***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: Background Approximately 20 - 40 % of out patients with diabetes experience elevated levels of emotional distress , varying from disease-specific distress to general symptoms of anxiety and depression . The patient 's emotional well-being is related to other unfavorable outcomes , like reduced quality of life , sub-optimal self-care , impaired glycemic control , higher risk of complications , and increased mortality rates . The purpose of this study is to test the effectiveness of a new diabetes-specific , mindfulness-based psychological intervention . First , with regard to reducing emotional distress ; second , with respect to improving quality of life , dispositional mindfulness , and self-esteem of patients with diabetes ; third , with regard to self-care and clinical outcomes ; finally , a potential effect modification by clinical and personality characteristics will be explored . Methods / Design The Diabetes and Mindfulness study ( DiaMind ) is a r and omized controlled trial . Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics . Eligible patients will be r and omized to an intervention group or a wait-list control group . The intervention group will receive the mindfulness program immediately , while the control group will receive the program eight months later . The primary outcome is emotional distress ( anxiety , stress , depressive symptoms ) , for which data will be collected at baseline , four weeks , post intervention , and after six months follow-up . In addition , self-report data will be collected on quality of life , dispositional mindfulness , self-esteem , self-care , and personality , while complications and glycemic control will be assessed from medical files and blood pressure will be measured . Group differences will be analyzed with repeated measures analysis of covariance . The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee . Discussion It is hypothesized that emotional well-being , quality of life , dispositional mindfulness , self-esteem , self-care , and blood pressure will improve significantly more in the mindfulness group compared to the control group . Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being .  It is expected that the first results will become available in 2012.Trial registration Dutch Trial Register NTR2145 Background Research on the effects of treating sub-threshold depression in persons with diabetes is scarce in spite of the findings indicating that this condition is highly prevalent in the diabetic population and may increase the risk of developing a subsequent major depression . This study was aim ed at exploring the effects of a psycho-educational intervention on depression- and diabetes-related outcomes in patients with mild to moderate depressive symptoms . Methods A r and omized controlled study design with a one-year follow-up was used . Fifty patients with mild to moderate depressive symptoms ( 74 % female , aged 57 ± 9 yrs , diabetes duration of 10 ± 8 yrs , BMI 31 ± 6 kg/m2 , HbA1C 7.7 % ± 1.4 , 53 % insulin treated ) were r and omly assigned to either an intervention or a control group . The intervention group underwent four psycho-educational sessions aim ed at enabling self-management of depressive symptoms . The control group was informed about the screening results and depression treatment options while continuing diabetes treatment as usual . Both groups were contacted by phone in 2–3-month intervals , and re-assessed for depression after 6 and 12 months . Changes in depressive symptoms and glycaemic control were considered primary outcomes . Mann-Whitney U test and Friedman ANOVA were used to compare between- and within-group indicators at 6- and 12-month follow-ups . Results Both the intervention and the control group reported a significant decrease in depressive symptoms as measured by the CES-D scale ( Friedman ANOVA χ2 = 10.8 p = .004 and χ2 = 7.3 p = 0.03 , respectively ) . The 6-month and 1-year indicators of glycaemic control as compared to baseline HbA1C values were also improved in both groups ( χ2 = 11.6 p = 0.003 and χ2 = 17.1 p = 0.0002 , respectively ) . Between-group differences in depressive symptoms and HbA1C values were not statistically significant either at 6- or at 12-month follow-up ( all p > 0.05 ) . Conclusion Psycho-educational treatment appears to be beneficial in diabetic patients with mild to moderate depressive symptoms  , but its effects are comparable with the non-specific support given to the subjects in the control group . Trial registration Current Controlled Trials IS RCT Background The prevalence of mood difficulties in persons with diabetes is approximately twice that in the general population , affecting the health outcomes and patients ' quality of life in an undesirable way . Although subsyndromal depression is an important predictor of a more serious clinical depression , it is often overlooked . This study aims to compare the effects of two non-pharmacological interventions for subsyndromal depression , psychoeducation and physical exercise , with diabetes treatment as usual on mood- and diabetes-related outcomes . Methods and Design Type 2 diabetic patients aged 18 - 65 yrs . who report mood difficulties and the related need for help in a mail survey will be potential participants . After giving informed consent , they will be r and omly assigned to one of the three groups ( psychoeducation , physical activity , treatment as usual ) . Depressive symptoms , diabetes distress , health-related quality of life and diabetes self-care activities will be assessed at baseline , at 6 weeks , 6 months and 12 months . A structured clinical interview for DSM-IV Axis I Disorders ( SCID-I ) will be performed at baseline and at one-year follow-up in order to determine the clinical significance of the patients ' depressive symptoms . Disease-related data will be collected from patients ' files and from additional physical examinations and laboratory tests . The two interventions will be comparable in terms of format ( small group work ) , duration ( six sessions ) and approach ( interactive learning ; supporting the participants ' active roles ) . The group treated as usual will be informed about their screening results and about the importance of treating depression . They will be provided with brief re-education on diabetes and written self-help instructions to cope with mood difficulties . Primary outcomes will be depressive symptoms . Secondary outcomes will be glycaemic control , diabetes-related distress , self-management of diabetes and health-related quality of life . Tertiary outcomes will be biochemical markers reflecting common pathophysiological processes of insulin resistance , inflammation and oxidative damage that are assumed to be intertwined in both diabetes and depression . The mixed-effect linear model will be used to compare the outcome variables . Power analysis has indicated that the two intervention groups and the control group should comprise 59 patients to enable detection of clinical ly meaningful differences in depressive symptoms with a power of 80 % and alpha = 0.05 . Outcomes will be analysed on an intention-to-treat basis . Trial Registration IS RCT N : IS RCT Objective : The presence of co-morbid depressive symptoms may have a negative impact on the management of diabetes mellitus . Moreover , some antidepressants may adversely affect glycemic control . Selective serotonin reuptake inhibitors ( SSRIs ) may improve glycemic control and may be beneficial for patients with co-morbid depression and diabetes . We examined the safety and efficacy of s-citalopram therapy in patients with co-morbid depression and diabetes , and its ability to improve glycemic control . Research Design and Methods : 17 patients were enrolled into the trial and 14 patients received open-label s-citalopram therapy for up to 16 weeks . Clinical outcome measures included the 17-item Hamilton depression rating ( HAM-D 17 ) and the clinical global impressions severity ( CGI/S ) and change ( CGI/C ) ratings . In addition , fasting glucose , fructosamine , and glycosylated hemoglobin-A1C measures were obtained before and during s-citalopram therapy . Results : We observed a significant reduction in mean HAM-D 17 ( p < 0.001 ) , CGI/S ( p = 0.001 ) and CGI/C ( p = 0.001 ) ratings during s-citalopram therapy . We also observed a modest , non-significant reduction in fasting glucose , fructosamine , and glycosylated hemoglobin-A1C levels during s-citalopram therapy . Limitation : Limitations of this study include a modest patient sample size and a 16-week treatment duration which may have been insufficient to demonstrate the full effect of SSRI therapy on glycemic control . Conclusion : We observed a significant reduction in depressive symptoms and modest , non-significant reductions in fasting glucose , fructosamine , and glycosylated hemoglobin-A1C levels during SSRI therapy of co-morbid depression and diabetes Background Depressive disorder is one of the most common disorders , and is highly prevalent in chronically ill patients . The presence of comorbid depression has a negative influence on quality of life , health care costs , self-care , morbidity , and mortality . Early diagnosis and well-organized treatment of depression has a positive influence on these aspects . Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm . In the UK ' Problem Solving Treatment ' has proved to be feasible . However , in the general hospital setting this approach has not yet been evaluated . Methods / Design CC : DIM ( Collaborative Care : Depression Initiative in the Medical setting ) is a two-armed r and omised controlled trial with r and omisation at patient level . The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherl and s based on a collaborative care framework , including contracting , ' Problem Solving Treatment ' , antidepressant algorithm , and manual-guided self-help .  126 out patients with diabetes mellitus , chronic obstructive pulmonary disease , or cardiovascular diseases will be r and omised to either the intervention group or the control group . Patients will be included if they have been diagnosed with moderate to severe depression , based on the DSM-IV criteria in a two-step screening method .  The intervention group will receive treatment based on the collaborative care approach ; the control group will receive ' care as usual ' . Baseline and follow-up measurements ( after 3 , 6 , 9 , and 12 months ) will be performed by means of question naires . The primary outcome measure is severity of depressive symptoms , as measured with the PHQ-9 . The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P , the EuroQol and the SF-36 . Discussion Earlier research has indicated that depressive disorder is a chronic , mostly recurrent illness , which tends to cluster with physical comorbidity . Even though the treatment of depressive disorder based on the guidelines for depression is proven effective , these guidelines are often insufficiently adhered to . Collaborative care and ' Problem Solving Treatment ' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherl and To evaluate the efficacy and safety of oral magnesium supplementation , with magnesium chloride ( MgCl2 ) , in the treatment of newly diagnosed depression in the elderly with type 2 diabetes and hypomagnesemia . Twenty-three elderly patients with type 2 diabetes and hypomagnesemia were enrolled and r and omly allocated to receive either 50 mL of MgCl2 5 % solution equivalent to 450 mg of elemental magnesium or Imipramine 50 mg daily during 12 weeks . Widowhood or divorce in the last six months , alcoholism , degenerative illnesses of the nervous central system , recent diagnosis of diabetes , previous or current treatment with antidepressants , chronic diarrhea , use of diuretics , and reduced renal function were exclusion criteria . Hypomagnesemia was defined by serum magnesium levels < 1.8 mg/dL and depression by Yasavage and Brink score > or = 11 points . The primary trial end point was the improvement of depression symptoms . At baseline , there were no differences by age ( 69 + /- 5.9 and 66.4 + /- 6.1 years , p = 0.39 ) , duration of diabetes ( 11.8 + /- 7.9 and 8.6 + /- 5.7 years , p = 0.33 ) , serum magnesium levels ( 1.3 + /- 0.04 and 1.4 + /- 0.04 mg/dL , p = 0.09 ) , and Yasavage and Brink Score ( 17.9 + /- 3.9 and 16.1 + /- 4.5 point , p = 0.34 ) in the groups with MgCl2 and imipramine , respectively . At end of follow-up , there were no significant differences in the Yasavage and Brink score ( 11.4 + /- 3.8 and 10.9 + /- 4.3 , p = 0.27 ) between the groups in study ; whereas serum magnesium levels were significantly higher in the group with MgCl2 ( 2.1 + /- 0.08 mg/dL ) than in the subjects with imipramine ( 1.5 + /- 0.07 mg/dL ) , p 
    Output:
    
Psychological and pharmacological interventions have a moderate and clinical ly significant effect on depression outcomes  in diabetes patients .
Glycaemic control improved moderately in pharmacological trials , while the evidence is inconclusive for psychological interventions .
Adherence to diabetic treatment regimens , diabetes complications , death from any cause , health economics and QoL have not been investigated sufficiently .