***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 the effect of regular diabetic health education on cardiovascular risk factors in Chinese Type 2 diabetic patients . METHODS This was a 1-year prospect i ve r and omized study . One hundred and eighty Type 2 diabetic subjects were recruited from three regional diabetic centres in Hong Kong . Ninety received additional structured reinforcement of diabetic health education by a trained nurse after the doctors ' consultations every 3 months ( intervention group ) . The others received the same medical care except no nursing reinforcement ( control group ) . Outcome measures included fasting plasma glucose , HbA(1c ) , body mass index , waist circumference , blood pressure and lipid profiles , which were assessed before the study and after 1 year . RESULTS Two of the controls defaulted follow-up . The intervention group and controls had similar age and sex distribution . At the end of study , the intervention group had reducted their waist circumference , diastolic blood pressure , HbA(1c ) , total cholesterol and low-density lipoprotein cholesterol levels . The controls had reduced their total cholesterol and low-density lipoprotein cholesterol levels . Other cardiovascular risk factors were not significantly changed in the controls . Addition of drugs and /or dosage increment of anti-diabetic drugs , lipid-lowering agents and anti-hypertensive agents were similar between the two groups . CONCLUSIONS Regular structured reinforcement with diabetic health education is useful . It helps to control more successfully some of the cardiovascular risk factors in Chinese Type 2 diabetic patients OBJECTIVE To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus . DESIGN A r and omized pretest-posttest control group design was used . SUBJECTS/ SETTING Participants ( 48 experimental , 50 control ) were aged 65 years and older with type 2 diabetes for 1 year or longer ; 93 participants ( 95 % ) completed the study , conducted in an outpatient setting . INTERVENTION The intervention included 10 weekly group sessions led by a dietitian . Information processing , learning theory , and Social Cognitive Theory principles were used in program development and evaluation . MAIN OUTCOME MEASURES Participants ' knowledge , outcome expectations ( expected results of behavior ) , self-efficacy , and decision-making skills were assessed . Instrument validity and reliability were established before program evaluation . STATISTICAL ANALYSES PERFORMED Factor analysis identified underlying factor structures . Analysis of covariance with pretest score as covariate was used to compare groups at posttest . Paired t tests compared results within groups . RESULTS Two factors were identified for outcome expectations ( positive and negative ) and for self-efficacy ( promoters of and barriers to diabetes management ) . The experimental group had greater improvement in total knowledge scores ( mean + /- st and ard error of the mean : 7.8+/-0.7 ) than the control group ( 0.2+/-0.7 ) ( P < .0001 ) , positive outcome expectations ( 0.59+/-0.15 vs 0.06+/-0.15 , P = .01 ) , promoters of diabetes management ( 0.83+/-0.12 vs -0.09+/-0.18 , P < or = .001 ) and decision-making skills ( 5.1+/-0.5 vs 0.3+/-0.5 , P < .0001 ) and greater reduction in barriers to diabetes management ( 1.1+/-0.16 vs 0.34+/-0.16 , P < .01 ) . No significant difference in negative outcome expectations occurred between groups at posttest . APPLICATIONS/ CONCLUSIONS Older adults with diabetes can benefit from nutrition education design ed to improve knowledge and skills necessary for diabetes management Introduction Diabetes self-management education interventions in community gathering places have been moderately effective , but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes . This paper describes a church-based diabetes self-management education intervention for African Americans , a r and omized controlled trial to evaluate the intervention , and baseline characteristics of study participants . Methods A New DAWN : Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina . Each church recruited congregants with type 2 diabetes and design ated a diabetes advisor , or peer counselor , to be part of the intervention team . Participants were enrolled at each church and r and omized as a unit to either the special intervention or the minimal intervention . The special intervention included one individual counseling visit , twelve group sessions , three postcard messages from the participant 's diabetes care provider , and twelve monthly telephone calls from a diabetes advisor . Baseline data included measures of weight , hemoglobin A1c , blood pressure , physical activity , dietary and diabetes self-care practice s , and psychosocial factors . The study to evaluate the intervention ( from enrollment visit to last follow-up ) began in February 2001 and ended in August 2003 . Results Twenty-four churches ( with 201 total participants ) were r and omized . Sixty-four percent of the participants were women . On average , the participants were aged 59 years and sedentary . They had an average of 12 years of education , had been diagnosed with diabetes for 9 years , had a body mass index of 35 , had a  hemoglobin  A1c level of 7.8 % , and had a reported dietary intake of 39 % of calories from fat . Conclusion A New DAWN is a culturally sensitive , church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a r and omized controlled trial . The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority population s and help to inform the selection of approaches to improve diabetes care in this population We investigated the effect of a structured group diabetes education program ( 1 ) on insulin-treated patients who had received individual counseling ( at the time of diagnosis and insulin initiation ) . A total of 1,369 type 1 and insulin-treated type 2 diabetic patients with mean disease duration of 11.7 and 13.7 years , respectively , were allocated to receive or not receive structured group education , which was delivered in 10 45-min sessions over 3–5 days . Baseline GHb levels of type 1 diabetic patients were 9.3 % for Aims To examine whether motivating patients to gain expertise and closely follow their risk parameters will attenuate the course of microvascular and cardiovascular sequelae of diabetes This study compared an activation intervention to passive education in a r and omized attention-control trial of 232 patients with type 2 diabetes . The activation intervention was based on Exp and ing Patient Involvement in Care ( EPIC ) trials , and was compared to time-matched passive education viewing of ADA video-tapes . Patient demographics and clinical characteristics of their diabetes were assessed with question naires , active involvement was assessed via ratings of taped interactions between patients and providers , and serum sample s were analyzed for HbA1c . Patients in the activation condition were rated as more actively involved in discussion s of diabetes self-management , and rated active involvement was predictive of improvement in glycemic control . No effect of the activation intervention was found on HbA1c . Thus , the activation intervention increased the active involvement of patients with type 2 diabetes in visits with practitioners , and active involvement led to improved glycemic control . However , the activation intervention did not improve glycemic control directly Background Epidemiologic data have shown that the prevalence of Type 2 diabetes varies with ethnic origin . Type 2 diabetes is up to four times more common in British South Asians than in the indigenous white population . The aim of this study was to develop a culturally appropriate educational intervention programme for South Asians with Type 2 diabetes . We then investigated whether this intervention could produce an improvement , and finally whether any improvement was greater than background changes in knowledge in comparison groups . Methods A multi-site prospect i ve , r and omised controlled study was conducted in all day care centres and three general practice registers with high proportion patients from different ethnic minority groups in Glasgow , Scotl and . The intervention consisted of 18 educational sessions in 6 separate programmes . A modified question naire was used to measure the knowledge , attitudes , and practice of diabetes before and after intervention . Results Baseline assessment showed that Indian and Pakistani subjects had less knowledge about diabetes , regarded the disease less seriously , and had a lesser underst and ing of the relationship between control and complications than the white population . No differences in initial responses were found between those who completed the second assessment and those who did not . The intervention group showed significant improvements in scores for Knowledge ( + 12.5 % ) ; Attitudes toward seriousness ( + 13.5 % ) , complications ( + 8.1 % ) , Practice ( + 20.0 % ) . However there were also changes in the ethnic control group scores ; respectively + 5.0 % , + 16.3 % ( significant P < 0.001 ) , + 1.5 % , + 1.7 % . The single white control group also showed some improvements ; respectively + 12.2 % , + 12.4 % ( P = 0.04 ) , + 6.0 % , + 25.0 % ( P = 0.007 ) , but the differences in improvement between these two control groups were not significant . Overall , the improvement seen was similar in both intervention and ethnic control groups and there was no significant difference in the amount of change ( P = 0.36 CI -0.9 to + 2.6 ) . Conclusion This study has shown that conducting a culturally-competent educational intervention in patients with Type 2 diabetes from ethnic minority groups is feasible and can improve their knowledge and attitudes and practice . However there was no net benefit compared with the control group BACKGROUND In Turkish immigrant diabetics , problems with communication and cultural differences may hinder delivery of diabetes care . METHODS In a prospect i ve controlled study , the effect of an ethnic-specific diabetes education programme on glycaemic control and cardiovascular risk factors in Turkish type 2 diabetes patients was assessed , by comparing  Turkish diabetics who were offered the education programme with Turkish diabetics offered routine care only ( control group ) .  From 16 general practice s ( 31 GPs ) in Rotterdam , 104 Turkish type 2 diabetes patients were recruited , 85 of whom could be assessed at one-year follow-up .  Glycaemic control , lipid concentrations , blood pressure and body mass index were measured . RESULTS Compared with the control group , mean HbA(1C ) in the intervention group decreased by 0.3 % ( 95 % CI -0.8 to 0.2 ) . A significant decrease in HbA(1C ) was observed in women with HbA(1C ) > 7 % at baseline ( -0.9 % ; 95 % CI -1.73 to -0.09 ) but not in the other subgroups studied . serum lipid concentrations , blood pressure and body mass index remained unchanged in the intervention group . CONCLUSION Ethnic-specific diabetes education by Turkish female educators has no obvious beneficial effect on glycaemic control or cardiovascular risk profile . More focus on specific patient selection and gender e quality between educators/ patients may prove worthwhile BACKGROUND Lifestyle modifications may affect the development of diabetes and prevent complications . However , there is no direct evidence to show that lifestyle intervention is beneficial for patients with established type 2 diabetes . OBJECTIVE The ultimate goal is to determine whether long-term lifestyle intervention can improve glycemic control and prevent complications in patients with type 2 diabetes . This initial report on a multi-year study describes protocol s and the analysis of baseline data and three-year interim results . DESIGN The study was a r and omized , controlled , multi-centre , prospect i ve intervention trial . The trial included patients from 59 Japanese institutes specializing in diabetes care . PATIENTS The study enrolled 2 205 patients with previously diagnosed type 2 diabetes . INTERVENTION The lifestyle modification program included intensive lifestyle management at each outpatient clinic visit and frequent telephone counseling . The intervention group received educational material s concerning the importance of lifestyle and behavioural changes , a diary to record progress of laboratory and other data , and a pedometer . MEASUREMENTS Parameters and indices related to glycemic control , diabetic complications , dyslipidemia , hypertension , obesity , and atherosclerosis were measured several times a year . RESULTS Small but significant differences in HbA1c levels between the intervention ( INT ) and conventional ( CON ) therapy groups appeared as early as two years after the start of intervention and were maintained in the third year ( CON group , 7.78 + /- 1.27 % vs. INT group , 7.62 + /- 1.20 % , the initial HbA1c level was 7.80 + /- 1.42 % for the CON group and 7.68 + /- 1.28 % for the INT group ) . Data on differences in occurrence of micro- or macrovascular complications are not yet available . CONCLUSIONS The effect of lifestyle modification on improving the glycemic control of patients with established type 2 diabetes mellitus was small but significant three years after initiation of the intervention AIMS Scarcity of re sources , expertise and evidence -based models have so far limited delivery of patient-centred diabetes education . We have developed and vali date d a group care approach that is applicable to everyday clinical practice and cost-effective in improving metabolic control , knowledge of diabetes , health behaviours , and quality of life in Type 2 diabetes . A clinical trial ( ROMEO ) was 
    Output:
    
Positive effects may be attributable to longer-term interventions with a shorter duration between the end of the intervention and the follow-up evaluation point .
There may also be an effect of having a multi-professional team delivering the educational programme .
Studies of focused educational interventions did not yield consistent results .
Some effects were shown on measures of diabetic control in studies that focused on diet or exercise alone .
Although the effects shown were generally small , those that were present did appear to be relatively long-lasting .
Based on the evidence , it would seem that education delivered by a team of educators , with some degree of reinforcement of that education made at additional points of contact , may provide the best opportunity for improvements in patient outcomes .
From the evidence reported it is unclear what re sources would need to be directed at the educators themselves to ensure that they can deliver programmes successfully .