***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: The authors examined whether tailored self-management support ( SMS ) strategies reach patients in a safety net system and explored variation by language , literacy , and insurance . English- , Spanish- , and Cantonese-speaking diabetes patients were r and omized to weekly automated telephone disease  management ( ATDM ) or monthly group medical visits . The SMS programs employ distinct communication methods but share common objectives , including behavioral “ action plans . ” Reach was measured using three complementary dimensions : ( a ) participation among clinics , clinicians , and patients ; ( b ) patient representativeness ; and ( c ) patient engagement with SMS . Participation rates were high across all levels and preferentially attracted Spanish- language speakers , uninsured , and Medicaid recipients . Although both programs engaged a significant proportion in action planning , ATDM yielded higher engagement , especially among those with limited English proficiency and limited literacy . These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities PURPOSE We compared a 3-month diabetes self-management education ( DSME ) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin ( HbA1c ) . Secondary outcomes were risk factors for cardiovascular disease ( CVD ) , diabetes distress , and social support . METHODS We r and omized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support . Assessment s were conducted at baseline , 3 , 9 , and 15 months . RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group . The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months . At 15 months , the peer-support group had significantly lower low-density lipoprotein cholesterol levels ( −15 mg/dL , P = .03 ) , systolic blood pressure ( −10 mm Hg , P = .01 ) , diastolic blood pressure ( −8.3 mm Hg , P = .001 ) , and body mass index ( −0.8 kg/m2 , P = .032 ) than the DSME-alone group . CONCLUSIONS In this population of African American adults , an initial DSME program , whether or not followed by 12 months of peer support , had no effect on glycemic control . Participants in the peer-support arm of the trial did , however , experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined Abstract Aims / Introduction The purpose of the study was to determine the feasibility and effect of a reward‐based , task‐ setting strategy for low‐income out patients with type 2 diabetes . Material s and Methods Indigent diabetes out patients without glucometers were eligible to participate in this trial . A total of 132 cases were r and omly recruited . Participants in group B used glucometers for self‐monitoring at no cost . Group A participants could keep the glucometers only if the glycosylated hemoglobin level declined compared with the baseline visit ; for those not achieving a reduction in the glycosylated hemoglobin level , the glucometers would have to be returned . Group C served as the control group without self‐monitoring setout . Diabetes education was provided to all groups . Metabolic indices and self‐management were evaluated after 6 months of follow up . Results Group A had a significant decline in the glycosylated hemoglobin level ( −0.97 % ) and medical costs ( −159 yuan ) compared with the baseline visit , whereas groups B and C had a decrease in the glycosylated hemoglobin levels alone ( −0.62 and −0.57 % , respectively ) . The body mass index did not change significantly in any group . There was a statistical difference in the glycosylated hemoglobin level of group A compared with groups B and C. Self‐management in group A improved the outcome relative to groups B and C. Conclusions This preliminary evidence suggests that the program is feasible , acceptable for improving patient self‐management , and cost‐effective in reducing the glycosylated hemoglobin level and medical costs OBJECTIVE To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population . RESEARCH DESIGN AND METHODS Five public clinics in Chicago , Illinois , participated in the study with computer kiosks installed in waiting room areas . Two hundred forty-four subjects with diabetes were r and omized to receive either supplemental computer multimedia use ( intervention ) or st and ard of care only ( control ) . The intervention includes audio/video sequences to communicate information , provide psychological support , and promote diabetes self-management skills without extensive text or complex navigation .  HbA(1c ) ( A1C ) , BMI , blood pressure , diabetes knowledge , self-efficacy , self-reported medical care , and perceived susceptibility of complications were evaluated at baseline and 1 year . Computer usage patterns and implementation barriers were also examined . RESULTS Complete 1-year data were available for 183 subjects ( 75 % ) . Overall , there were no significant differences in change in A1C , weight , blood pressure , knowledge , self-efficacy , or self-reported medical care between intervention and control groups . However , there was an increase in perceived susceptibility to diabetes complications in the intervention group . This effect was greatest among subjects with lower health literacy . Within the intervention group , time spent on the computer was greater for subjects with higher health literacy . CONCLUSIONS Access to multimedia lessons result ed in an increase in perceived susceptibility to diabetes complications , particularly in subjects with lower health literacy . Despite measures to improve informational access for individuals with lower health literacy , there was relatively less use of the computer among these participants Purpose The purpose of this study is to evaluate the impact of a promotores-led diabetes self-management program by comparing the outcomes ( knowledge , beliefs , and HbA1c level ) of Mexican American patients with type 2 diabetes who received usual diabetic care in a wait-list control group  to those who received self-management education and follow-up by promotores in consultation with clinic providers and staff . Methods This r and omized control study compared the results of 63 patients who attended a promotores-led culturally sensitive diabetes self-management course at a commu- nity clinic with 68 patients in a wait-list , usual-care control group . Participants were Mexican Americans with type 2 diabetes who were patients at the clinic and at least 18 years of age . At baseline , 3 months , and 6 months , the Diabetes Knowledge Question naire ( DKQ ) , Health Beliefs Question naire ( HBQ ) , and HbA1c levels ( drawn by the clinic laboratory ) were collected . Results There was a significant improvement in the intervention group 's DKQ scores over time and in treatment by time . The baseline HbA1c level was 7.49 and did not change over time in either group . The DKQ , HBQ , and HbA1c results were significantly affected by age ; the DKQ and HbA1c were affected by years with diabetes . Conclusions The promotores-led diabetes self-management course improved the knowledge of patients with diabetes . Participant baseline HbA1c level was close to therapeutic level ( much lower than reported in previous studies ) , suggesting participants received good medical care within the community clinic Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants ( KAIs ) with type 2 diabetes . Methods A r and omized controlled pilot trial with 2 parallel arms ( intervention vs control ) with a delayed intervention design was used . A total of 79 KAIs , recruited from the Baltimore-Washington area , completed baseline , 18-week , and 30-week follow-ups ( intervention , n = 40 ; control , n = 39 ) . All participants had uncontrolled type 2 diabetes ( hemoglobin A1C ≥7.5 % ) at baseline . The authors ’ comprehensive , self-help intervention program for type 2 diabetes management ( SHIP-DM ) consisted of a 6-week structured psychobehavioral education , home glucose monitoring with teletransmission , and bilingual nurse telephone counseling for 24 weeks . The primary outcome of the study was A1C level , and secondary outcomes included an array of psychobehavioral variables . Results Using analysis of covariance , the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample . Specifically , the amount of reduction in A1C among intervention group participants was 1.19 % at 18 weeks and 1.31 % at 30 weeks , with 10 % and 15.5 % of the participants achieving the suggested goal of A1C < 7 % at 18 and 30 weeks of follow-up , respectively . Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program , self-monitoring , and follow-up counseling , in terms of maintaining the improved intervention effects obtained and in terms of glucose control PURPOSE The purpose of this r and omized controlled trial is to determine the effectiveness of an intervention led by promotoras ( community lay workers ) on the glycemic control , diabetes knowledge , and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border . METHODS One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and r and omized into 2 groups . Personal characteristics , acculturation , baseline A1C level , diabetes knowledge , and diabetes health beliefs were measured . The intervention was culturally specific and consisted of participative group education , telephone contact , and follow-up using inspirational faith-based health behavior change postcards . The A1C levels , diabetes knowledge , and diabetes health beliefs were measured 3 and 6 months postbaseline , and the mean change between the groups was analyzed . RESULTS The 80 % female sample , with a mean age of 58 years , demonstrated low acculturation , income , education , health insurance coverage , and strong Catholicism . No significant changes were noted at the 3-month assessment , but the mean change of the A1C levels , F(1 , 148 ) = 10.28 , P < .001 , and the diabetes knowledge scores , F(1 , 148 ) = 9.0 , P < .002 , of the intervention group improved significantly at 6 months , adjusting for health insurance coverage . The health belief scores decreased in both groups . CONCLUSIONS The intervention result ed in decreased A1C levels and increased diabetes knowledge , suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes . Clinical implication s and recommendations for future research are suggested PURPOSE The purpose of this pilot study was to determine the effectiveness of an edited Diabetes Prevention Program ( DPP ) Lifestyle Re sources Core Teaching Plan for managing patients with type 2 diabetes in an urban underserved setting . Modifications were made to attempt to cut to the bare essentials to work within the constrained budgets of safety net providers . The primary aim was to achieve a mean absolute reduction in HbA1c level of 1 percentage point . METHODS The authors conducted a r and omized controlled trial of 9 months ' duration for patients with type 2 diabetes with an HbA1c > or=8.0 % . A total of 67 patients r and omized into usual-care and case management groups were evaluated with an intention-to-treat analysis . A modified DPP workbook was used during 7 monthly visits with a nurse case manager . RESULTS As compared with the usual-care group , those in the case management group experienced a greater reduction in HbA1c level ( -1.87 vs -0.54 ; P=.011 ) and weight ( -2.47 kg vs + 0.88 kg ; P=.011 ) . CONCLUSION Use of an edited version of the DPP workbook in an urban , low-income , minority population with type 2 diabetesproduced a significant absolute reduction in HbA1c percentage and weight BACKGROUND Although African American adults bear a disproportionate burden from diabetes mellitus ( DM ) , few r and omized controlled trials have tested culturally appropriate interventions to improve DM care . METHODS We r and omly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group . The intensive intervention group consisted of all components of the minimal intervention plus individualized , culturally tailored care provided by a nurse case manager ( NCM ) and a community health worker ( CHW ) , using evidence -based clinical algorithms with feedback to primary care providers ( eg , physicians , nurse practitioners , or physician assistants ) . The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings . Data on diabetic control were collected at baseline and at 24 months by blind observers ; data emergency department ( ER ) visits and hospitalizations were assessed using administrative data . RESULTS At baseline , participants had a mean age of 58 years , 73 % were women , and 50 % were living in poverty . At 24 months , compared with the minimal intervention group , those in the intensive intervention group were 23 % less likely to have ER visits ( rate difference [ RD ] , -14.5 ; adjusted rate ratio [ RR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.59 - 1.00 ) . In on-treat 
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Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities .
Conclusions This review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable .