***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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    Input: PURPOSE We compared a 3-month diabetes self-management education ( DSME ) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin ( HbA1c ) . Secondary outcomes were risk factors for cardiovascular disease ( CVD ) , diabetes distress , and social support . METHODS We r and omized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support . Assessment s were conducted at baseline , 3 , 9 , and 15 months . RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group . The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months . At 15 months , the peer-support group had significantly lower low-density lipoprotein cholesterol levels ( −15 mg/dL , P = .03 ) , systolic blood pressure ( −10 mm Hg , P = .01 ) , diastolic blood pressure ( −8.3 mm Hg , P = .001 ) , and body mass index ( −0.8 kg/m2 , P = .032 ) than the DSME-alone group . CONCLUSIONS In this population of African American adults , an initial DSME program , whether or not followed by 12 months of peer support , had no effect on glycemic control . Participants in the peer-support arm of the trial did , however , experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined OBJECTIVE To determine the concurrent , prospect i ve , and time-concordant relationships among  major depressive disorder ( MDD ) , depressive symptoms , and diabetes distress with glycemic control . RESEARCH DESIGN AND METHODS In a noninterventional study , we assessed 506 type 2 diabetic patients for MDD ( Composite International Diagnostic Interview ) , for depressive symptoms ( Center for Epidemiological Studies -Depression ) , and for diabetes distress ( Diabetes Distress Scale ) , along with self-management , stress , demographics , and diabetes status , at baseline and 9 and 18 months later . Using multilevel modeling ( MLM ) , we explored the cross-sectional relationships of the three affective variables with A1C , the prospect i ve relationships of baseline variables with change in A1C over time , and the time-concordant relationships with A1C . RESULTS All three affective variables were moderately intercorrelated , although the relationship between depressive symptoms and diabetes distress was greater than the relationship of either with MDD . In the cross-sectional MLM , only diabetes distress but not MDD or depressive symptoms was significantly associated with A1C . None of the three affective variables were linked with A1C in prospect i ve analyses . Only diabetes distress displayed significant time-concordant relationships with A1C . CONCLUSIONS We found no concurrent or longitudinal association between MDD or depressive symptoms with A1C , whereas both concurrent and time-concordant relationships were found between diabetes distress and A1C . What has been called “ depression ” among type 2 diabetic patients may really be two conditions , MDD and diabetes distress , with only the latter displaying significant associations with A1C . Ongoing evaluation of both  diabetes distress and MDD may be helpful in clinical setting Technology and improved care coordination models can help diabetes educators and providers meet national care st and ards and provide culturally sensitive diabetes education that may improve diabetes outcomes . The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program ( Comprehensive Diabetes Management Program , CDMP ) for poorly controlled Hispanic type 2 diabetes ( T2DM ) patients in an urban community health center setting . Patients were r and omized to the intervention condition ( IC ; n = 21 ) or an attention control condition ( AC ; n = 18 ) . IC and AC conditions were compared on rates of adherence to national clinical practice guidelines ( blood glucose , blood pressure , foot exam , eye exam ) , and levels of diabetes distress , depression , and treatment satisfaction . IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC ( −1.6 % ± 1.4 % versus −0.6 % ± 1.1 % ; P = .01 ) . The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c ( IC = 45 % ; AC = 28 % ) , systolic blood pressure ( IC = 55 % ; AC = 28 % ) , eye screening ( IC = 91 % ; AC = 78 % ) , and foot screening , ( IC = 86 % ; AC = 72 % ) . Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC ( P = .05 and P = .06 , respectively ) , with no differences for depression . The CDMP intervention was more effective than an attention control condition in helping patients meet evidence -based guidelines for diabetes care Background Culturally adapted interventions are needed to reduce diabetes-related morbidity and mortality among Native Hawaiian and Pacific People . Purpose The purpose of this study is to pilot test the effectiveness of a culturally adapted diabetes self-management intervention . Methods Participants were r and omly assigned in an unbalanced design to the Partners in Care intervention ( n = 48 ) or wait list control group ( n = 34 ) . Assessment s of hemoglobin A1c , underst and ing of diabetes self-management , performance of self-care activities , and diabetes-related distress were measured at baseline and 3 months ( post intervention ) . Analysis of covariance was used to test between-group differences . The community steering committee and focus group data informed the cultural adaptation of the intervention . Results There were significant baseline adjusted differences at 3 months between the Partners in Care and wait list control group in intent-to-treat ( p < 0.001 ) and complete case analyses ( p < 0.0001 ) for A1c , underst and ing ( p < 0.0001 ) , and performing diabetes self-management ( p < 0.0001 ) . Conclusions A culturally adapted diabetes self-management intervention of short duration was an effective approach to improving glycemic control among Native Hawaiian and Pacific Isl and ers OBJECTIVE The determinants of  insulin-associated weight gain in type 2 diabetes mellitus ( T2DM ) are partly unknown . Therefore , we conducted a prospect i ve study to identify predictors of insulin-associated weight gain . RESEARCH DESIGN AND METHODS In patients with T2DM , we assessed physical activity by accelerometry and measured diabetes-related distress by question naires before and 6 and 12 months after starting insulin therapy .  Glycemic control ( HbA1c ) and  insulin dose were monitored . RESULTS After 12 months of insulin therapy , mean body weight had increased by 3.0 ± 2.5 kg ( P < 0.001 ) . The drop in HbA1c was correlated with insulin-associated weight gain . With the use of a multiple linear regression model , a cluster of variables was identified that significantly related to weight gain . Diabetes-related distress , initial insulin dose , and the increase of insulin dose during the course of the study as well as age appeared to be important predictors of weight gain after initiation of insulin  therapy . Physical activity ( measured as MET ) decreased from 1.40 ± 0.04 at baseline to 1.32 ± 0.04 MET ( P < 0.05 ) but was not significantly related to weight changes . CONCLUSIONS Diabetes-related distress , initial and titration of insulin dose , and age all significantly predict insulin-associated weight gain . After the initiation of insulin therapy , physical activity decreased significantly , but this did not determine weight gain over the first 12 months . Our study findings may have clinical implication OBJECTIVE To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes ( MIND ) in routine diabetes care on psychological status and glycemic control , identify predictors of poor psychological outcomes , and evaluate care providers ’ experiences . RESEARCH DESIGN AND METHODS The MIND procedure was implemented as part of the annual review in diabetes clinics across eight countries in a prospect i ve observational study with a 1-year follow-up . MIND encompasses well-being ( World Health Organization Five Well-Being Index [ WHO-5 ] ) , diabetes-related distress ( Problem Areas in Diabetes [ PAID ] ) , a Life Event Inventory , and the patient ’s agenda for their consultation . Medical data and agreed case-management actions were retrieved from the charts . RESULTS Of the total 1,567 patients , 891 patients ( 57 % ) were monitored at a 1-year follow-up . Twenty-eight percent of the patients screened positive for depression and /or diabetes distress at baseline and considered cases , 17 % of whom were receiving psychological care . Cases were significantly more often female and had type 2 diabetes and worse glycemic control compared with noncases . Clinical ly relevant improvements in WHO-5 and PAID were observed over time in cases , irrespective of referral ( effects sizes 0.59 and 0.48 , respectively ; P < 0.0001 ) . Glycemic control did not change . Female sex , life events , and concomitant chronic diseases were predictors of poor psychological outcomes . MIND was well received by patients and staff . CONCLUSIONS MIND appears suitable for screening and discussion of emotional distress as part of the annual review . Broader dissemination in diabetes care is recommendable , but sustainability will depend on reimbursement and availability of support services OBJECTIVE —We examined the association between depression , measured as either a continuous symptom severity score or a clinical disorder variable , with self-care behaviors in type 2 diabetes . RESEARCH DESIGN AND METHODS —We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale ( H AND S ) , the Summary of Diabetes Self-Care Activities , and self-reported medication adherence . RESULTS —Of the patients , 19 % met the criteria for probable major depression ( H AND S score ≥9 ) , and an additional 66.5 % reported at least some depressive symptoms . After controlling for covariates , patients with probable major depression reported significantly fewer days ' adherent to diet , exercise , and glucose self-monitoring regimens  ( P < 0.01 ) and 2.3-fold increased odds of missing medication doses in the previous week ( 95 % CI 1.5–3.6 , P < 0.001 ) compared with all other respondents . Continuous depressive symptom severity scores were better predictors of nonadherence to diet , exercise , and medications than categorically defined probable major depression . Major depression was a better predictor of glucose monitoring . Among the two-thirds of patients not meeting the criteria for major depression ( H AND S score < 9 , n = 709 ) , increasing H AND S scores were incrementally associated with poorer self-care behaviors ( P < 0.01 ) . CONCLUSIONS —These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care . Interventions aim ed at alleviating depressive symptoms , which are quite common , could result in significant improvements in diabetes self-care Abstract Aims / Introduction To evaluate the effects of a caloric restricted weight loss program with or without supervised resistance exercise training ( EX ) on diabetes‐related emotional distress and quality of life ( QOL ) in overweight and obese patients with type 2 diabetes . Material s and Methods In a parallel design , 106 men and women with type 2 diabetes were r and omized to a prescriptive 16‐week caloric restricted diet ( D ; 6,000–7,000 kJ/day ) , with ( n = 65 ) or without ( n = 41 ) EX ( three times per week ) . Bodyweight , glycated hemoglobin , diabetes‐specific emotional distress ( Problem Areas in Diabetes [ PAID ] question naire ) and QOL ( Diabetes‐39 [ D‐39 ] question naire ) was assessed pre‐ and post‐intervention . Results A total of 84 participants completed the study ( D n = 33 , D + EX n = 51 ) . Weight loss was significantly greater in D + EX compared with D ( −11.4 ± 5.8 vs −8.8 ± 5.8 kg , P = 0.04 time × diet ) . Overall , there were significant improvements in glycated hemoglobin , PAID total score and the D‐39 dimensions of ‘ diabetes control ’ , ‘ anxiety and worry ’ , ‘ sexual functioning ’ , ‘ energy and mobility ’ , ‘ overall rating of QOL ’ and ‘ severity of diabetes ’ ( P ≤ 0.01 for time ) . The D‐39 dimension , ‘ social burden ’ , did not change ( P = 0.07 for time ) . There was no difference between groups in the response for any of these variables ( P ≥ 0.10 ) . Conclusion A structured caloric restricted diet with or without EX improves emotional distress and QOL in over 
    Output:
    
Diabetes distress is a prominent issue in people with Type 2 diabetes that is associated with female gender and comorbid depressive symptoms .