***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 investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients . RESEARCH DESIGN AND METHODS This 6-month study , which included 6 months of follow-up , adopted a prospect i ve , multicenter , r and omized controlled design . Subjects were r and omized to two groups : one group used a blood glucose-monitoring device , kept a blood glucose/eating diary , and received st and ardized counseling ; the control group received nonst and ardized counseling on diet and lifestyle . The primary efficacy parameter was the change in HbA(1c ) . Secondary efficacy variables included changes in body weight , lipids , and microalbumin and changes in treatment satisfaction and well-being . RESULTS In the per- protocol analysis , the use of a self-monitoring blood glucose device significantly reduced HbA(1c ) levels by 1.0 + /- 1.08 % compared with 0.54 + /- 1.41 % for the control group ( P = 0.0086 ) ; subgroup analysis showed three types of responders . Body weight , total cholesterol , and microalbumin improved when using a glucometer , but there was no statistically significant difference between the two groups . Treatment satisfaction increased in both groups to a similar extent ( P = 0.9 ) . Self-monitoring result ed in a marked improvement of general well-being with significant improvements in the subitems depression ( P = 0.032 ) and lack of well-being ( P = 0.02 ) . CONCLUSIONS Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study . The finding of three types of responders will be important for future planning of counseling and educational interventions AIM To determine if therapeutic management programmes for type 2 diabetes that include self-monitoring of blood glucose ( SMBG ) result in greater reductions in glycated haemoglobin ( HbA1c ) compared with programmes without SMBG in non-insulin requiring patients . METHODS Multicentre , r and omized , parallel-group trial . A total of 610 patients were r and omized to SMBG or non-SMBG groups . Patients in both groups received the same oral antidiabetic therapy using a gliclazide modified release (MR)-based regimen for 27 weeks . The primary efficacy end-point was the difference between groups in HbA1c at the end of observation . RESULTS A total of 610 patients were r and omized : 311 to the SMBG group and 299 to the non-SMBG group .  HbA1c decreased from 8.12 to 6.95 % in the SMBG group and from 8.12 to 7.20 % in the non-SMBG group ; between-group difference was 0.25 % ( 95 % CI : 0.06 , 1.03 ; p = 0.0097 ) . Symptoms suggestive of mild to moderate hypoglycaemia was the most commonly reported adverse event , reported by 27 ( 8.7 % ) and 21 ( 7.0 % ) patients in the SMBG and non-SMBG groups , respectively ; the incidence of symptomatic hypoglycaemia was lower in the SMBG group . CONCLUSION In patients with type 2 diabetes , the application of SMBG as an adjunct to oral antidiabetic agent therapy results in further reductions in HbA1c BACKGROUND Real-time continuous glucose monitoring ( CGM ) was studied in 140 adults with diabetes over a 12-week period of home use .  Hemoglobin A(1c)(HbA1c ) was measured on day 1 ( baseline ) and at weeks 6 and 12 . METHODS On day 1 , participants received the CGM device ( STS(R ) System , DexCom , Inc. , San Diego , CA ) and underwent training on proper use . Insertion of the first sensor was performed under staff supervision . Subjects inserted subsequent sensors on their own . After calibration , the device ( a 3-day sensor , receiver , and transmitter ) provided users with real-time glucose values up date d at 5-min intervals , glucose trend graphs , configurable high/low alerts , and a hypoglycemia alarm ( < or=55 mg/dL ) . Study participants were given supplies sufficient for 3 weeks of device use . Follow-up visits were performed at 3-week intervals for resupply and to download CGM data , with a final visit at the end of week 12 . RESULTS Overall , a reduction in HbA1c of 0.4 + /- 0.05 % ( least squares mean + /- SE ) was observed , P < 0.0001 . Significant HbA1c reductions were observed across subgroups of subjects with both type 1 and 2 diabetes , and those delivering insulin by multiple daily injections and pumps . The largest HbA1c reduction ( 1.4 + /- 0.4 % ) was observed in subjects with baseline HbA1c > 9.0 % . Increased CGM use was associated with greater reductions in HbA1c . CONCLUSIONS This observational study showed that home use of real-time GCM was safe and well tolerated and associated with a clinical ly and statistically significant reduction in HbA1c . Large-scale r and omized , controlled outcome studies of CGM are indicated Objective To determine whether self monitoring , alone or with instruction in incorporating the results into self care , is more effective than usual care in improving glycaemic control in non-insulin treated patients with type 2 diabetes . Design Three arm , open , parallel group r and omised trial . Setting 48 general practice s in Oxfordshire and South Yorkshire . Participants 453 patients with non-insulin treated type 2 diabetes ( mean age 65.7 years ) for a median duration of three years and a mean haemoglobin A1c level of 7.5 % . Interventions St and ardised usual care with measurements of HbA1c every three months as the control group ( n=152 ) , blood glucose self monitoring with advice for patients to contact their doctor for interpretation of results , in addition to usual care ( n=150 ) , and blood glucose self monitoring with additional training of patients in interpretation and application of the results to enhance motivation and maintain adherence to a healthy lifestyle ( n=151 ) . Main outcome measure HbA1c level measured at 12 months . Results At 12 months the differences in HbA1c level between the three groups ( adjusted for baseline HbA1c level ) were not statistically significant ( P=0.12 ) . The difference in unadjusted mean change in HbA1c level from baseline to 12 months between the control and less intensive self monitoring groups was −0.14 % ( 95 % confidence interval −0.35 % to 0.07 % ) and between the control and more intensive self monitoring groups was −0.17 % ( −0.37 % to 0.03 % ) . Conclusions Evidence is not convincing of an effect of self monitoring blood glucose , with or without instruction in incorporating findings into self care , in improving glycaemic control compared with usual care in reasonably well controlled non-insulin treated patients with type 2 diabetes . Trial registration Current Controlled Trials IS RCT N47464659 AIMS To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring ( SBGM ) and improves glycaemic control in diabetic patients . METHODS Sixty-two insulin-treated diabetic patients were r and omized to two groups , matched for age , gender , education , income , type and duration of diabetes , years of insulin treatment , number of daily insulin injections , and haemoglobin (Hb)A1c . All patients were given a glucometer , but one group ( no cost , NC ) was provided glucometer test strips free of charge . The other group ( control , C ) had to purchase strips as they found it necessary . Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c , and the frequency of SBGM was determined by downloading the glucometer memory . RESULTS The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months ( 2.0 + /- 0.2 tests/day vs. 1.4 + /- 0.1 tests/day , P<0.025 ) . Mean HbA1c remained stable over the 12 months in the NC group , whereas an increase with time was observed in the C group . The difference in HbA1c between the two groups was significant ( P<0.002 ) after 6 months . R and om blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group ( P<0.005 ) . There was a negative correlation between HbA1c and SBGM frequency , and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day ( 8.8 + /- 0.2 % vs. 9.6 + /- 0.2 % , P<0.001 ) . CONCLUSIONS In this prospect i ve study , having easy access to glucometer strips provided free of charge to patients increased SBGM frequency . The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management Abstract Objective : To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes . Design : Incremental cost effectiveness analysis alongside r and omised controlled trial . Setting : 23 UK hospital clinic based study centres . Participants : 3867 patients with newly diagnosed type 2 diabetes ( mean age 53 years ) . Interventions : Conventional ( primarily diet ) glucose control policy versus intensive control policy with a sulphonylurea or insulin . Main outcome measures : Incremental cost per event-free year gained within the trial period . Results : Intensive glucose control  increased trial treatment costs by £ 695 ( 95 % confidence interval £ 555 to £ 836 ) per patient but reduced the cost of complications by £ 957 ( £ 233 to £ 1681 ) compared with conventional management . If st and ard practice visit patterns were assumed rather than trial conditions , the incremental cost  of intensive management was £ 478 ( -£275 to £ 1232 ) per patient . The within trial event-free time gained in the intensive group was 0.60 ( 0.12 to 1.10 ) years and the lifetime gain 1.14 ( 0.69 to 1.61 ) years . The incremental cost per event-free year gained was £ 1166 ( costs and effects discounted at 6 % a year ) and £ 563 ( costs discounted at 6 % a year and effects not discounted ) . Conclusions : Intensive blood glucose control in patients with type 2 diabetes  significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications OBJECTIVE —We sought to determine whether self-monitoring of blood glucose ( SMBG ) is associated with better glycemic control in type 2 diabetes . RESEARCH DESIGN AND METHODS —We used cross-sectional and longitudinal data from type 2 diabetic participants in the observational , community-based Fremantle Diabetes Study ( FDS ) who reported SMBG status at study entry ( n = 1,286 ) and annual review s over 5 years ( n = 531 ) . RESULTS —At study entry , 70 % of patients performed SMBG , with a median of four tests per week ( interquartile range two to seven ) . Patients with shorter diabetes duration ; who were attending diabetes education , diabetes-related clinics , or medical specialists ; who were taking insulin with or without oral hypoglycemic agents ( OHAs ) ; and who were self-reporting hypoglycemic events were more likely to use SMBG . Both cross-sectional and longitudinal FDS data showed that HbA1c ( A1C ) was not significantly different between SMBG users and nonusers , either overall or within diabetes treatment groups ( diet , OHAs , and insulin with or without OHAs ) . There was also no independent cross-sectional relationship between A1C and SMBG frequency . The average annual societal cost of using SMBG ( in year 2000 Australian dollars [ A$ ] , excluding glucometers ) was A$ 162 per type 2 diabetic patient or A$ 51 million when projected to the Australian diagnosed type 2 diabetic population . CONCLUSIONS —Neither SMBG testing nor its frequency was associated with glycemic benefit in type 2 diabetic patients regardless of treatment . Our data did not include methods of SMBG delivery and application , factors that require further assessment in the evaluation of SMBG utility in non – insulin-treated type 2 diabetes . SMBG may be still of value in the identification and prevention of hypoglycemia and in dose adjustment in insulin-treated patients OBJECTIVE Recent Veterans Affairs ( VA ) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose ( SMBG ) twice weekly . We assessed the impact of a modification of these guidelines on hemoglobin A1c ( HbA1c ) and monitoring cost . STUDY DESIGN Retrospective , noncrossover clinical trial . PATIENTS AND METHODS We instruct 
    Output:
    
The present meta- analysis showed an SMBG-related HbA(1c ) reduction in non-insulin-treated type 2 diabetes patients that was similar to that in previous systematic review s but in a substantially larger patient sample .
This finding is consistent with most observational studies of similarly treated patients