***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: Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus . We have design ed and evaluated an electronic information system which facilitates this task . The system is voice-interactive , physician directed and affords , to remote patients , 24 h access via touch-tone telephone . Accordingly , patients access the system each day to report self-measured blood glucose levels or hypoglycaemic symptoms together with dietary changes , planned exercise , stress , illness or other lifestyle events . In turn they receive immediate advice with respect to medication dosing changes , and other pertinent feedback . Preliminary system beta-testing for safety and efficacy was performed for one year in an open study of 204 patients derived from two independent , health-care environments . Among the two testing centres , over 60,000 telephone cells were received by the computer systems during the start-up year . Safety and efficacy expectations were met . In addition , prevalence of diabetes related crises ( hyperglycaemia or hypoglycaemia ) fell approximately 3-fold . Glycated haemoglobin fell significantly ( 1.0 - 1.3 % ) in patients actively using the system . In control groups of patients not actively using the system , there were no improvements in metabolic control while body weights were stable in all groups . The new system was safe and effective in our h and s and empowered our health professionals to provide improved diabetes care Newly diagnosed mild Type 2 diabetic patients , aged 30 - 55 years , were included in the prospect i ve , multi-centre Diabetes Intervention Study . They were r and omly allotted to either an intervention group receiving intensified health education or to a control group on usual care . This paper reports the incidence , duration of and causes for absence from work due to any disease in the patients who were working during the first 5-year follow-up . Data from 817 patients could be taken into account . 14.5 % of the intervention patients and 17.3 % of the control patients had never been on the sick list . Those patients who had undergone intensified health education were listed sick less often . Women showed a higher work absenteeism in either group ; they had higher blood pressure and higher body mass index at entry . Cardiovascular diseases and musculo-skeletal disorders were major reasons for absence from work . However , when compared to the general population , these Type 2-diabetic patients were approximately four times more often on the sick list . Thus , the health education programme of the Diabetes Intervention Study was shown to be effective with respect to work absenteeism . Teaching patients is recommended as an important part of the therapeutic regimen The treatment of choice for Type II or non-insulin-dependent diabetes mellitus is a behavioral program for the management of weight . However , compliance with this lifelong dietary regimen is often poor . In the current investigation male and female adults with diagnosed Type II diabetes were r and omly assigned to either a behavior modification , a cognitive modification , a cognitive-behavior modification , or a control group . Patients were evaluated in terms of weight , percentage of body fat , and glycosylated hemoglobin measures . Men lost signficantly more weight than women and subjects in the behavior modification group lost more weight and demonstrated greater decreases in diabetes control than subjects in the cognitive-behavior modification , cognitive , and control groups . A significant interaction indicated that diabetic men may benefit more from  behavioral weight reduction programs  than diabetic women . Several explanations for these findings are considered OBJECTIVE To examine whether intensive glycemic control could decrease the frequency or severity of diabetic microvascular complications , an 8-year prospect i ve study of Japanese patients with type 2 diabetes was performed . RESEARCH DESIGN AND METHODS A total of 110 patients with type 2 diabetes ( 55 with no retinopathy [ the primary prevention cohort ] and 55 with simple retinopathy [ the secondary intervention cohort ] ) were r and omly assigned to multiple insulin injection therapy ( MIT ) groups and administered three or more daily insulin injections or assigned to conventional insulin injection therapy ( CIT ) groups and administered one or two daily intermediate-acting insulin injections . Worsening of microvascular complications was regularly assessed during 8 years . Two or more steps up in the 19 stages of the modified Early Treatment of Diabetic Retinopathy Study classification in retinopathy and one or more stages up among three stages in nephropathy ( normoalbuminuria , microalbuminuria , and albuminuria ) were defined as worsening of complications . RESULTS In both primary prevention and secondary intervention cohorts , the cumulative percentages of worsening in retinopathy and nephropathy were significantly lower ( P < 0.05 ) in the MIT group than in the CIT group . In neurological tests after 8 years , the MIT group showed significant improvement ( P < 0.05 ) in the median nerve conduction velocities ( motor and sensory nerves ) , whereas the CIT group showed significant deterioration ( P < 0.05 ) in the nerve conduction velocities and vibration threshold . From this study , the glycemic threshold to prevent the onset and progression of diabetic microvascular complications was as follows : HbA1c < 6.5 % , fasting blood glucose concentration < 110 mg/dl , and 2-h postpr and ial blood glucose concentration < 180 mg/dl . CONCLUSIONS Intensive glycemic control can delay the onset and progression of the early stages of diabetic microvascular complications in Japanese patients with type 2 diabetes We have followed prospect ively , 46 obese , type 2 diabetic patients for a 55-week period , in order to evaluate the efficiency of an educational programme based on behaviour modification to enhance weight loss and changes of other cardiovascular risk factors . No patient received pharmacological treatment during the study . At the end of the follow-up the patients obtained an average weight loss of 9.250 kg ( range : 0.500 - 17.500 kg ) ; the BMI was reduced from 34.2 + /- 0.8 kg/m2 to 30.6 + /- 1.1 kg/m2 ( P less than 0.01 ) ; fasting serum glucose descended from 7.9 + /- 0.4 to 6.1 + /- 0.5 mM ( P less than 0.05 ) ; SBP ( systolic blood pressure ) decreased from 145.7 + /- 3 to 126.4 + /- 5.1 mmHg ( P less than 0.01 ) ; DBP ( diastolic blood pressure ) decreased from 83.5 + /- 2.5 to 65 + /- 2.6 mmHg ( P less than 0.01 ) ; triglyceride levels were lowered from 164.5 + /- 12 to 109.7 + /- 10 mg/dl ( P less than 0.01 ) ; HDL-cholesterol levels increased from 1.27 + /- 0.05 to 1.53 + /- 0.12 mM ( P less than 0.01 ) . Serum glucose 2 h after a 75 g glucose oral load decreased from 14.9 + /- 0.6 to 12.7 + /- 0.9 mM ( P less than 0.05 ) on week 35 of follow-up . Twelve patients no longer presented a diabetic curve ( 8 normal oral glucose tolerance test ( OGTT ) curves , and 4 impaired glucose tolerance ( IGT ) curves ) . No significant changes in the parameters studied were obtained in the group of patients on conventional treatment . ( ABSTRACT TRUNCATED AT 250 WORDS PURPOSE this paper describes a clinic and community-based diabetes intervention program design ed to improve dietary , physical activity , and self-care behaviors of older African American women with type 2 diabetes . It also describes the study to evaluate this program and baseline characteristics of participants . METHODS The New Leaf ... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits , a community intervention with 12 monthly phone calls from peer counselors , and 3 group sessions . A r and omized , controlled trial to evaluate the effectiveness of this intervention is described . RESULTS Seventeen focus groups of African American women were used to assessed the cultural relevance /acceptability of the intervention and measurement instruments . For the r and omized trial , 200 African American women with type 2 diabetes were recruited from 7 practice s in central North Carolina . Mean age was 59 , mean diabetes duration was 10 years , and participants were markedly overweight and physically inactive .  CONCLUSIONS Participants found this program to be culturally relevant and acceptable . Its effects on diet , physical activity , and self-care behaviors will be assessed in a r and omized trial PURPOSE This study was design ed to develop and test an intervention for college students with type 1 diabetes . METHODS A diabetes program , " Control on Campus , " and guide were developed based on the Exp and ed Health Belief Model and Social Learning Theory . Diabetes knowledge , attitudes , and behaviors were assessed preprogram , postprogram , and at follow-up for 3 intervention cohorts and a control group . RESULTS Reporting of HbAlc values and diabetes knowledge improved significantly as a result of the intervention compared with no increase in the control group . Furthermore , participants reported feeling more support on campus after the intervention , appeared to have overcome their fears associated with testing their blood glucose , reported an increased frequency of blood glucose testing , and were more likely to test when they felt their blood glucose level was low . CONCLUSIONS Overall , this research yielded substantial insight into the characteristics of college students with diabetes and was successful in design ing and evaluating an intervention trial for this population PURPOSE The Women to Women Diabetes Project tested the use of telecommunication technology to deliver diabetes education and social support to rural women with diabetes . The aims were to ( 1 ) test the effects of the computer intervention in providing support , information , and education on selected outcomes , and ( 2 ) evaluate the women 's attitudes toward and satisfaction with the intervention and the support provided . METHODS Thirty women were r and omized into computer and noncomputer groups and participated for 10 months . For 5 months , one group participated in a self-help support and educational group via the computer ; the other group continued to use their usual modes of support and communication .  Psychosocial well-being scales were administered and attitudes were surveyed . RESULTS Improving health and higher educational levels positively influenced measures of social support and quality of life .  Women who were married or who reported greater support had higher scores on the Personal Re source Question naire . The women expressed positive effects of the computer-based support group on their lives . CONCLUSIONS The intervention was enthusiastically accepted , and could be conducted effectively in isolated rural areas There is very little reported information concerning the participation of older adults in diabetes education and care programs  , factors related to their attendance , and the influence of attendance on program outcomes . In this study , which was part of a larger study of insulin therapy , subjects ( ≥65 years old ) assigned to the intensive management group ( n=53 ) were provided with educational sessions during the 18-month study period . Data for this group were examined to determine factors that influenced enrollment and attendance . Attendance rates for individual participants averaged 72 % during the first 6 months months and 68 % during the subsequent 12 months . Demographic factors . baseline knowledge test scores , and baseline glycosylated hemoglobin levels did not significantly influence participation . Greater distance from the clinic and shorter time using insulin were significantly related ( P=.05 ) to attendance . Perceived benefits of the program included diabetes education ( 45 % ) , glucose control ( 23 % ) , and interacting with others who have diabetes ( 23 % ) PURPOSE Few culturally competent health programs have been design ed for Mexican Americans , a group that bears a disproportionate burden of Type 2 diabetes . In Starr County , a Texas-Mexico border community , investigators design ed and tested a culturally competent intervention aim ed at improving the health of this target population . The purpose of this article is to describe the development process of this diabetes education and support group intervention . METHODS The development stages were ( 1 ) community assessment , ( 2 ) intervention design , ( 3 ) selection or development of outcomes , ( 4 ) pilot testing , and ( 5 ) a r and omized clinical investigation . RESULTS Focus group participants identified knowledge deficits regarding diabetes and self-management strategies , and suggested characteristics of an effective intervention for Mexican Americans . Outcome measures included metabolic control indicators , a newly developed knowledge instrument , and an existing health belief instrument . Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population . CONCLUSIONS Developing successful diabetes interventions for minority groups requires a number of stages , careful planning , assessment of cultural characteristics of the target population , and a systematic approach to implementation OBJECTIVE To study the efficacy of the nutritional education software , Nutri-Expert , in the management of obese adult patients . MATERIAL AND METHODS Two groups of obese patients were followed up over one year in a r and omized study : the first group received close traditional management ( seven nutritional visits over the year , with physicians and dietitians conjointly ) and the second one also used at home by Minitel the Nutri-Expert system .  557 patients were enrolled in the study by 16 French centers of diabetology and nutrition .  Body mass index ( BMI ) , tests of dietetic knowledge , dietary records and central ized biological measurements were assessed at inclusion , 6 and 12 months . 341 patients were evaluable at the end of the year . RESULTS The group using Nutri-Expert scored significantly better in the tests of 
    Output:
    
As part of treatment intensification , education in Type 1 diabetes ( four studies ) result ed in significant and long-lasting improvements in metabolic control and reductions in complications .
In Type 2 diabetes ( 16 studies ) a diversity of educational programmes did not yield consistent results on measures of metabolic control .
Education as part of intensification of treatment produces improvement in diabetic control in Type 1 diabetes .
Mixed results in Type 2 diabetes mean that no clear characterisation is possible as to what features of education may be beneficial .