***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: OBJECTIVE : To compare adherence data from an electronic medication-event monitoring device ( MEMS , Aprex ) with pill counts in assisting pharmacists in making recommendations regarding diabetes therapy . DESIGN : Two-month , double-blind , r and omized , controlled trial . SETTING : Veterans Affairs Medical Center ambulatory care clinics . PATIENTS : Forty-seven patients with poor to fair metabolic control of diabetes mellitus were enrolled . Patients were excluded if they were receiving insulin , had a concurrent infection , required child-resistant caps or medication reminder devices , or could not return for follow-up visits . Twenty patients were r and omized to the MEMS and 27 to the control group ( pill counts ) . Fasting plasma glucose concentrations were measured monthly and glycohemoglobin concentrations were measured at baseline and 60 days . Thirty-two patients were evaluable : 15 using MEMS and 17 using pill counts . INTERVENTION : Investigators made pharmacologic or educational recommendations to the patient 's healthcare provider based on both laboratory data and MEMS readings in the treatment group or laboratory data and pill counts in the control group . MAIN OUTCOME MEASURE : Quantities and types of recommendations regarding diabetes therapy made by pharmacists using adherence data from the two methods were tabulated . RESULTS : In the MEMS group , 47 percent of the recommendations related to patient education compared with 12 percent in the control group ( p=0.028 ) . MEMS data would have changed four recommendations in the control group to involve patient education . CONCLUSIONS : MEMS data result ed in different numbers and types of recommendations than pill counts . Pharmacists then could make specific recommendations regarding patient education before resorting to pharmacologic manipulations Medication compliance may be a problem in the management of patients with diabetes . Some physicians initially treat patients having non-insulin-dependent diabetes with oral sulfonylureas because they fear greater compliance problems with insulin therapy . We compared compliance with insulin and chlorpropamide in patients newly beginning medication for NIDDM . Seventy-seven adults with hyperglycemia despite diet therapy were r and omly assigned to chlorpropamide or insulin . Compliance was measured four times over 24 wk . Patients then crossed over to the other medication and were followed for 24 additional weeks . Overall , there were no differences in compliance with the two medications in terms of percent of prescription used , proportion taking at least 80 % of prescribed medication , self-report of medication or diet compliance , or protocol dropout rates . However , treatment satisfaction was higher with chlorpropamide , and most patients preferred chlorpropamide to insulin ( P < 0.0001 ) . While such differences in satisfaction may affect long-term compliance , physicians should not assume that their patients will be less compliant with insulin than with oral sulfonylureas Abstract OBJECTIVE : To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians . DESIGN : R and omized , controlled trial . SETTING : Veterans Affairs general medical clinic . PATIENTS : 275 veterans who had NIDDM and were receiving primary care from general internists . INTERVENTION : Nurse-initiated contacts were made by telephone at least monthly to provide patient education ( with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia ) , reinforce compliance with regimens , monitor patients ’ health status , facilitate resolution of identified problems , and facilitate access to primary care . MEASUREMENTS : Glycemic control was assessed using glycosylated hemoglobin ( GHb ) and fasting blood sugar ( FBS ) levels . Health-related quality of life ( HRQOL ) was measured with the Medical Outcomes Study SF-36 , and diabetes-related symptoms were assessed using patients ’ self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month . MAIN RESULTS : At one year , between-group differences favored intervention patients for FBS ( 174.1 mg/dL vs 193.1 mg/dL , p=0.011 ) and GHb ( 10.5 % vs 11.1 % , p=0.046 ) . Statistically significant differences were not observed for either SF-36 scores ( p=0.66 ) or diabetes-related symptoms ( p=0.23 ) . CONCLUSIONS : The intervention , design ed to be a pragmatic , low-intensity adjunct to care delivered by physicians , modestly improved glycemic control but not HRQOL or diabetes-related symptoms 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 An intervention package was examined to determine its effectiveness in increasing office visits and in reducing the incidence of nonelective hospitalizations ( those for urgent or emergent reasons ) . The intervention included mailings of information , appointment reminders , and intense follow-up by telephone of visit failures for rescheduling .  Eight hundred fifty-four patients receiving drug therapy for diabetes mellitus were stratified by risk of nonelective hospitalization and r and omly assigned to the control group or the intervention group . After two years , the intervention group averaged 9.1 per cent more kept scheduled visits per month than the control group ( 0.371 vs. 0.340 , p=0.02 ) . However , the mean incidence of nonelective hospitalizations per month was not significantly different between intervention and control groups ( 0.040 vs. 0.041 , p=0.9 ) , nor was there a difference in nonelective hospital days per month ( 0.443 vs. 0.425 , p=0.7 ) . The authors conclude that while mailings and telephone calls can increase office visits , the intervention is not sufficient to reduce morbidity necessitating nonelective hospitalizations of diabetic patients OBJECTIVES In type 2 diabetes , the primary and secondary prevention of long-term micro- and macrovascular complications requires a control of blood glucose levels 24 hours a day . The present study was undertaken to assess the effect of a new formulation of gliclazide administered once daily , gliclazide modified release , on plasma glucose levels over 24 hours . MATERIAL AND METHODS In 21 type 2 diabetic patients previously treated by diet alone or oral antidiabetic agents , glycemic profile ( 8 am , 10 am , 12 am , 2 pm , 5 pm , 8 pm , 10 pm , 3 am and 8 am ) , overall glycemic control , acceptability , and compliance with treatment were assessed before and after a 10-week treatment with gliclazide modified release , ( 30 - 60 mg ) , given once daily at breakfast . RESULTS The results indicate a significant decrease in plasma glucose levels at all points of the cycle . Mean plasma glucose levels over 24 hours and mean plasma glucose levels during the fasting and the postpr and ial periods were significantly improved after treatment . In previous drug-naive patients , decrease in HbA1C was observed ( 1.0 + /- 1.1 % , P=0.022 ) . The acceptability was good , with no hypoglycemic events , and a high compliance with treatment was also observed . CONCLUSION We can therefore conclude that gliclazide modified release , given once daily at breakfast , is effective over 24 hours in reducing plasma glucose levels in type 2 diabetes . This once-daily administration should lead to an optimal patient compliance with treatment The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose ( SMBG ) with routine urine testing in the management of patients with type II ( non-insulin-dependent ) diabetes mellitus not treated with insulin . Fifty-four patients with type II diabetes mellitus , not treated with insulin , who had inadequate glucose control on diet aloneor diet and oral hypoglycemic agents were studied . Patients performed SMBG or urine glucose testing as part of a st and ardized treatment program that also included diet and exercise counseling . During the 6-mo study , both the urine-testing and SMBG groups showed similar improvement in glycemic control ; within each group , there were significant improvements in fasting plasma glucose ( reduction of 1.4 ± 3.2 mM , P < 0.03 ) and glycosylated hemoglobin ( reduction of 2.0 ± 3.4 % , P < 0.01 ) levels . Seventeen ( 31 % ) of54 patients actually normalized their glycosylated hemoglobin values , 9 in the urine-testing group and 8 in the SMBG group . Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose ( P > 0.86 ) , glycosylated hemoglobin ( P > 0.95 ) , or weight ( P < 0.19 ) . In patients with type II diabetes mellitus not treated with insulin , SMBG is no more effective , but is 8–12 times more expensive , thanurine testing in facilitating improved glycemic control . Our results do not support widespread use of SMBG in diabetic patients not treated with insulin An estimated 20 million Americans suffer from diabetes . Patients with non-insulin-dependent diabetes mellitus ( NIDDM ) comprise approximately 90 % of the diabetic population . An estimated 10 - 30 % of patients with NIDDM withdraw from their prescribed regimen within 1 year of diagnosis , and of the remainder , nearly 20 % administer insufficient medication to facilitate an adequate reduction in blood glucose . A r and omized trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription-refill compliance with sulfonylurea therapy and health service utilization . The subjects were 258 Medicaid beneficiaries from the state of South Carolina , previously untreated for NIDDM , prescribed 5 mg of the second-generation sulfonylurea glyburide twice daily  , and monitored with regard to prescription-refill compliance and health service utilization for 1 year . Subjects provided informed consent and were r and omly assigned to one of four experimental groups : ( i ) the control cohort received st and ard pharmaceutical care with each dispensing of glyburide ; ( ii ) the second cohort received st and ard pharmaceutical care and was mailed a medication-refill reminder 10 days prior to each sequential refill date ; ( iii ) the third cohort received st and ard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request ; ( iv ) the fourth cohort received st and ard pharmaceutical care , mailed medication-refill reminders , and unit-of-use packaging . Analysis of variance ( ANOVA ) procedures revealed that patients receiving mailed prescription-refill reminders , unit-of-use packaging , or a combination of both interventions achieved a significant ( P < or = 0.05 ) increase in the Medication Possession Ratio ( MPR ) for sulfonylurea therapy relative to controls . ( ABSTRACT TRUNCATED AT 250 WORDS By use of an interview , return tablet count , and a pharmacologic indicator ( low‐dose phenobarbital ) , we compared compliance with tablets prescribed to be taken once , twice , or three times daily . One hundred seventy‐nine patients with type II diabetes were r and omly allocated to take one 2 mg phenobarbital tablet once , twice , or three times daily for 28 days . Phenobarbital level/dose ratios indicated that compliance was similar with once‐ and twice‐daily regimens , and both were better than thrice‐daily dosing . Mean return tablet counts suggested that compliance was best with the once‐daily regimen ; both twice‐ and thrice‐daily regimens were similarly inferior . This difference between the techniques may be explained by the inadequacies of the residual tablet count , which identified only 13 % of cases identified by phenobarbital . We conclude that compliance with the once‐daily regimen was best , but that compliance with a twice‐daily regimen was very similar , and both were superior to dosing three times a day OBJECTIVE To demonstrate improvements in diabetes care stimulated by comprehensive evaluation of community-based diabetic patients with feedback to the patients and their physicians . RESEARCH DESIGN AND METHODS A comprehensive evaluation of community-based diabetic patients with annotated reporting of results to both patients and their physicians ( universal intervention ) was followed by r and om assignment of 50 % of patients to individual counseling ( r 
    Output:
    
Outcomes evaluated in these studies were heterogeneous , there was a variety of adherence measurement instruments .
Nurse led interventions , home aids , diabetes education , pharmacy led interventions , adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c .
Current efforts to improve or to facilitate adherence of people with type 2 diabetes to treatment recommendations do not show significant effects nor harms .