***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 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 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 Being able to manage and adjust insulin doses is a key part of managing type-1 diabetes . Children and adolescents with type-1 diabetes mellitus often have serious difficulties with this dosage adjustment . Therefore , this paper aims to investigate the impact of using novel mobile , web and communication technologies in assisting their therapy and treatment . A trial was conducted in the north-eastern part of Germany to evaluate the impact of the “ Mobil Diab ” , a mobile diabetes management system , on the clinical outcome . 68 subjects aged between 8 and 18 years , divided r and omly into control and intervention groups , were included into the study . Metrics such as changes in the quality of metabolic control , changes in psychological parameters , usability and acceptance of the technology were used for evaluation purpose . Metabolic control was mainly assessed by the mean HbAlc . Analysis showed a good acceptance of the proposed system . An overall improvement in mean levels of HbA1c was observed , however further studies will be conducted to prove evidence of the weight and BMI improvements . Moreover , initial indications of positive impact on the improvement in psychological parameters were presumed based on the result of the conducted study . The system appeared to be an efficient and time saving tool in diabetes management Background While optimal blood glucose control is known to reduce the long-term complications associated with type 1 diabetes mellitus , adolescents often struggle to achieve their blood glucose targets . However , their strong propensity toward technology presents a unique opportunity for the delivery of novel self-management interventions . To support type 1 diabetes self-management in this population , we developed the diabetes self-management app bant , which included wireless blood glucose reading transfer , out-of-range blood glucose trend alerts , coaching around out-of-range trend causes and fixes , and a point-based incentive system . Objective The primary objective was to evaluate bant ’s effect on hemoglobin A1c ( HbA1c ) through a r and omized controlled trial ( RCT ) . Secondary measures ( eg , self-monitoring of blood glucose [ SMBG ] ) were also collected to assess bant ’s impact on the self-management behaviors of adolescents with type 1 diabetes . Methods We enrolled 92 adolescents into a 12-month RCT , with 46 receiving usual care and 46 receiving usual care plus bant .  Clinical outcome data were collected at quarterly research visits via vali date d tools , electronic chart review , glucometer downloads , and semistructured interviews . App satisfaction was assessed at 6 and 12 months , and at trial end , users ranked bant components based on perceived usefulness . Mobile analytics captured frequency of blood glucose uploads , which were used to categorize participants into high , moderate , low , or very low engagement levels . Results Linear mixed models showed no changes in primary and secondary clinical outcomes . However , exploratory regression analysis demonstrated a statistically significant association between increased SMBG and improved HbA1c in the intervention group . For a subgroup of bant users taking SMBG ≥5 daily , there was a significant improvement in HbA1c of 0.58 % ( P=.02 ) , while the parallel subgroup in the control arm experienced no significant change in HbA1c ( decrease of 0.06 % , P=.84 ) . Although app usage did diminish over the trial , on average , 35 % ( 16/46 participants ) were classified as moderately or highly engaged ( uploaded SMBG ≥3 days a week ) over the 12 months . Conclusion Although primary analysis of clinical outcomes did not demonstrate differences between the bant and control groups , exploratory analysis suggested that bant may positively impact the use of SMBG data and glycemic control among youth . The next generation of bant will aim to remove barriers to use , such as deploying the app directly to personal devices instead of secondary research phones , and to explore the utility of integrating bant into routine clinical care to facilitate more frequent feedback . Future evaluations of mHealth apps should consider more robust research tools ( eg , Research Kit ) and alternative RCT study design s to enable more rapid and iterative evaluations , better suited to the nature of rapidly evolving consumer technology . Trial Registration Clinical Trials.gov NCT01899274 ; https:// clinical trials.gov/ct2/show/NCT01899274 ( Archived by WebCite at http://www.webcitation.org/6qWrqF1yw Aims : To investigate use of targeted self study material in type I diabetes patient education regarding dissemination , perceived patient benefit , and prevention of severe hypoglycaemia . Methods : In a r and omised 1:1:1 controlled study , 332 patients with type I diabetes ( aged 2.6–18.9 years ) were studied ; 313 completed clinical follow up , 261 completed endpoint question naire . The intervention group received videotapes and a brochure design ed to review skills for self control and treatment , aim ed at preventing severe hypoglycaemia . Two control groups received a videotape and brochure with general diabetes information , or traditional treatment only , respectively . Results : Yearly incidence of severe hypoglycaemia decreased from 42 % to 27 % in the intervention group , but not in controls . HbA1c remained unchanged . Levels of use ranged from 1 to 20 times ( median 2 ) ; 40–49 % had shown the material s to friends , relatives , school staff , sports coaches , etc ( there was little difference between intervention and control groups ) . Higher benefit and learning levels result ed from the intervention material , especially in patients with severe hypoglycaemia . Conclusions : Mass distributed pedagogical devices such as high quality video programmes and brochures may contribute to the prevention of severe hypoglycaemia . Such self study material s can reach high dissemination levels and constitute a cost effective complement to regular visits to a diabetes team and to other types of education . The findings may have implication s for other topics , other ages , and other diagnosis groups OBJECTIVE To evaluate the feasibility of an online interactive treatment environment for adolescents with type 1 diabetes , called Sugarsquare , to supplement usual care . RESEARCH DESIGN AND METHODS Sugarsquare provides easily accessible contact with the diabetes team , peer support , and treatment overview . Of 120 eligible patients , 62 adolescents aged 11 - 21 ( M = 15.23 , SD = 2.00 ) were assigned to a usual-care group ( n = 31 ) or a usual-care + intervention group ( n = 31 ) . Feasibility was assessed in terms of acceptability , dem and , practicability , integration , and efficacy in a 9-month study -period . RESULTS Assessment of acceptability and dem and revealed that 20 adolescents in the intervention group ( 65 % ) logged in at least once ; 16 adolescents ( 52 % ) logged in repeatedly . Usage result ed in 5795 page-views , 3580 chat-messages , 427 forum-messages , and in 40 private interactions between 11 adolescents ( 35 % ) and professionals . Assessment of practicability revealed that all 13 professionals ( 100 % ) accessed the intervention . Slow processing speed and security procedures formed obstacles for usage . Assessment of integration showed that international st and ards for diabetes care ( International Diabetes Federation/International Society for Pediatric and Adolescent Diabetes/American Diabetes Association ) were met . Assessment of efficacy revealed improvement in the intervention group in evaluation of care ( Patients ' Evaluation of Quality of Diabetes ) , F(1,30 ) = 5.35 , p < 0.05 , and quality of life , communication ( PedsQL ) , F(1,30 ) = 11.65 , p < 0.05 . The latter was correlated with posted chat-messages ( r = 0.42 , p < 0.05 ) . No between-group differences were found . CONCLUSIONS This study shows that Sugarsquare is feasible in adolescents with type 1 diabetes . It meets a dem and in adolescents and can support professionals when organizing on-going care according to international st and ards . Results are promising and next steps are a full-scale r and omized controlled trial and subsequent implementation in daily care Background : Poor management of type 1 diabetes mellitus ( T1DM ) may result in serious medical complications . Psychological intervention may improve adherence to medical regimens ; however , access to trained professionals is limited , particularly in rural communities . Telehealth interventions may address this by allowing families to access services at home ; however , little is known about the efficacy of such services . Method : This study presents results from a pilot trial of a r and omized waitlist controlled trial of Telehealth Behavioral Therapy ( TBT ) for youths with T1DM . Primary outcome measures were adherence to the diabetes regimen , glycemic control , and level of family discord .  Thirty-two youths ( 23 female ) with T1DM ( aged 9 to 17 years ) and one parent or caregiver participated .  Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each . Results : Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist , though this was not statistically significant . Youths in treatment reported increased unsupportive and decreased caring parental behaviors . Conclusion : Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinical ly significant improvement in glycemic control . Despite some youths experiencing an increase in unsupportive parental behaviors , TBT is a promising method of service delivery that warrants further investigation OBJECTIVE To assess whether pedometers and text messaging increase physical activity in adolescents with type 1 diabetes . RESEARCH DESIGN AND M 
    Output:
    
The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome , with some benefits found for clinical and /or psychological diabetes self-management outcomes .
Technological interventions were well accepted by children and young people .
For the majority of included outcomes , clinical relevance was deemed to be little or none .
To produce clinical ly relevant outcomes , interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes .