***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 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 The purpose of this report is to summarize and integrate the findings of the Diabetes Control and Complications Trial ( DCCT ) , a r and omized controlled clinical trial , and the succeeding observational follow-up of the DCCT cohort in the Epidemiology of Diabetes Interventions and Complications ( EDIC ) study , regarding the effects of intensive treatment on the  microvascular complications of type 1 diabetes mellitus . The DCCT proved that intensive treatment reduced the risks of retinopathy , nephropathy , and neuropathy by 35 % to 90 % compared with conventional treatment . The absolute risks of retinopathy and nephropathy were proportional to the mean glycosylated hemoglobin ( HbA(1c ) ) level over the follow-up period preceding each event . Intensive treatment was most effective when begun early , before complications were detectable . These risk reductions , achieved at a median HbA(1c ) level difference of 9.1 % for conventional treatment vs 7.3 % for intensive treatment have been maintained through 7 years of EDIC , even though the difference in mean HbA(1c ) levels of the 2 former r and omized treatment groups was only 0.4 % at 1 year ( P<.001 ) ( 8.3 % in the former conventional treatment group vs 7.9 % in the former intensive treatment group ) , continued to narrow , and became statistically nonsignificant by 5 years ( 8.1 % vs 8.2 % , P = .09 ) . The further rate of progression of complications from their levels at the end of the DCCT remains less in the former intensive treatment group . Thus , the benefits of 6.5 years of intensive treatment extend well beyond the period of its most intensive implementation . Intensive treatment should be started as soon as is safely possible after the onset of type 1 diabetes mellitus and maintained thereafter , aim ing for a practicable target HbA(1c ) level of 7.0 % or less OBJECTIVE Widespread use of carbohydrate counting is limited by its complex education . In this study we compared a Diabetes Interactive Diary ( DID ) with st and ard carbohydrate counting in terms of metabolic and weight control , time required for education , quality of life , and treatment satisfaction . RESEARCH DESIGN AND METHODS Adults with type 1 diabetes were r and omly assigned to DID ( group A , n = 67 ) or st and ard education ( group B , n = 63 ) and followed for 6 months . A subgroup also completed the  SF-36 Health Survey ( SF-36 ) and World Health Organization-Diabetes Treatment Satisfaction Question naire ( WHO-DTSQ ) at each visit . RESULTS Of 130 patients ( aged 35.7 ± 9.4 years ; diabetes duration 16.5 ± 10.5 years ) , 11 dropped out .  Time for education was 6 h ( range 2–15 h ) in group A and 12 h ( 2.5–25 h ) in group B ( P = 0.07 ) . A1C reduction was similar in both groups ( group A from 8.2 ± 0.8 to 7.8 ± 0.8 % and group B from 8.4 ± 0.7 to 7.9 ± 1.1 % ; P = 0.68 ) . Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight . No severe hypoglycemic episode occurred . WHO-DTSQ scores increased significantly more in group A ( from 26.7 ± 4.4 to 30.3 ± 4.5 ) than in group B ( from 27.5 ± 4.8 to 28.6 ± 5.1 ) ( P = 0.04 ) . Role Physical , General Health , Vitality , and Role Emotional SF-36 scores improved significantly more in group A than in group B. CONCLUSIONS DID is at least as effective as traditional carbohydrate counting education , allowing dietary freedom for a larger proportion of type 1 diabetic patients . DID is safe , requires less time for education , and is associated with lower weight gain . DID significantly improved treatment satisfaction and several quality -of-life dimensions OBJECTIVE To conduct a 1-year r and omized clinical trial to evaluate a remote comprehensive diabetes self-management education ( DSME ) intervention , Diabetes TeleCare , administered by a dietitian and nurse/certified diabetes educator ( CDE ) in the setting of a federally qualified health center ( FQHC ) in rural South Carolina . RESEARCH DESIGN AND METHODS Participants were recruited from three member health centers of an FQHC and were r and omized to either Diabetes TeleCare , a 12-month , 13-session curriculum delivered using telehealth strategies , or usual care .  RESULTS Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin ( GHb ) in the Diabetes TeleCare group from baseline to 6 and 12 months ( 9.4 ± 0.3 , 8.3 ± 0.3 , and 8.2 ± 0.4 , respectively ) compared with usual care ( 8.8 ± 0.3 , 8.6 ± 0.3 , and 8.6 ± 0.3 , respectively ) . LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care . Although not part of the original study design , GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group ( 9.2 ± 0.4 , 7.4 ± 0.5 , and 7.6 ± 0.5 , respectively ) compared with usual care ( 8.7 ± 0.4 , 8.1 ± 0.4 , and 8.1 ± 0.5 , respectively ) in a post hoc analysis of a subset of the r and omized sample who completed a 24-month follow-up visit . CONCLUSIONS Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . BACKGROUND The objective was to compare glycemic control between prepr and ial and postpr and ial bolus administration ( 15 min before [ PRE ] or immediately after the meal [ POST ] ) in patients with type 1 diabetes using insulin pump and real-time continuous glucose monitoring . METHODS Between September 2015 and February 2016 , a single-centre , open r and omized , 2-way crossover study of patients on bolus insulin aspart administration  was conducted during two 14-day periods and according to 2 administration regimen schedules ( PRE/POST or POST/PRE ) . Inclusion criteria were as follows : patients with type 1 diabetes , ≥18 and ≤ 65 years old , treated with insulin aspart using a Medtronic ® insulin pump and trained on functional insulin therapy . Patients were r and omly assigned to either regimen schedule . At the beginning of each period , each patient was provided with a st and ardized high fat meal . Primary outcome was the area under the curve for interstitial glucose above 140 mg/dL per minute ( AUC > 140 mg/dL/min ) during each period . Secondary outcomes were time spent in hypo/eu/hyperglycemia , glycemic variability indices , and AUC during 4 hours after high fat meal calculated with continuous glucose monitoring data . RESULTS Twenty-two patients were included . Mean AUC > 140 mg/dL/min was statistically higher in patients on POST ( 43.70 mg/dL/min ; 95%CI : 34.08 to 53.31 ) versus PRE insulin aspart regimen ( 37.24 mg/dL/min 95%CI : 27.63 to 46.85 ) ( P = 0.03 ) . Mean interstitial glycemia and glycemic variability indices were also increased ( P < 0.05 ) on POST regimen . The mean AUC 4 hours after the high fat meal was higher on POST regimen but not statistically different ( P = 0.06 ) . CONCLUSIONS In our study , postpr and ial administration of insulin aspart appears to mildly increase glycemic excursion and glycemic variability OBJECTIVE To report results from YourWay , an Internet-based self-management intervention for adolescents with type 1 diabetes . RESEARCH DESIGN AND METHODS A total of 72 adolescents with type 1 diabetes , ages 13–17 years , were r and omized to a  usual-care-plus-Internet support or a usual-care group . The intervention was design ed to enhance problem-solving barriers to self-management . A1C was obtained from medical records , and problem-solving and self-management were obtained via adolescent report . RESULTS Group differences were not statistically significant using intent-to-treat analyses . Using as-treated analyses , adolescents in the treatment condition showed statistically significant improvement in self-management ( d = 0.64 ; P = 0.02 ) and important improvements in problem-solving ( d = 0.30 ; P = 0.23 ) and A1C ( d = −0.28 ; P = 0.27 ) . Mean A1C for the intervention group remained constant ( −0.01 % ) , while the control group increased ( 0.33 % ) . CONCLUSIONS This brief trial suggests that self-management support delivered through a secure website may improve self-management and offset typical decreases in adolescent glycemic control OBJECTIVE DAFNE ( Dose Adjustment For Normal Eating ) , a structured education program in flexible insulin therapy , has been widely adopted in the U.K. after validation in a r and omized trial . To determine benefits in routine practice , we collected biomedical and psychological data from all participants attending during a 12-month period . RESEARCH DESIGN AND METHODS HbA1c , weight , self-reported hypoglycemia awareness , severe hypoglycemia frequency , PAID ( Problem Areas In Diabetes ) , HADS ( Hospital Anxiety and Depression Scale ) , and EuroQol Group 5-Dimension Self-Report  Question naire scores were recorded prior to DAFNE and after 1 year . RESULTS Complete baseline and follow-up HbA1c data were available for 639 ( 54.9 % ) of 1,163 attendees . HbA1c fell from 8.51 ± 1.41 ( mean ± SD ) to 8.24 ± 1.29 % ( difference 0.27 [ 95 % CI 0.16–0.38 ] ; P < 0.001 ) , with a greater mean fall of 0.44 % from baseline HbA1c > 8.5 % . Severe hypoglycemia rate fell from 1.7 ± 8.5 to 0.6 ± 3.7 episodes per person per year ( 1.1 [ 0.7–1.4 ] ) and hypoglycemia recognition improved in 43 % of those reporting unawareness . Baseline psychological distress was evident , with a PAID score of 25.2 and HADS scores of 5.3 ( anxiety ) and 4.8 ( depression ) , falling to 16.7 ( 8.5 [ 6.6–10.4 ] ) , 4.6 ( 0.7 [ 0.4–1.0 ] ) , and 4.2 ( 0.6 [ 0.3–0.8 ] ) , respectively ( all P < 0.001 at 1 year ) . Clinical ly relevant anxiety and depression ( HADS ≥8 ) fell 
    Output:
    
The effect of e-health educational interventions on HbA1c in patients with T1D is comparable to the st and ard care .