***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 investigate whether monitoring and discussing psychological well-being in out patients with diabetes improves mood , glycemic control , and the patient 's evaluation of the quality of diabetes care . RESEARCH DESIGN AND METHODS This study was a r and omized controlled trial of 461 out patients with diabetes who were r and omly assigned to st and ard care or to the monitoring condition .  In the latter group , the diabetes nurse specialist assessed and discussed psychological well-being with the patient ( with an interval of 6 months ) in addition to st and ard care . The computerized Well-being Question naire was used for this purpose . Primary outcomes were mood , HbA(1c ) , and the patient 's evaluation of the quality of diabetes care at 1-year follow-up . The number of referrals to the psychologist was analyzed as a secondary outcome . Intention-to-treat analysis was used . RESULTS The monitoring group reported better mood compared with the st and ard care group , as indicated by significantly lower negative well-being and significantly higher levels of energy , higher general well-being , better mental health , and a more positive evaluation of the quality of the emotional support received from the diabetes nurse . The two groups did not differ for HbA(1c ) or in their overall evaluation of the quality of diabetes care . In the monitoring condition , significantly more subjects were referred to the psychologist . CONCLUSIONS Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c ) . Our results support the recommendation to monitor psychological well-being in patients with diabetes Purpose The purpose of this pilot study was to evaluate the effects of a culturally sensitive , empowerment-based diabetes self-management education program for Spanish-speaking Hispanic/Latinos . Methods A prospect i ve quasi-experimental repeated measures design tested the effectiveness of the ¡ Si , Yo Puedo Controlar Mi Diabetes ! diabetes self-management education program . In sum , 144 persons residing in 2 Texas counties at the Texas-Mexico border ( Starr and Hidalgo ) served as participants . Two groups were formed , an intervention and a control ( wait list ) . Clinical ( A1C ) , cognitive , attitudinal , behavioral , and cultural assessment s were collected at baseline and 3 months . Results Demographic characteristics for the intervention and control groups were similar . Both groups were predominately female , low income , older than 40 years , and minimally acculturated . Baseline and posttest findings showed that the intervention group had a significant reduction in A1C values ; median difference was 0.3 ( n = 45 ) , especially for those with higher baseline values . Participants in the intervention group also improved in their self-efficacy and self-care scores . Conclusions Findings from the study suggest that additional dissemination of a diabetes self-management education program for Spanish-speaking Hispanic/Latinos is warranted to improve clinical outcomes and associated diabetes self-efficacy and self-care behaviors Purpose The purpose of this pilot study was to determine the feasibility of offering the authors ' Diabetes Coaching Program ( DCP ) , adapted for African Americans , in a sample of African American adults with type 2 diabetes . Methods The study used a 1-group , pretest-posttest design to test the acceptance and potential effectiveness of the DCP .  Subjects were a convenience sample of 16 African Americans ( 8 women , 8 men ) with type 2 diabetes ; 12 subjects ( 6 women , 6 men ) completed the program . The DCP included 4 weekly class sessions devoted to resilience education and diabetes self-management , followed by 8 biweekly support group meetings .  Psychosocial process variables ( resilience , coping strategies , diabetes empowerment ) and proximal ( perceived stress , depressive symptoms , diabetes self-management ) and distal outcomes ( body mass index [ BMI ] , fasting blood glucose , HbA1C , lipidemia , blood pressure ) were assessed at baseline and at 6 months after study entry . Qualitative data were collected at 8 months via a focus group conducted to examine the acceptability of the DCP . Results Preliminary paired t tests indicated statistically significant improvements in diabetes empowerment , diabetes self-management , BMI , HbA1c , total cholesterol , low-density lipoprotein cholesterol , and systolic and diastolic blood pressure . Medium to large effect sizes were reported . Resilience , perceived stress , fasting blood glucose , and high-density lipoprotein cholesterol improved , but changes were not statistically significant . Focus group data confirmed that participants held positive opinions regarding the DCP and follow-up support group sessions , although they suggested an increase in program length from 4 to 8 weeks . Conclusions The pilot study documented the feasibility and potential effectiveness of the DCP to enhance diabetes empowerment , diabetes self-management , and reductions in the progression of obesity , type 2 diabetes , and cardiovascular disease in the African American community . R and omized experimental design s are needed to confirm these findings PURPOSE The purpose of this r and omized clinical study was to test the efficacy of a resiliency training approach for people with diabetes who have previously received st and ard diabetes self-education . METHODS A single-blinded , r and omized design was employed with repeated measures ( baseline , 3 months , 6 months ) with 67 participants assigned to either  treatment as usual ( n = 37 ) or the resiliency classes ( n = 30 ) . Outcome variables included physiological measures ( glycosylated hemoglobin , waist measurement , eating and exercise habits ) and psychosocial measures ( self-efficacy , locus of control , social support , and purpose in life ) . RESULTS Analyses of variance indicated that the intervention group had higher levels of resiliency as reported by knowing positive ways of coping with diabetes-related stress , knowing enough about themselves to make right diabetes choices , having fun in life , eating healthier , and increasing physical activity compared with the control group at 3 months ( P < .05 ) . Glycosylated hemoglobin and waist measurement improved but not significantly . CONCLUSIONS Interventions to foster resilience among people with diabetes have the potential to make an important contribution to increasing positive life outcomes . Diabetes educators using the resiliency approach in t and em with st and ard diabetes education programs can assist their patients to become more self-directed in their diabetes care 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 Positive psychology has flourished in the last 5 years . The authors review recent developments in the field , including books , meetings , courses , and conferences . They also discuss the newly created classification of character strengths and virtues , a positive complement to the various editions of the Diagnostic and Statistical Manual of Mental Disorders ( e. g. , American Psychiatric Association , 1994 ) , and present some cross-cultural findings that suggest a surprising ubiquity of strengths and virtues . Finally , the authors focus on psychological interventions that increase individual happiness . In a 6-group , r and om-assignment ,  placebo-controlled Internet study , the authors tested 5 purported happiness interventions and 1 plausible control exercise . They found that 3 of the interventions lastingly increased happiness and decreased depressive symptoms . Positive interventions can supplement traditional interventions that relieve suffering and may someday be the practical legacy of positive psychology The authors prospect ively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese out patients with Type 2 diabetes . Using structural-equation modeling , they first developed a causal model in which glycosylated hemoglobin ( HbA(1c ) ) at 6 months after assessment was influenced by the baseline psychosocial factors . Then , the reliability of the causal model was investigated with measurement of  HbA(1c ) at 12 months after baseline . Self-efficacy directly reinforced adherence , and adherence had a direct association with future HbA(1c ) . Other psychosocial factors , including social support , diabetes-related distress , daily burden , and emotion-focused coping prospect ively influenced HbA(1c ) indirectly through self-efficacy BACKGROUND Patients with depression and poorly controlled diabetes , coronary heart disease , or both have an increased risk of adverse outcomes and high health care costs . We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients . METHODS We conducted a single-blind , r and omized , controlled trial in 14 primary care clinics in an integrated health care system in Washington State , involving 214 participants with poorly controlled diabetes , coronary heart disease , or both and coexisting depression . Patients were r and omly assigned to the usual-care group or to the intervention group , in which a medically supervised nurse , working with each patient 's primary care physician , provided guideline -based , collaborative care management , with the goal of controlling risk factors associated with multiple diseases . The primary outcome was based on simultaneous modeling of glycated hemoglobin , low-density lipoprotein ( LDL ) cholesterol , and systolic blood-pressure levels and Symptom Checklist-20 ( SCL-20 ) depression outcomes at 12 months ; this modeling allowed estimation of a single overall treatment effect . RESULTS As compared with controls , patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels ( difference , 0.58 % ) , LDL cholesterol levels ( difference , 6.9 mg per deciliter [ 0.2 mmol per liter ] ) , systolic blood pressure ( difference , 5.1 mm Hg ) , and SCL-20 depression scores ( difference , 0.40 points ) ( P<0.001 ) . Patients in the intervention group also were more likely to have one or more adjustments of insulin ( P=0.006 ) , antihypertensive medications ( P<0.001 ) , and antidepressant medications ( P<0.001 ) , and they had better quality of life ( P<0.001 ) and greater satisfaction with care for diabetes , coronary heart disease , or both ( P<0.001 ) and with care for depression ( P<0.001 ) . CONCLUSIONS As compared with usual care , an intervention involving nurses who provided guideline -based , patient-centered management of depression and chronic disease significantly improved control of medical disease and depression . ( Funded by the National Institute of Mental Health ; Clinical Trials.gov number , NCT00468676 . ) Vagal tone ( VT ) , an index of autonomic flexibility , is linked to social and psychological well-being . We posit that the association between VT and well-being reflects an " upward spiral " in which autonomic flexibility , represented by VT , facilitates capitalizing on social and emotional opportunities and the result ing opportunistic gains , in turn , lead to higher VT . Community-dwelling adults were asked to monitor and report their positive emotions and the degree to which they felt socially connected  each day for 9 weeks . VT was measured at the beginning and end of the 9-week period . Adults who possessed higher initial levels of VT increased in connectedness and positive emotions more rapidly than others . Furthermore , increases in connectedness and positive emotions predicted increases in VT , independent of initial VT level . This evidence is consistent with an " upward spiral " relationship of reciprocal causality , in which VT and psychosocial well-being reciprocally and prospect ively predict one another We measured affect in 334 healthy adults on each of 7 days over a 3-week period . On the last day ,  salivary cortisol  was assessed 14 times yielding scores for total concentration , morning rise amplitude , and slope of the time function . Trait negative affect ( NA ) was associated with higher total cortisol concentrations and greater morning rise in men . Cortisol levels for men low in trait positive affect ( PA ) did not decrease in the afternoon , result ing in a relatively high , flat rhythm . In contrast , women high in trait PA had low morning cortisol result ing in a low flat rhythm . State ( person-centered ) NA was not associated with same-day cortis 
    Output:
    
In people with diabetes , positive psychological characteristics are significantly associated with improved glycemic control , fewer complications , and reduced rates of mortality .
Potential mechanisms mediating these associations include behavioral factors ( e.g. , improved treatment adherence ) , reduced inflammation , and improved neuroendocrine and autonomic functioning .
Most psychosocial treatments in this population have focused on improving self-efficacy and resilience ; such interventions may improve quality of life , well-being , and diabetes self-care .