***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: AIMS To evaluate the effectiveness of a family-centred group education programme , in adolescents with Type 1 diabetes . METHODS Three hundred and five adolescents with Type 1 diabetes ; age 13.1 ± 1.9 years , diabetes duration 5.6 ± 3.3 years , BMI 20.9 ± 3.7 kg/m(2 ) , HbA(1c ) 78 ± 6 mmol/mol ( 9.3 ± 1.9 % ) were r and omly allocated to the Families and Adolescents Communication and Teamwork Study ( FACTS ) diabetes education programme ; ( six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork ) or conventional clinical care . Primary outcome was HbA(1c ) at 18 months ( 12 months post-intervention ) . Secondary outcomes were HbA(1c ) at 9 months , psychosocial outcomes , adolescent quality of life , well-being , family responsibility and insulin dose adjustment behaviours at 12 months ( 6 months post-intervention ) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention . All analyses are intention to treat . RESULTS Session attendance was poor with 48/158 families ( 30.4 % ) not attending any sessions and only 75/158 ( 47.5 % ) families attending ≥ 4 group education sessions . All biomedical and psychosocial outcomes were comparable between groups . At 18 months there was no significant difference in HbA(1c ) in either group and no between-group differences over time : intervention group 75 mmol/mol ( 9.0 % ) to 78 mmol/mol ( 9.3 % ) , control group 77 mmol/mol ( 9.2 % ) to 80 mmol/mol ( 9.5 % ) . Adolescents perceived no changes in parental input at 12 months . CONCLUSION Poor attendance of group education sessions delivered in routine clinics was a major challenge . More personalized educational approaches may be required to support and motivate families who are struggling to integrate the dem and s of intensive insulin regimens into their daily lives AIMS To assess Sweet Talk , a text-messaging support system design ed to enhance self-efficacy , facilitate uptake of intensive insulin therapy and improve glycaemic control in paediatric patients with Type 1 diabetes . METHODS One hundred and twenty-six patients fulfilled the eligibility criteria ; Type 1 diabetes for > 1 year , on conventional insulin therapy , aged 8 - 18 years . Ninety-two patients were r and omized to conventional insulin therapy  ( n = 28 ) , conventional therapy and Sweet Talk ( n = 33 ) or  intensive insulin therapy and Sweet Talk ( n = 31 ) . Goal - setting at clinic visits was reinforced by daily text-messages from the Sweet Talk software system , containing personalized goal -specific prompts and messages tailored to patients ' age , sex and insulin regimen . RESULTS HbA(1c ) did not change in patients on conventional therapy without or with Sweet Talk ( 10.3 + /- 1.7 vs. 10.1 + /- 1.7 % ) , but improved in patients r and omized to intensive therapy and Sweet Talk ( 9.2 + /- 2.2 % , 95 % CI -1.9 , -0.5 , P < 0.001 ) . Sweet Talk was associated with improvement in diabetes self-efficacy  ( conventional therapy 56.0 + /- 13.7 , conventional therapy plus Sweet Talk 62.1 + /- 6.6 , 95 % CI + 2.6 , + 7.5 , P = 0.003 ) and self-reported adherence  ( conventional therapy 70.4 + /- 20.0 , conventional therapy plus Sweet Talk 77.2 + /- 16.1 , 95 % CI + 0.4 , + 17.4 , P = 0.042 ) . When surveyed , 82 % of patients felt that Sweet Talk had improved their diabetes self-management and 90 % wanted to continue receiving messages . CONCLUSIONS Sweet Talk was associated with improved self-efficacy and adherence ; engaging a classically difficult to reach group of young people . While Sweet Talk alone did not improve glycaemic control , it may have had a role in supporting the introduction of intensive insulin therapy . Scheduled , tailored text messaging offers an innovative means of supporting adolescents with diabetes and could be adapted for other health-care setting s and chronic diseases 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 The objective of this study was to compare the relative effectiveness of two modes of delivering Behavioral Family Systems Therapy for Diabetes ( BFST-D ) to improve adherence and glycemic control among adolescents with type 1 diabetes with suboptimal glycemic control ( HbA1c ≥9.0 % [ ≥74.9 mmol/mol ] ) :  face to face in clinic ( Clinic ) and Internet videoconferencing ( Skype ) conditions . RESEARCH DESIGN AND METHODS Adolescents aged 12 to 18 years and at least one adult caregiver were r and omized to receive BFST-D via the Clinic or Skype condition . Participants completed up to 10 therapy sessions within a 12-week period . Changes in youth- and parent-reported adherence and glycemic control were compared before and after the intervention and at follow-up assessment . RESULTS Using an intent-to-treat analytic approach , no significant between-group differences were identified between the before , after , and follow-up assessment s. Groups were collapsed to examine the overall effects of BFST-D on adherence and glycemic control . Results identified that statistically significant improvements in adherence and glycemic control occurred from before to after the intervention ; improvements were maintained at 3-month follow-up . CONCLUSIONS Delivery of BFST-D via Internet-based videoconferencing is viable for addressing nonadherence and suboptimal glycemic control in adolescents with type 1 diabetes , potentially reducing important barriers to care for youth and families OBJECTIVE : To test the effect on diabetes management outcomes of a low-intensity , clinic-integrated behavioral intervention for families of youth with type 1 diabetes . METHODS : Families ( n = 390 ) obtaining care for type 1 diabetes participated in a 2-year r and omized clinical trial of a clinic-integrated behavioral intervention design ed to improve family diabetes management practice s. Measurement of hemoglobin A1c , the primary outcome , was obtained at each clinic visit and analyzed central ly . Blood glucose meter data were downloaded at each visit . Adherence was assessed by using a semistructured interview at baseline , mid- study , and follow-up . Analyses included 2- sample t tests at predefined time intervals and mixed-effect linear-quadratic models to assess for difference in change in outcomes across the study duration . RESULTS : A significant overall intervention effect on change in glycemic control from baseline was observed at the 24-month interval ( P = .03 ) . The mixed-effect model showed a significant intervention by age interaction ( P < .001 ) . Among participants aged 12 to 14 , a significant effect on glycemic control was observed ( P = .009 for change from baseline to 24-month interval ; P = .035 for mixed-effect model across study duration ) , but there was no effect among those aged 9 to 11 . There was no intervention effect on child or parent report of adherence ; however , associations of change in adherence with change in glycemic control were weak . CONCLUSIONS : This clinic-integrated behavioral intervention was effective in preventing the deterioration in glycemic control evident during adolescence , offering a potential model for integrating medical and behavioral sciences in clinical care Background Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control . Purpose This study aims to determine whether multisystemic therapy ( MST ) , an intensive , home-based , tailored family treatment , was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control . Methods A r and omized controlled trial was conducted with 146 adolescents with types 1 or 2 diabetes . Data were collected at baseline , 7 months ( treatment termination ) , and 12 months ( 6 months follow-up ) . Results Adolescents receiving MST had significantly improved metabolic control at 7 ( 1.01 % decrease ) and 12 months ( 0.74 % decrease ) compared to adolescents in telephone support . Parents of adolescents receiving MST reported significant improvements in adolescent adherence . However , adolescent-reported adherence was unchanged . Conclusions MST improved health outcomes among adolescents with chronic poor metabolic control  when compared to telephone support . Home-based approaches may provide a viable means to improve access to behavioral interventions for such youth The purpose of this pilot study was to test the hypothesis that adolescents with type 1 diabetes can learn to become better problem solvers in diabetes self-care and thereby improve their metabolic control . METHODS Fifty-three adolescents aged 13 to 17 with type 1 diabetes were r and omly assigned to either a 6-week problem-solving diabetes education program or to a control group ( usual care ) .  Al C levels were obtained as well as assessment s of problem solving , frequency of behavior , level of responsibility , and 24-hour behavior recall at baseline and 6 months . RESULTS The experimental group participants showed significantly improved problem-solving test scores and Al C values from baseline to 6 months , changes not evident in the control group . At 6 months , the experimental group participants were doing blood glucose testing more often than those in the control group . However , there was no significant difference in problem-solving test scores or Al C values . CONCLUSIONS This 6-week intervention for adolescents with diabetes result ed in better problem-solving skills , more frequent blood glucose testing , and improved Al C values . The results suggest that a diabetes problem-solving program for adolescents can be effective in improving metabolic control OBJECTIVE To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c ) , self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients . METHODS Ninety-four type 1 diabetes patients were r and omly assigned to either an intervention group or a control group . The intervention was based on CBT and was mainly delivered in group format , but individual sessions were also included . All subjects were provided with a continuous glucose monitoring system ( CGMS ) during two 3-day periods . HbA(1c ) , self-care behaviors and psychosocial factors were measured up to 48 weeks . RESULTS Significant differences were observed with respect to HbA(1c ) ( P<0.05 ) , well-being ( P<0.05 ) , diabetes-related distress ( P<0.01 ) , frequency of blood glucose testing ( P<0.05 ) , avoidance of hypoglycemia ( P<0.01 ) , perceived stress ( P<0.05 ) , anxiety ( P<0.05 ) and depression ( P<0.05 ) , all of which showed greater improvement in the intervention group compared with the control group . A significant difference ( P<0.05 ) was registered with respect to non-severe hypoglycemia , which yielded a higher score in the intervention group . CONCLUSION This CBT-based intervention appears to be a promising approach to diabetes self-management . PRACTICE IMPLICATION S Diabetes care may benefit from applying tools commonly used in CBT . For further scientific evaluation in clinical practice , there is a need for specially educated diabetes care teams , trained in the current approach , as well as cooperation between diabetes care teams and psychologists trained in CBT The feasibility of a family-based clinic-integrated behavioral intervention to improve family management of type 1 diabetes  was evaluated . In each of four clinical sites , 30 - 32 families ( a total of 122 ) were r and omized to intervention or usual care comparison groups . The WE*CAN intervention , based on family problem-solving methods , was delivered during three routine clinic visits by trained ' Health Advisors ' . Of eligible families across the four sites , 83 % agreed to participate , of whom 96 % completed the baseline , mid-term , and postintervention assessment s. Families participated in an average of 2.85 intervention sessions over an 8-month period . The intervention was integrated into the clinic setting without impairing clinic flow 
    Output:
    
For instance , intensive lowering of blood pressure has reduced major cardiovascular events by 11 % ( 6 ) .