***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: Evaluated the effects of stress management training ( SMT ) for adolescents with diabetes  in a 9-month controlled treatment- outcome study . Nine patients were r and omly assigned to a  stress management group while another 10 patients served as controls and received st and ard outpatient treatment . The treatment program consisted of 10 sessions over 3 months , 3 additional sessions over 3 months , and a 3-month follow-up without treatment .  Diabetes-specific stress decreased significantly for patients in the SMT group over the course of the intervention and follow-up . However , metabolic control , regimen adherence , coping styles , and self-efficacy about diabetes were unchanged . These findings suggest a SMT program for adolescents with diabetes may be helpful in reducing diabetes-specific stress , but additional procedures are necessary to improve adherence , coping styles , and metabolic control Objective To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams . Design Pragmatic cluster r and omised controlled trial . Setting 26 UK secondary and tertiary care paediatric diabetes services . Participants 79 healthcare practitioners ( 13 teams ) trained in the intervention ( 359 young people with type 1 diabetes aged 4 - 15 years and their main carers ) and 13 teams allocated to the control group ( 334 children and their main carers ) . Intervention Talking Diabetes programme , which promotes shared agenda setting and guiding communication style , through flexible menu of consultation strategies to support patient led behaviour change . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) level one year after training . Secondary outcomes were clinical measures ( hypoglycaemic episodes , body mass index , insulin regimen ) , general and diabetes specific quality of life , self reported and proxy reported self care and enablement , perceptions of the diabetes team , self reported and carer reported importance of , and confidence in , undertaking diabetes self management measured over one year . Analysis was by intention to treat . An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training ( intervention group ) and at one year follow-up ( intervention and control group ) . Two key domains of skill assessment were use of the guiding communication style and shared agenda setting . Results 660/693 patients ( 95.2 % ) provided blood sample s at follow-up . Training diabetes care teams had no effect on HbA1c levels ( intervention effect 0.01 , 95 % confidence interval −0.02 to 0.04 , P=0.5 ) , even after adjusting for age and sex of the participants . At follow-up , trained staff ( n=29 ) were more capable than controls ( n=29 ) in guiding ( difference in means 1.14 , P<0.001 ) and agenda setting ( difference in proportions 0.45 , 95 % confidence interval 0.22 to 0.62 ) . Although skills waned over time for the trained practitioners , the reduction was not significant for either guiding ( difference in means −0.33 , P=0.128 ) or use of agenda setting ( difference in proportions −0.20 , −0.42 to 0.05 ) . 390 patients ( 56 % ) and 441 carers ( 64 % ) completed follow-up question naires . Some aspects of diabetes specific quality of life improved in controls : reduced problems with treatment barriers ( mean difference −4.6 , 95 % confidence interval −8.5 to −0.6 , P=0.03 ) and with treatment adherence ( −3.1 , −6.3 to −0.01 , P=0.05 ) . Short term ability to cope with diabetes increased in patients in intervention clinics ( 10.4 , 0.5 to 20.4 , P=0.04 ) . Carers in the intervention arm reported greater excitement about clinic visits ( 1.9 , 1.05 to 3.43 , P=0.03 ) and improved continuity of care ( 0.2 , 0.1 to 0.3 , P=0.01 ) . Conclusions Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief , team-wide training in consultation skills . Trial registration Current Controlled Trials IS RCT N61568050 OBJECTIVE Sub clinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis . Since there is a lack of specific intervention concepts for this patient group , a self-management – oriented group program ( DIAMOS [ Diabetes Motivation Strengthening ] ) was newly developed and evaluated in a r and omized trial . RESEARCH DESIGN AND METHODS DIAMOS is composed of cognitive behavioral interventions aim ing at the reduction of  diabetes distress . The active control group ( CG ) received diabetes education . The primary outcome was depressive symptoms . Secondary outcomes were diabetes distress , well-being , self-care behavior , diabetes acceptance , diabetes treatment satisfaction , HbA1c , and sub clinical inflammation . RESULTS Two hundred fourteen participants ( mean age 43.3 ± 13.3 years , female sex 56.5 % , type 2 diabetes 34.1 % , mean diabetes duration 14.2 ± 10.5 years , HbA1c 8.9 ± 1.8 % , BMI 28.7 ± 71 kg/m2 ) were r and omized . The 12-month follow-up revealed a significantly stronger reduction of depressive symptoms ( Center for Epidemiologic Studies Depression Scale score ) in the DIAMOS group compared with the CG ( Δ3.9 [ 95 % CI 0.6–7.3 ] , P = 0.021 ) . Of the secondary variables , the Patient Health Question naire-9 ( Δ1.7 [ 95 % CI 0.2–3.2 ] , P = 0.023 ) , Problem Areas in Diabetes scale ( Δ8.2 [ 95 % CI 3.1–13.3 ] , P = 0.002 ) , and Diabetes Distress Scale scores ( Δ0.3 [ 95 % CI 0.1–0.5 ] , P = 0.012 ) displayed significant treatment effects . Moreover , the risk of incident major depression in the DIAMOS group was significantly reduced ( odds ratio 0.63 [ 95 % CI 0.42–0.96 ] , P = 0.028 ) . Inflammatory variables were not substantially affected . CONCLUSIONS DIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with sub clinical depression . DIAMOS also has a preventive effect with respect to the incidence of major depression OBJECTIVE Given the urgent need to develop effective programs that improve the ability for adolescents to achieve metabolic control equivalent to programs studied in the Diabetes . Control and Complications Trial , we have undertaken a clinical trial to determine if a behavioral intervention ( coping skills training [ CST ] ) combined with intensive diabetes management can improve metabolic control and quality of life in adolescents implementing intensive therapy regimens . RESEARCH DESIGN AND METHODS A total of 65 youths between the ages of 13 and 20 years , who elected to initiate intensive insulin therapy  , were r and omly assigned to one of two groups : the intensive management with CST group and the intensive management without CST group . CST consists of a series of small group efforts design ed to teach adolescents the coping skills of social problem-solving , social skills training , cognitive behavior modification , and conflict resolution . Data were collected at pre-intervention and at 3 months following the use of the Self-Efficacy for Diabetes scale , Children 's Depression Inventory , Issues in Coping with IDDM scale , and the Diabetes Quality of Life : Youth scale . Clinical data ( HbA1c , adverse effects ) were collected monthly . RESULTS The experimental and control groups were comparable on all measures at baseline . Results show that adolescents who received CST had lower HbA1c and better diabetes self-efficacy and were less upset about coping with diabetes than adolescents receiving intensive management alone . In addition , adolescents who received the CST found it easier to cope with diabetes and experienced less of a negative impact of diabetes on quality of life than those who did not receive CST . CONCLUSIONS CST is useful in improving not only an adolescent 's metabolic control , but also their quality of life . As more pediatric providers aim for improved control , in adolescents with diabetes , the addition of this behavioral intervention may be helpful in achieving metabolic and life goals PURPOSE this study examined the metabolic and quality -of-life effects of using lispro insulin  in teenagers . METHODS Teenagers on multiple daily injections who had not reached metabolic treatment goals were offered the opportunity to use lispro insulin as part of a larger ongoing study of intensive management in youth . Of the 51 who were eligible , 35 used lispro and were followed for 12 months ; the remaining 16 had reached treatment goals , were not offered lispro , and comprised the control group . RESULTS After 12 months , the teens who received lispro insulin achieved equivalent levels of metabolic control to those achieved by teens in the control group , without differences in total daily dose , insulin regimen , or adverse events . Those who received lispro found coping with diabetes less difficult than those who continued on regular insulin , and they reported less negative impact of diabetes on quality of life and fewer worries about diabetes . Both groups were equally satisfied with their diabetes treatment . CONCLUSIONS Lispro insulin is a safe alternative for youth on intensive regimens , may assist youth in coping with diabetes , and may improve their quality of life PURPOSE This study examined the metabolic trend and factors associated with an unexpected rise in HbA1c levels during the summer , with a return to baseline when school resumed , in 40 intensively treated adolescents with type 1 diabetes . METHODS Psychosocial data were collected using a variety of diabetes evaluation instruments . HbA1c was measured monthly . RESULTS HbA1C values increased by a mean of .73 % from May to July and decreased by a mean of .75 % from August to October . Lack of consistency in summer routines compared with school days was associated with a worsening in metabolic control during the summer months . Other factors associated with the summer increase in HbA1c included lower guidance scores on the Diabetes Family Behavior Scale , and higher impact and worry scores on the Diabetes Quality of Life for Youth Scale . CONCLUSIONS Interviews suggested that teenagers need to take a vacation from intensive diabetes care during the summer PURPOSE The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes  cope with stress . METHODS Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies . Treatment impact was assessed on measures of coping , anxiety level , diabetes-specific stress , and metabolic control . RESULTS Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up . However , the small sample size and within-group variability may have precluded finding significant results . Therefore , within-group comparisons were conducted , and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety , stress , and coping measures . No differences were found in the control group . CONCLUSIONS Results suggest that the intervention had some positive impact , although this interpretation must be considered preliminary . Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific population OBJECTIVE To develop and evaluate a health-care communication training programme to help diabetes health-care professionals ( HCPs ) counsel their patients more skilfully , particularly in relation to behaviour change . DESIGN The HCP training was assessed using a pragmatic , cluster r and omised controlled trial . The primary and secondary analyses were intention-to-treat comparisons of outcomes using multilevel modelling to allow for cluster ( service ) and individual effects , and involved two-level linear models . SETTING Twenty-six UK paediatric diabetes services . PARTICIPANTS The training was delivered to HCPs ( doctors , nurses , dietitians and psychologists ) working in paediatric diabetes services and the effectiveness of this training was measured in 693 children aged 4 - 15 years and families after 1 year ( 95.3 % follow-up ) . INTERVENTIONS A blended learning programme was informed by a systematic review of the literature , telephone and question naire surveys of professional practice , focus groups with children and parents , experimental consultations and three developmental workshops involving a stakeholder group . The programme focused on agenda- setting , flexible styles of communication ( particularly guiding ) and a menu of strategies using web-based training and practical workshops . MAIN OUTCOME MEASURES The primary trial outcome was a change in glycosylated haemoglobin ( HbA1c ) levels between the start and finish of a 12-month study period . Secondary trial outcomes included change in quality of life , other clinical [ including body mass index ( BMI ) ] and psychosocial measures ( assessed at participant level as listed above ) and cost ( assessed at service level ) . In addition , patient details ( HbA1c levels , height , weight , BMI , insulin regimen ) , health service contacts and patient-borne costs were recorded at each clinic visit , along with details of who patients consulted with , for how long , and whether or not patients consulted on their own at each visit . Patients and carers were also asked to complete an 
    Output:
    
Consistent with adult studies , around one third of adolescents experience elevated DD and this is frequently associated with suboptimal glycemic control , low self-efficacy and reduced self-care .