only peripheral neuropathy differed between the groups , being more common in Group 1 ( n = 12 ) than Group 2 ( n = 4 ) ; p < 0.05 . There was also no significant difference between the HbA1 concentration ( mean + /- SD ) in Group 1 ( 9.7 + /- 2.2 % ) and Group 2 ( 9.4 + /- 2.0 % ) . The mean frequency of home monitoring  was four tests weekly , but only 21 ( 22 % ) kept a written record and 60 ( 62 % ) would never alter their treatment on the basis of their results . Almost a third of patients could not interpret the results of monitoring or give the normal range of values . Home glucose monitoring , particularly of urine , is widely practised in Type 2 diabetes , at considerable overall expense . However , convincing evidence of its value in helping patients improve their blood glucose control or preventing the complications of the disease is lacking OBJECTIVE To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients . RESEARCH DESIGN AND METHODS This 6-month study , which included 6 months of follow-up , adopted a prospect i ve , multicenter , r and omized controlled design . Subjects were r and omized to two groups : one group used a blood glucose-monitoring device , kept a blood glucose/eating diary , and received st and ardized counseling ; the control group received nonst and ardized counseling on diet and lifestyle . The primary efficacy parameter was the change in HbA(1c ) . Secondary efficacy variables included changes in body weight , lipids , and microalbumin and changes in treatment satisfaction and well-being . RESULTS In the per- protocol analysis , the use of a self-monitoring blood glucose device significantly reduced HbA(1c ) levels by 1.0 + /- 1.08 % compared with 0.54 + /- 1.41 % for the control group ( P = 0.0086 ) ; subgroup analysis showed three types of responders . Body weight , total cholesterol , and microalbumin improved when using a glucometer , but there was no statistically significant difference between the two groups . Treatment satisfaction increased in both groups to a similar extent ( P = 0.9 ) . Self-monitoring result ed in a marked improvement of general well-being with significant improvements in the subitems depression ( P = 0.032 ) and lack of well-being ( P = 0.02 ) . CONCLUSIONS Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study . The finding of three types of responders will be important for future planning of counseling and educational interventions Background Diabetes specific emotional problems interfere with the dem and ing daily management of living with type 2 diabetes mellitus ( T2DM ) . Possibly , offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients ' belief they are able to manage their illness . It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy . Methods and design Six hundred patients with T2DM ( 45 ≤ 75 years ) who receive care in a structured diabetes care system , HbA1c ≥ 7.0 % , and not using insulin  will be recruited and r and omized into 3 groups ; Self-monitoring of Blood Glucose ( SMBG ) , Self-monitoring of Urine Glucose ( SMUG ) and usual care ( n = 200 per group ) . Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year . All 3 groups will receive st and ardized diabetes care . The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results . Main outcome measures are changes in diabetes specific emotional distress and self-efficacy . Secondary outcome measures include difference in HbA1c , patient satisfaction , occurrence of hypoglycaemia , physical activity , costs of direct and indirect healthcare and changes in illness beliefs . Discussion The IN CONTROL-trial is design ed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy . Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions , guiding the patient to reduce emotional responses to experienced threats , and influences the patients ability to perform and maintain self-management skills . Trial registration Current Controlled Trials IS RCT Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life ( HRQOL ) in people with diabetes were studied cross-sectionally using the SF-20 question naire . Of the 381 subjects with Type 2 diabetes aged under 65 years , 260 ( 68 % ) participated in the study . On univariate analysis , HRQOL was associated with regular clinical review ( check-up at least twice a year ) and continuity of care ( the same GP for at least 2 years ) , education by a diabetes nurse , and satisfaction with diabetes education . No associations were found between the HRQOL dimensions and home glucose monitoring , participation in educational courses , or satisfaction with care . On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 ( ORs 2.5 - 6.0 ) . However , good continuity of care was also associated with less satisfactory glucose control ( HbA(1c ) 8.9 + /- 2.0 ( + /- SD ) vs 8.3 + /- 2.0 % , P=0.04 ) . It is concluded that a permanent physician-patient relationship may improve HRQOL in subjects with Type 2 diabetes , but further prospect i ve studies are needed to confirm this finding The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose ( SMBG ) with routine urine testing in the management of patients with type II ( non-insulin-dependent ) diabetes mellitus not treated with insulin . Fifty-four patients with type II diabetes mellitus , not treated with insulin , who had inadequate glucose control on diet aloneor diet and oral hypoglycemic agents were studied . Patients performed SMBG or urine glucose testing as part of a st and ardized treatment program that also included diet and exercise counseling . During the 6-mo study , both the urine-testing and SMBG groups showed similar improvement in glycemic control ; within each group , there were significant improvements in fasting plasma glucose ( reduction of 1.4 ± 3.2 mM , P < 0.03 ) and glycosylated hemoglobin ( reduction of 2.0 ± 3.4 % , P < 0.01 ) levels . Seventeen ( 31 % ) of54 patients actually normalized their glycosylated hemoglobin values , 9 in the urine-testing group and 8 in the SMBG group . Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose ( P > 0.86 ) , glycosylated hemoglobin ( P > 0.95 ) , or weight ( P < 0.19 ) . In patients with type II diabetes mellitus not treated with insulin , SMBG is no more effective , but is 8–12 times more expensive , thanurine testing in facilitating improved glycemic control . Our results do not support widespread use of SMBG in diabetic patients not treated with insulin A diabetes protocol characterized by self-monitoring of blood glucose was introduced in four general practice s with the aim of making the frequency of consultations dependent on the metabolic regulation and emphasizing body weight reduction . The feasibility of the programme was investigated and the results after 1 year were compared with those of conventional care in four control practice s. In the experimental practice s , 13 patients switched from a medical specialist 's to a general practitioner 's supervision  , 20 remained under supervision of their GP  and 33 started self-monitoring .  The self-monitoring rate , the consultation frequency according to protocol , the low number of dropouts and inadequate referrals and adherence to the therapeutic scheme showed that the protocol was feasible for both the GPs and the patients . At the initial assessment , the regulation of the diabetes was worse in patients of the experimental group , compared with those of the control group ( mean HbA1 9.7 % vs 8.9 % ; p less than 0.05 ) . On average , patients in the experimental group ( n = 56 ) lost 0.4 kg of body weight , whereas those in the control group ( n = 73 ) gained 0.1 kg ( n.s . ) . The mean change in HbA1 , adjusted for the initial value , was -0.4 % in the experimental and + 0.5 % in the control group ( p less than 0.05 ) . The results of the protocol can be attributed to a combination of greater participation of the patient , the individualized consultation frequency and the prescription of oral hypoglycaemic agents according to body weight development OBJECTIVE Recent Veterans Affairs ( VA ) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose ( SMBG ) twice weekly . We assessed the impact of a modification of these guidelines on hemoglobin A1c ( HbA1c ) and monitoring cost . STUDY DESIGN Retrospective , noncrossover clinical trial . PATIENTS AND METHODS We instructed persons with type 2 diabetes to perform SMBG testing according to modified adapted VA guidelines . We compared patients ' baseline average testing frequency and HbA1c with those obtained during a 6-month interval beginning 2 months after implementation of the modified guidelines . The impact on the cost of monitoring was calculated . RESULTS At baseline , 913 of 1,213 SMBG users with diabetes on oral hypoglycemic agents had HbA1c tested ( HbA1c = 7.83 % + /- 1.34 % ) ; their frequency of SMBG was 1.36 + /- 0.95 strips per patient per day . Postimplementation , 974 of 1,278 persons with diabetes had HbA1c tested ( HbA1c = 7.86 % + /- 1.54 % ; P= .63 vs baseline ) ; frequency of SMBG decreased by 46 % to 0.74 + /- 0.50 strips per patient per day ( P < .0001 ) . At baseline , 154 of 254 SMBG users with diabetes on diet therapy had HbA1c tested ( HbA1c = 6.85 % + /- 0.97 % ) ; their frequency of SMBG was 1.07 + /- 0.90 strips per patient per day . Postimplementation , 177 of 282 diet-treated persons with diabetes had HbA1c tested ( HbA1c = 6.78 % + /- 1.20 % ; P = .56 vs baseline ) ; frequency of SMBG decreased by 35 % to 0.70 + /- 0.51 strips per patient per day ( P < .0001 ) . Similar findings were observed in a cohort of 421 drug-treated patients with paired HbA1c data before and after implementation , and a cohort of 50 diet-treated patients with paired HbA1c data . Linear regression analysis showed no significant impact on individuals ' HbA1c with reduction in strip use . Average monthly cost savings were $ 8,800 , or $ 6.37 per patient per month . CONCLUSIONS This program decreased the frequency of SMBG in persons with type 2 diabetes , result ing in substantial cost savings without affecting glucose control OBJECTIVE The Internet is used worldwide as a communication tool . To improve the quality of diabetes control , we investigated the effectiveness of an Internet-based blood glucose monitoring system ( IBGMS ) on controlling the changes in HbA(1c ) levels . RESEARCH DESIGN AND METHODS We conducted a r and omized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary 's Hospital for 3 months . The study subjects were treated with IBGMS for 12 weeks , and the control group received the usual outpatient management over the same period .  HbA(1c ) and other laboratory tests were performed twice , once at the beginning of the study and again at the end of the study . RESULTS The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age , sex , di 
    Output:
    
The evidence suggested that SMBG is of limited clinical effectiveness in improving glycaemic control in people with T2DM on oral agents , or diet alone , and is therefore unlikely to be cost-effective .
SMBG may lead to improved glycaemic control only in the context of appropriate education - both for patients and health-care professionals - on how to respond to the data , in terms of lifestyle and treatment adjustment .
Also , SMBG may be more effective if patients are able to self-adjust drug treatment .