***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 compare the utility values and quality -adjusted life years ( QALYs ) obtained by the Time Trade-Off instrument ( TTO ) and the EuroQol-5D ( EQ-5D ) in patients with rheumatoid arthritis ( RA ) ; to analyze the association between utility values and Disease Activity Score 28 ( DAS28 ) and Health Assessment Question naire ( HAQ ) . METHODS We conducted a longitudinal , prospect i ve , 1-year study of RA patients selected r and omly from 10 rheumatology clinics .  TTO and EQ-5D were administered at 4 scheduled visits . RESULTS The study sample comprised 300 RA patients ( 82 % women , mean age 59 years , mean disease duration 10.3 years ) . A total of 260 patients completed both the TTO and the EQ-5D at baseline , and the mean + /- SD TTO scores were significantly higher than the EQ-5D scores ( 0.81 + /- 0.22 versus 0.53 + /- 0.35 , P < 0.0001 ) . The intraclass correlation coefficient ( ICC ) for the utility methods was 0.19 . Data about changes in both TTO and EQ-5D scores during the study year were available in 163 patients . These changes tended to be larger in the TTO scores than the EQ-5D scores ( mean + /- SD 0.05 + /- 0.25 versus -0.005 + /- 0.35 , P = 0.054 ) . The ICC for the mean changes in the utility scores was 0.24 . Patients obtained a mean + /- SD of 0.04 + /- 0.20 QALYs based on TTO scores and 0.004 + /- 0.27 based on EQ-5D scores ( P = 0.12 ) . At baseline , the EQ-5D scores were highly correlated with the HAQ ( r = -0.74 ) and moderately correlated with the DAS28 ( r = -0.47 ) , whereas the TTO correlated poorly with both the HAQ and DAS28 . Correlation between the mean change in the EQ-5D and in the HAQ was moderate ( r = -0.55 ) . CONCLUSION TTO and EQ-5D do not yield the same utility values . The results suggest that the EQ-5D is more representative of RA status than the TTO , a valuable conclusion when addressing economic evaluations in RA Aims /hypothesisThe aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime , in order to calculate health economic outcomes such as quality -adjusted life expectancy . Methods Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) . After examining the internal validity , the UKPDS Outcomes Model was used to simulate the mean difference in expected quality -adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control . Results The model ’s forecasts fell within the 95 % confidence interval for the occurrence of observed events during the UKPDS follow-up period . When the model was used to simulate event history over patients ’ lifetimes , those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality -adjusted life years , and those receiving treatment with intensive glucose control could expect 16.62 quality -adjusted life years , a difference of 0.27 ( 95 % CI : −0.48 to 1.03 ) . Conclusions /interpretationsThe UKPDS Outcomes Model is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients ’ lifetimes . Its validity in estimating outcomes in other groups of patients , however , remains to be evaluated . The model allows simulation of a range of long-term outcomes , which should assist in informing future economic evaluations of interventions in Type 2 diabetes OBJECTIVE This study examined the effectiveness of the German diabetes disease management program ( DMP ) for patients with varying numbers of other medical conditions with respect to their health-related quality of life ( HRQoL ) . RESEARCH DESIGN AND METHODS A question naire , including the HRQoL-measured EQ-5D , was mailed to a r and om sample of 3,546 patients with type 2 diabetes ( 59.3 % female ) . The EQ-5D score was analyzed by grouping patients according to those on a DMP and those receiving routine care . RESULTS The analysis showed that participation in the DMP  ( P < 0.001 ) , the number of other medical conditions ( P < 0.001 ) , and the interaction between the DMP and the number of other conditions ( P < 0.05 ) had a significant impact on the EQ-5D score . CONCLUSIONS Our findings suggest that the number of other medical conditions may have a negative impact on the HRQoL of patients with type 2 diabetes . The results demonstrate that the German DMP for type 2 diabetes may help counterbalance this effect OBJECTIVE The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes . RESEARCH DESIGN AND METHODS We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta , Canada . The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers .  Clinical and patient-reported outcomes were assessed after 6 months . Patient-reported outcomes included changes in health-related quality of life ( Health Utilities Index Mark 3 [ HUI3 ] ) , satisfaction with care , lifestyle ( Diabetes Lifestyle Form ) , and adherence to self-care activities . Analysis of covariance was used to assess differences over time between the control and intervention regions . RESULTS A total of 200 intervention and 172 control subjects were included in this analysis . After adjusting for important clinical and demographic differences , a statistically significant and clinical ly important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region ( 0.06 [ 95 % CI 0.02 - 0.10 ] ) compared with the control region ( 0.01 [ -0.04 to 0.04 ] ) ( P = 0.03 for the difference between groups ) . Satisfaction with general medical care ( P < 0.001 between groups ) and diabetes care ( P < 0.001 between groups ) increased among patients in the intervention region compared with the control region . Self-efficacy , attitudes , and beliefs about diabetes control all increased in the intervention region when compared with the control region , but adherence to self-care activities did not . CONCLUSIONS A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life , satisfaction with care , and other humanistic outcomes Background Patient-reported measures can be used to examine whether drug differences other than clinical efficacy have an impact on outcomes that may be important to patients . Although exenatide and insulin glargine appear to have similar efficacy for treatment of type 2 diabetes , there are several differences between the two treatments that could influence outcomes from the patient 's perspective . The purpose of the current study was to examine whether the two drugs were comparable as assessed by patient-reported outcomes using data from a clinical trial in which these injectable medications were added to pre-existing oral treatment regimens . Methods Patients were r and omized to either twice daily exenatide or once daily insulin glargine during a 26-week international trial . At baseline and endpoint , five patient-reported outcome measures were administered : the Vitality Scale of the SF-36 , The Diabetes Symptom Checklist – Revised ( DSC-R ) , the EuroQol EQ-5D , the Treatment Flexibility Scale ( TFS ) , and the Diabetes Treatment Satisfaction Question naire ( DTSQ ) . Change from baseline to endpoint was analyzed within each treatment group . Group differences were examined with General linear models ( GLMs ) , controlling for country and baseline scores . Results A total of 549 patients with type 2 diabetes were enrolled in the trial , and current analyses were conducted with data from the 455 per protocol patients ( 228 exenatide and 227 insulin glargine ) . The sample was primarily Caucasian ( 79.6 % ) , with slightly more men ( 55.2 % ) than women , and with a mean age of 58.5 years . Paired t-tests found that both treatment groups demonstrated statistically significant baseline to endpoint change on several of the health outcomes instruments including the DSC-R , DTSQ , and the SF-36 Vitality subscale . GLMs found no statistically significant differences between groups in change on the health outcomes instruments . Conclusion This analysis found that both exenatide and insulin glargine were associated with significant improvements in patient-reported outcomes when added to oral medications among patients with type 2 diabetes . Despite an additional daily injection and a higher rate of gastrointestinal adverse events , treatment satisfaction in the exenatide group was comparable to that of the glargine group , possibly because of weight reduction observed in patients treated with exenatide Context The Diabetes Prevention Program ( DPP ) showed that lifestyle changes or metformin effectively decreased the development of  type 2 diabetes in adults with impaired glucose tolerance . The economics of these interventions is important to policymakers . Contribution This cost-effectiveness model estimates that the DPP life-style intervention would cost society about $ 8800 and metformin would cost about $ 29900 per quality -adjusted life-year saved . While lifestyle intervention had a favorable cost-effectiveness profile at any adult age , metformin was not cost-effective after age 65 years . Implication s The cost-effectiveness of lifestyle intervention to prevent type 2 diabetes  in high-risk individuals is within the range that American society typically finds acceptable for health care interventions . The Editors During the past half century , the number of persons with diagnosed diabetes in the United States has increased 4- to 6-fold ( 1 ) . Recent large clinical trials from Asia , Europe , and North America have demonstrated that behavioral and medication interventions can delay or prevent the development of type 2 diabetes in persons with impaired glucose tolerance , which is defined by a plasma glucose level between 7.77 mmol/L ( 140 mg/dL ) and 11.04 mmol/L ( 199 mg/dL ) 2 hours after a 75-g oral glucose load ( 2 - 6 ) . The Diabetes Prevention Program ( DPP ) r and omly assigned 3234 nondiabetic persons 25 years of age or older with impaired glucose tolerance and fasting glucose levels between 5.27 mmol/L ( 95 mg/dL ) and 6.94 mmol/L ( 125 mg/dL ) to placebo ; a lifestyle-modification program with the goals of at least a 7 % weight loss and 150 minutes of physical activity per week ; or metformin , 850 mg twice daily ( 4 ) . The mean age of participants was 51 years , and the mean body mass index was 34.0 kg/m2 ; 68 % were women and 45 % were members of minority groups ( 4 ) . The average follow-up was 2.8 years . Compared with the placebo intervention , the lifestyle intervention reduced the incidence of type 2 diabetes by 58 % and the metformin intervention reduced the incidence of type 2 diabetes by 31 % ( 4 ) . We have previously described the costs of the DPP interventions and their cost-effectiveness within the 3-year trial period ( 7 , 8) . In this analysis , we project the costs , health outcomes , and cost-effectiveness of the DPP lifestyle and metformin interventions over a lifetime relative to the placebo intervention . Methods Clinical Trial The lifestyle intervention involved a healthy , low-calorie , low-fat diet and moderate physical activity , such as brisk walking . The lifestyle intervention was implemented with a 16-lesson core curriculum covering diet , exercise , and behavior modification that was taught by case managers on a one-on-one basis , followed by individual sessions ( usually monthly ) and group sessions with case managers ( 9 ) . At the end of the study , 38 % of participants in the lifestyle intervention group had lost at least 7 % of their initial body weight .  The metformin and placebo interventions were initiated at a dosage of 850 mg once a day . At 1 month , the dosage of metformin or placebo was increased to 850 mg twice daily . Case managers reinforced adherence during individual quarterly sessions ( 10 ) . At the end of the study , 72 % of participants in the metformin intervention group and 77 % of participants in the placebo intervention group took at least 80 % of the prescribed dose . All participants received st and ard lifestyle recommendations through written information and an annual 20- to 30-minute individual session that emphasized the importance of a healthy lifestyle ( 10 ) . Simulation Model We assessed the progression from impaired glucose tolerance to onset of diabetes to clinical ly diagnosed diabetes to diabetes with complications and death by using a lifetime simulation model originally developed by the Centers for Disease Control and Prevention and Research Triangle Institute International . The model has a Markov 
    Output:
    
Conclusions We provide summary utility scores for diabetes and its major complications that could help inform economic evaluation and policy analysis