***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: Abbreviations ACCORD Action to Control Cardiovascular Risk in Diabetes ADVANCE Action in Diabetes and Vascular Disease : Preterax and Diamicron Modified-Release Controlled Evaluation AGI α-Glucosidase inhibitor  CAD Coronary artery disease CKD Chronic kidney disease CVD Cardiovascular disease DPP-4 Dipeptidyl peptidase IV GIP Glucose-dependent insulinotropic peptide GLP-1 Glucagon-like peptide 1 NPH Neutral protamine Hagedorn TZD Thiazolidinedione UKPDS UK Prospect i ve Diabetes Study VADT Veterans Affairs Diabetes Purpose : The purpose of this study was to test the effect of keeping daily activity records on physical activity levels and self-efficacy for physical activity in adults with type 2 diabetes , and to examine the feasibility and acceptability of this intervention from the perspective of the participants . Methods : This intervention study included 58 individuals with type 2 diabetes aged 40 to 65 years . Participants were r and omly assigned : individuals in the intervention group kept daily activity records for 6 weeks , mailed to the research er every 2 weeks . Data collection was completed at the beginning of the study and 6 weeks later , using the habitual physical activity index and the self-efficacy for exercise scale . Participants in the intervention group also completed the perceived feasibility checklist . Results : The intervention result ed in enhanced self-efficacy . Physical activity improved in both the intervention and control groups . Activity recording was judged to be acceptable and feasible . Conclusions : Daily activity recording can be used as part of a program to increase physical activity self-efficacy levels . Focused interactions between health care providers and patients may be enough to motivate people to higher levels of physical activity . The relationship between self-efficacy and behavior is complex and should be the subject of further research OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Objective To test the effectiveness of  peer support  for patients with type 2 diabetes . Design Cluster r and omised controlled . Setting 20 general practice s in the east of the Republic of Irel and . Participants 395 patients ( 192 in intervention group , 203 in control group ) and 29 peer supporters with type 2 diabetes . Intervention All practice s introduced a st and ardised diabetes care system . The peer support intervention ran over a two year period and contained four elements : the recruitment and training of peer supporters , nine group meetings led by peer supporters in participant ’s own general practice , and a retention plan for the peer supporters . Main outcome measures HbA1c ; cholesterol concentration ; systolic blood pressure ; and wellbeing score . Results There was no difference between intervention and control patients at baseline . All practice s and 85 % ( 337 ) of patients were followed up . At two year follow-up , there were no significant differences in HbA1c ( mean difference −0.08 % , 95 % confidence interval −0.35 % to 0.18 % ) , systolic blood pressure ( −3.9 mm Hg , −8.9 to 1.1 mm Hg ) , total cholesterol concentration ( −0.03 mmol/L , −0.28 to 0.22 mmol/L ) , or wellbeing scores ( −0.7 , −2.3 to 0.8 ) . While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up , particularly for systolic blood pressure ( 52 % ( 87/166 ) > 130 mm Hg in intervention v 61 % ( 103/169 ) > 130 mm Hg in control ) , these changes were not significant . The process evaluation indicated that the intervention was generally delivered as intended , though 18 % ( 35 ) of patients in the intervention group never attended any group meetings . Conclusions A group based peer support intervention is feasible in general practice setting s , but the intervention was not effective when targeted at all patients with type 2 diabetes . While there was a trend towards improvements of clinical outcomes , the results do not support the widespread adoption of peer support . Trial registration Current Controlled Trials IS RCT N42541690 BACKGROUND Group education for patients with suboptimally controlled diabetes has not been rigorously studied . METHODS A total of 623 adults from Minnesota and New Mexico with type 2 diabetes and glycosylated hemoglobin ( HbA(1c ) ) concentrations of 7 % or higher were r and omized to ( 1 ) group education ( using the US Diabetes Conversation Map program ) , ( 2 ) individual education , or ( 3 ) usual care ( UC ; ie , no assigned education ) . Both education methods covered content as needed to meet national st and ards for diabetes self-management education and were delivered through accredited programs from 2008 to 2009 . General linear mixed-model methods assessed patient-level changes between treatment groups in mean HbA(1c ) levels from baseline to follow-up at 6.8 months . Secondary outcomes included mean change in general health status ( Medical Outcomes Study 12-Item Short Form Health Survey [ SF-12 ] ) , Problem Areas in Diabetes ( PAID ) , Diabetes Self-Efficacy ( DES-SF ) , Recommended Food Score ( RFS ) , and Physical Activity ( PA , min/wk ) . RESULTS Mean HbA(1c ) concentration decreased in all groups but significantly more with individual ( -0.51 % ) than group education ( -0.27 % ) ( P = .01 ) and UC ( -0.24 % ) ( P = .01 ) . The proportion of subjects with follow-up HbA(1c ) concentration lower than 7 % was greater for individual education ( 21.2 % ) than for group ( 13.9 % ) and UC ( 12.8 % ) ( P = .03 ) . Compared with UC , individual education ( but not group ) improved SF-12 physical component score ( + 1.88 ) ( P = .04 ) , PA ( + 42.95 min/wk ) ( P = .03 ) , and RFS ( + 0.63 ) ( P = .05 ) . Compared with group education , individual education reduced PAID ( -3.62 ) ( P = .02 ) and increased self-efficacy ( + 0.1 ) ( P = .04 ) . CONCLUSIONS Individual education for patients with established suboptimally controlled diabetes result ed in better glucose control outcomes than did group education using Conversation Maps . There was also a trend toward better psychosocial and behavioral outcomes with individual education . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00652509 OBJECTIVES To evaluate whether outcomes from diabetes self-management education for patients with suboptimal control were sustained . STUDY DESIGN A r and omized controlled trial of 623 adults with type 2 diabetes and glycated hemoglobin ( A1C ) > 7 % assigned to receive conventional individual education ( IE ) , group education ( GE ) using US Diabetes Conversation Maps , or usual care ( UC ) with no education . METHODS A1C tests , Problem Areas in Diabetes ( PAID ) , Diabetes Self-Efficacy ( DES ) , Recommended Food Score ( RFS ) , physical activity , and medication use were quantified at baseline and 1 year of follow-up through electronic health records and quarterly mailed surveys . Short-term ( mean 6.8 months ) and long-term ( 12.8 months ) outcomes were evaluated using linear mixed models . In addition , follow-up trajectories were plotted in a r and om effects generalized additive model with smooth splines . RESULTS Compared with UC , IE result ed in long-term improved DES and PAID scores ( DES , + .11 , P = .03 and PAID , -2.94 , P = .04 ) , but not significantly improved long-term RFS or physical activity change . The A1C trajectory declined more steeply in IE than GE and UC for the first 150 days post r and omization . However , by 250 days , there was no treatment group A1C difference . The model fit likelihood ratio test for A1C intervention trends was significant for 3 distinct non-linear trajectories ( P = .02 ) . CONCLUSIONS Conventional IE ( but not GE ) result ed in significant and sustained improvements in self-efficacy and reduced diabetes distress compared with UC , but short-term improvements in A1C , nutrition , and physical activity were not sustained . Patients may need ongoing reinforcement to achieve lasting behavioral change and glucose control OBJECTIVES To compare the effectiveness of group ( GE ) and individual ( IE ) health education in type-2 diabetes patients , and identify the improvement in knowledge , metabolic control and risk factors . DESIGN R and omised clinical trial . SETTING Primary care . Participants . 68 patients with type-2 diabetes , diagnosed 6 months before the start of the study and who had not received GE . Patients aged over 75 , those with sensory , psychological and /or physical deficiencies and those not monitored in primary care were excluded ( alpha=0.05 ; beta=0.2 ) . Interventions . Patients were selected according to the inclusion criteria and allocated at r and om to the IE ( n=33 ) or GE ( n=35 ) group . Individual and group lessons were given at the same time for a year . The contents were evaluated with a vali date d , self-administered test . MAIN MEASUREMENTS General , demographic variables , analyses , blood pressure , the Body Mass Index ( BMI ) , the presence of cardiovascular risk factors , diabetes-related complications and therapeutic variables were all measured . RESULTS The two kinds of education showed no significant differences from each other . The two groups improved the level of knowledge ( P<0.001 ) , and reduced HbA1c ( P<0.001 ) , HDL-C ( P<0.001 ) , the BMI ( P=0.001 ) and systolic pressure ( P=0.004 ) , and increased their use of reactive strips ( P=0.02 ) . CONCLUSIONS Health education on diabetes improved knowledge of the disease , metabolic control and cardiovascular risk factors . The two educational methods evaluated were equally effective Abstract Objective : To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes . Design : Prospect i ve observational study . Setting : 23 hospital based clinics in Engl and , Scotl and , and Northern Irel and . Participants : 4585 white , Asian Indian , and Afro-Caribbean UKPDS patients , whether r and omised or not to treatment , were included in analyses of incidence ; of these , 3642 were included in analyses of relative risk . Outcome measures : Primary predefined aggregate clinical outcomes : any end point or deaths related to diabetes and all cause mortality . Secondary aggregate outcomes : myocardial infa rct ion , stroke , amputation ( including death from peripheral vascular disease ) , and microvascular disease ( predominantly retinal photo-coagulation ) . Single end points : non-fatal heart failure and cataract extraction . Risk reduction associated with a 1 % reduction in up date d mean HbA1c adjusted for possible confounders at diagnosis of diabetes . Results : The incidence of clinical complications was significantly associated with glycaemia . Each 1 % reduction in up date d mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes ( 95 % confidence interval 17 % to 24 % , P<0.0001 ) , 21 % for deaths related to diabetes ( 15 % to 27 % , P<0.0001 ) , 14 % for myocardial infa rct ion ( 8 % to 21 
    Output:
    
Outcomes also favoured group-based education for fasting blood glucose , body weight , waist circumference , triglyceride levels and diabetes knowledge , but not at all time points .
Interventions facilitated by a single discipline , multidisciplinary teams or health professionals with peer supporters result ed in improved outcomes in HbA1c when compared with peer-led interventions .
Group-based education interventions are more effective than usual care , waiting list control and individual education at improving clinical , lifestyle and psychosocial outcomes in people with Type 2 diabetes