***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: Despite increasing rate of diabetes , no st and ard self-management education protocol has been developed in Iran . We design ed Persian Diabetes Self-Management Education ( PDSME ) program using intervention mapping . Effectiveness of program was assessed in newly diagnosed people with type 2 diabetes and those who had received little self-management education . Individuals aged 18 and older ( n = 350 ) were recruited in this prospect i ve controlled trial during 2009 - 2011 in Tehran , Iran . Patients were excluded if they were pregnant , were housebound or had reduced cognitive ability . Participants were r and omly allocated in intervention and control groups . PDSME patients attended eight workshops over 4-week period following two follow-up sessions . Vali date d question naires assessed cognitive outcomes at baseline , 2 and 8 weeks . HbA1c was assessed before and 18 - 21 months after intervention in both groups . The CONSORT statement was adhered to where possible . A total of 280 individuals ( 80 % ) attended the program . By 18 - 21 months , the PDSME group showed significant improvements in mean HbA1c ( -1.1 versus + 0.2 % , p = 0.008 , repeated measure ANOVA ( RMA ) ) . Diabetes knowledge improved more in PDSME patients treated with oral antidiabetic agents than in those receiving usual care over time ( RMA , F = 67.08 , p < 0.001 ) . Statistically significant improvements were seen in PDSME patients for self-care behaviors , health beliefs , attitudes toward diabetes , stigma , self-efficacy and patient satisfaction .  PDSME program was effective in improving self-management cognitive and clinical outcomes . Results support use of intervention mapping for planning effective interventions . Given the large number of people with diabetes and lack of affordable diabetes education , PDSME deserves consideration for implementation Background There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases . Objective The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program , which was supported by a remote monitoring system , could be used to improve the health-related quality of life ( HRQL ) and /or the clinical measures of type 2 diabetes and heart disease patients . Methods A r and omized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District . Patients were recruited by sending invitations to r and omly selected patients using the electronic health records system . Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight , blood pressure , blood glucose ( diabetics ) , and steps ( heart disease patients ) once per week . The primary outcome was HRQL measured by the Short Form ( 36 ) Health Survey ( SF-36 ) and glycosylated hemoglobin ( HbA1c ) among diabetic patients . The clinical measures assessed were blood pressure , weight , waist circumference , and lipid levels . Results A total of 267 heart patients and 250 diabetes patients started in the trial , of which 246 and 225 patients concluded the end-point assessment s , respectively . Withdrawal from the study was associated with the patients ’ unfamiliarity with mobile phones — of the 41 dropouts , 85 % ( 11/13 ) of the heart disease patients and 88 % ( 14/16 ) of the diabetes patients were familiar with mobile phones , whereas the corresponding percentages were 97.1 % ( 231/238 ) and 98.6 % ( 208/211 ) , respectively , among the rest of the patients ( P=.02 and P=.004 ) . Withdrawal was also associated with heart disease patients ’ comorbidities—40 % ( 8/20 ) of the dropouts had at least one comorbidity , whereas the corresponding percentage was 18.9 % ( 47/249 ) among the rest of the patients ( P=.02 ) . The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life — heart disease patients : beta=0.730 ( P=.36 ) for the physical component score and beta=-0.608 ( P=.62 ) for the mental component score ; diabetes patients : beta=0.875 ( P=.85 ) for the physical component score and beta=-0.770 ( P=.52 ) for the mental component score . There was a significant difference in waist circumference in the type 2 diabetes group ( beta=-1.711 , P=.01 ) . There were no differences in any other outcome variables . Conclusions A health coaching program supported with telemonitoring did not improve heart disease patients ' or diabetes patients '  quality of life or their clinical condition . There were indications that the intervention had a differential effect on heart patients and diabetes patients . Diabetes patients may be more prone to benefit from this kind of intervention . This should not be neglected when developing new ways for self-management of chronic diseases . Trial Registration Clinical Trials.gov NCT01310491 ; http:// clinical trials.gov/ct2/show/NCT01310491 ( Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM ) AIM This paper is a report of a study conducted to assess the effectiveness of an educational intervention for people with type 2 diabetes based on self-completed instruments to identify particular areas of self-care needs . BACKGROUND Diabetes is a dem and ing disease which requires self-care . Instruments that identify self-care needs or factors affecting self-care can be helpful to detect level of self-care , distress or knowledge among individuals with diabetes . METHODS Participants were r and omized into intervention ( n = 28 ) or control groups ( n = 25 ) . Both groups answered five vali date d instruments three times , at baseline and after 3 and 6 months , and biological measurements were conducted simultaneously . The intervention was based on an empowerment approach . The study started in November 2005 and lasted until March 2007 . FINDINGS There was no statistically significant difference between groups in level of glycated haemoglobin postintervention as it reduced statistically significantly in both groups between baseline and 3 months but increased again after 6 months . There was no statistically significant difference between groups in body mass index reduction ; the intervention group achieved a statistically significant body mass index reduction but this was unchanged in the control group . No statistically significant differences between groups were found in scores for empowerment , well-being and distress . There was a statistically significant difference between groups in knowledge postintervention . CONCLUSION Use of instruments to identify self-care needs can enable patient-tailored care as it allows direct focusing on issues that are challenging and of relevance for each individual . It seems to be feasible to use the telephone to conduct an empowering educational intervention after one meeting Purpose The purpose of this study was to evaluate the effectiveness of integrative health ( IH ) coaching on psychosocial factors , behavior change , and glycemic control in patients with type 2 diabetes . Methods Fifty-six patients with type 2 diabetes were r and omized to either 6 months of IH coaching or usual care ( control group ) . Coaching was conducted by telephone for fourteen 30-minute sessions . Patients were guided in creating an individualized vision of health , and goals were self-chosen to align with personal values . The coaching agenda , discussion topics , and goals were those of the patient , not the provider . Preintervention and postintervention assessment s measured medication adherence , exercise frequency , patient engagement , psychosocial variables , and A1C . Results Perceived barriers to medication adherence decreased , while patient activation , perceived social support , and benefit finding all increased in the IH coaching group compared with those in the control group . Improvements in the coaching group alone were also observed for self-reported adherence , exercise frequency , stress , and perceived health status . Coaching participants with elevated baseline A1C ( ≥7 % ) significantly reduced their A1C . Conclusions A coaching intervention focused on patients ’ values and sense of purpose may provide added benefit to traditional diabetes education programs . Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy , accountability , and clinical outcomes In recent years , patient-centered chronic care models ( CCMs ) have been widely recognized as the most effective approach for the management of chronic diseases including type 2 diabetes ( T2DM ) [ 1 ] ; however , their implementation in the real world is a dem and ing challenge [ 2 , 3 ] . In Italy , the SINERGIA CCM was developed in the diabetes outpatient clinic of Cusano Milanino [ 4 ] . In this model , self-monitoring blood glucose ( SMBG ) represents the key tool for patient engagement ; within the empowerment philosophy , patients undergo an educational process , which incorporates interactive teaching strategies design ed to involve patients in problem-solving and address their clinical , cultural and psychosocial needs [ 5 ] . Patients are actively involved in the discussion of their goals and instructed about the importance of glycemic control , lifestyle modifications , reduction in body weight and regular monitoring of diabetes complications and their risk factors . Organizational aspects , i.e. , training , skills and roles of each member of diabetes team , electronic data collection , and continuity of communication with the patients are also addressed by the model [ 4 ] . Following a preliminary evaluation of the SINERGIA impact in an observational cohort of over 1000 patients with T2DM cared for by the Cusano Milanino center [ 4 ] , the Self-Care Study was design ed as a multicenter , national , r and omized ( 1:1 ) , open-label , parallel group , controlled clinical trial of a duration of 12 months to compare SINERGIA models versus usual care . The primary end point was the change after 12 months from r and omization in HbA1c levels . Secondary end points were changes in body weight , waist circumference , blood pressure , lipid profile , specific quality -of-life scores , incidence of hypoglycemia and adverse events , and contacts between patient and center . After 24 months from r and omization , an additional analysis ( post-trial observational phase of the study ) assessed the long-term impact of SINERGIA versus  usual care . Inclusion criteria were : men or women aged ≥ 45 years with diagnosis of T2DM , at their first access at the diabetes clinic , with any diabetes duration , HbA1c > 7.0 and ≤ 9.0 % , treated or requiring the initiation of therapy with any oral oral hypoglycemic agent ( OHA ) , not using SMBG ( i.e. , frequency ≤ 1 test/week ) and signature of informed consent . Exclusion criteria were : treated or requiring the initiation of therapy with insulin , any condition that could render the subject unlikely or unable to comply with the protocol requirements ( full list of eligibility criteria available in https:// clinical trials.gov/ct2/show/NCT02082028?term= SINERGIA&cond = Diabetes+Mellitus%2C+Type+2&cntr y1=EU%3AIT&rank=1 ) . Patients were r and omized to two study arms :  patients allocated to the  experimental group received the SINERGIA diabetes educational model [ 4 ] and patients allocated to the control group received the st and ard diabetes education provided by the center , and SMBG ( any glucose meter ) was prescribed only if deemed appropriate based on physician ’s judgment . Patients in both groups were seen six times during the study period : 2 weeks before r and omization , at r and omization visit , 3 , 6 and 12 months after r and omization and 24 months after r and omization ( post-trial ) . Considering as clinical ly relevant a minimum betweengroup difference in HbA1c levels of 0.4 % after 12 months and assuming a st and ard deviation of HbA1c of 0.9 % and a Managed by Antonio Secchi Background : The prevalence of type 2 diabetes and diabetesrelated morbidity and mortality is higher among low-income Hispanics when compared to that of Whites . However , little is known about how to effectively promote self-management in this population . Purpose : The objectives were first to determine the feasibility of conducting a r and omized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects . Methods : Participants for this pilot study were recruited from a community health center , an elder program , and a community-wide data base developed by the community health center , in collaboration with other agencies serving the community , by surveying households in the entire community . Participants were r and omly assigned to an intervention  ( n = 15 ) or a control ( n = 10 ) condition . Assessment s were conducted at baseline and at 3 months and 6 months postr and omization . The intervention consisted of 10 group sessions that targeted diabetes knowledge , attitudes , and self-management skills through culturally specific and literacysensitive strategies . The intervention used a cognitivebehavioral theoretical framework . Results : Recruitment rates at the community health center , elder program , and community registry were 48 % , 69 % , and 8 % , respectively . Completion rates for baseline , 3-month , and 6-month assessment s were 100 % , 92 % , and 92 % , respectively . Each intervention participant attended an average of 7.8 out of 10 sessions , and as a group the participants showed high adherence to intervention activities ( 93 % turned in daily logs , and 80 % self-monitored glucose levels at least daily ) . There was an overall Group × Time interaction ( p = .02 ) indicating group differences in glycosylated hemoglobin over time . The estimated glycosylated hemoglobin decrease at 3 months for the intervention group 
    Output:
    
Salutogenic oriented interventions that significantly improved both physical and psychosocial health were characterized by being based on formative research , culturally targeted , and delivered in 10 - 20 sessions in group setting s , whereas salutogenic oriented interventions that neither improved physical or psychosocial health significantly were characterized by being individually tailored and delivered in less than 10 group sessions in individual setting s. CONCLUSIONS This systematic review suggests that salutogenic-oriented lifestyle interventions are effective for physical and psychosocial health in the short term .