human
***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 study time course changes in knowledge , problem solving ability , and quality of life in patients with type 2 diabetes managed by group compared with individual care and education . RESEARCH DESIGN AND METHODS We conducted a 5-year r and omized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit . There were 120 patients with non-insulin-treated type 2 diabetes enrolled and r and omly allocated to group or individual care . Eight did not start and 28 did not complete the study . The main outcome measures were knowledge of diabetes , problem solving ability , quality of life , HbA1c , BMI , and HDL cholesterol . RESULTS Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects ( P<0.001 for both ) . Quality of life improved from year 2 with group care but worsened with individual care ( P<0.001 ) . HbA1c level progressively increased over 5 years among control subjects ( + 1.7 % , 95 % CI 1.1 - 2.2 ) but not group care patients ( + 0.1 % , -0.5 to 0.4 ) , in whom BMI decreased ( -1.4 , -2.0 to -0.7 ) and HDL cholesterol increased ( + 0.14 mmol/l , 0.07 - 0.22 ) . CONCLUSIONS Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and setting s tailored to their needs . Traditional one-to-one care , although delivered according to optimized criteria , is associated with progressive deterioration of knowledge , problem solving ability , and quality of life . Better cognitive and psychosocial results are associated with more favorable clinical outcomes Purpose The purpose of this study was to assess whether the VA-MEDIC ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction ) , a pharmacist-led group medical visit program , could improve achievement of target goals in hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to usual care . Methods This was a r and omized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors . VA-MEDIC consisted of a 40- to 60-minute educational component by nurse , nutritionist , physical therapist , or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions . Measures The attainment of target goals in hemoglobin A1C ( A1C ) , blood pressure , fasting lipids , and tobacco use recommended by the American Diabetes Association . Results Of 118 participants , 109 completed the study . VA-MEDIC ( n = 58 ) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors . After 4 months , a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7 % and a systolic blood pressure less than 130 mm Hg . No significant change was found in lipid control or tobacco use between the 2 study arms . Conclusion Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans . Social Cognitive Theory provided the framework for the study . Methods Twenty-two participants were recruited and r and omly assigned to either Group or Individual diabetes self-management ( DSME ) . Group DSME included story-telling , h and s-on activities , and problem-solving exercises . Individual DSME sessions focused on goal - setting and problem-solving strategies . Sessions were offered in an accessible community center over a 10-week period . Results Outcomes included glycosylated hemoglobin ( A1C ) , self-care actions , self-efficacy level , goal attainment , and satisfaction with DSME . Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities , A1C level , and goal attainment . Although differences were not statistically significant , trends indicate improved scores on dietary actions , foot care , goal attainment , and empowerment for those experiencing Group DSME . Conclusions The culturally tailored approach was well received by all participants . Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control . Additional testing among more participants over a longer time period is recommended Background Current guidelines recommend education , physical activity and changes in diet for type 2 diabetes patients , yet the composition and organization of non-pharmacological care are still controversial . Therefore , it is very important that programmes aim ing to improve non-pharmacological treatment of type 2 diabetes are developed and evaluated . The Copenhagen Type 2 Diabetes Rehabilitation Project aims to evaluate the effectiveness of a new group-based lifestyle rehabilitation programme in a Health Care Centre in primary care . Methods / Design The group-based diabetes rehabilitation programme consists of empowerment-based education , supervised exercise and dietary intervention . The effectiveness of this multi-disciplinary intervention is compared with conventional individual counselling in a Diabetes Outpatient Clinic and evaluated in a prospect i ve and r and omized controlled trial . During the recruitment period of 18 months 180 type 2 diabetes patients will be r and omized to the intervention group and the  control group . Effects on glycaemic control , quality of life , self-rated diabetes symptoms , body composition , blood pressure , lipids , insulin resistance , beta-cell function and physical fitness will be examined after 6 , 12 and 24 months . Discussion The Copenhagen Type 2 Diabetes Rehabilitation Project evaluates a multi-disciplinary non-pharmacological intervention programme in a primary care setting and provides important information about how to organize non-pharmacological care for type 2 diabetes patients .Trail Registration Clinical Trials.gov registration number : NCT00284609 Aim : To verify if Group Care , a model to manage Type 2 diabetes ( T2DM ) by systemic continuing group education , can be administered by nurses and dieticians under pedagogic guidance , and improve metabolic control , quality of life , Locus of Control , and insulin resistance . Material and subjects : Twenty-five patients with non-insulin-treated T2DM were r and omized to Group Care and 24 to continued habitual individual care and education delivered by a diabetes specialist and pedagogist , respectively . Six nurses and 1 dietician received training by an accredited programme , a detailed operating manual and pedagogical supervision throughout the study . Follow-up was for 2 yr and included measurements of fasting blood glucose , glycated hemoglobin ( HbA1c ) , body mass index , waist circumference , lipids , creatinine , blood pressure , serum insulin , homeostasis model assessment ( HOMA ) index of insulin resistance , health behaviors , quality of life , state and trait anxiety , and Locus of Control . Results : One patient on Group Care and 3 controls dropped out . At the end of study , the patients on Group Care had lower HbA1c ( 7.6± 0.8 vs 8.4± 1.3 , p<0.05 ) , insulin ( 18.0± 9.6 vs 24.3± 13.7 , p<0.001 ) , HOMA index ( 6.9± 5.4 vs 9.2± 6.6 , p<0.05 ) , and fatalistic attitude ( 17.2± 5.9 vs 24.9± 4.2 , p<0.001 ) and better quality of life ( 65.0± 11.0 vs 78.4± 19.6 , p<0.001 ) than controls . Conclusions : Group Care delivered by trained nurses and dietitan is associated with better outcomes than those obtained by a medically and pedagogically qualified team . It may offer a model for health operators to re-organize clinical practice and for patients to improve lifestyle and strengthen the therapeutic alliance with their carers OBJECTIVE To implement an educational program in 10 Latin American countries and to evaluate its effect on the clinical , biochemical , and therapeutic aspects as well as the economic cost of diabetes . RESEARCH DESIGN AND METHODS Educators from each participating country were previously trained to implement the educational model .  The patient population included 446 individuals with type 2 diabetes ; all patients were < 65 years of age , did not require insulin for metabolic control , did not have severe complications of diabetes or life-limiting illnesses , and had not previously participated in diabetes education courses .  Clinical and therapeutic data and the cost of their pharmacological treatment were collected 6 months before participation in the educational program ( -6 months ) , on entry into the program ( time 0 ) , and at 4 , 8 , and 12 months after initiation of the program . RESULTS All parameters measured had improved significantly ( P < 0.001 ) by 1 year : fasting blood glucose ( mean + /- SD ) 10.6 + /- 3.5 vs. 8.7 + /- 3.0 mmol/l ; HbA(1c ) 9.0 + /- 2.0 vs. 7.8 + /- 1.6 % ; body weight 84.6 + /- 14.7 vs. 81.2 + /- 15.2 kg ; systolic blood pressure 149.6 + /- 33.6 vs. 142.9 + /- 18.8 mmHg ; total cholesterol 6.1 + /- 1.1 vs. 5.4 + /- 1.0 mmol/l ; and triglycerides 2.7 + /- 1.8 vs. 2.1 + /- 1.2 mmol/l . At 12 months , the decrease in pharmacotherapy required for control of diabetes , hypertension , and hyperlipidemia represented a 62 % decrease in the annual cost of treatment ( $ 107,939.99 vs. $ 41,106.30 [ U.S. ] ) . After deducting the additional cost of glucosuria monitoring ( $ 30,604 ) , there was still a 34 % annual savings . CONCLUSIONS The beneficial results of this educational model , implemented in 10 Latin American countries , reinforce the value of patient education as an essential part of diabetes care . They also suggest that an educational approach promoting healthy lifestyle habits and patient empowerment is an effective strategy with the potential to decrease the development of complications related to diabetes as well as the socioeconomic costs of the disease Background There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes . Objective We examine the impact of participation in a collaborative implementing the chronic care model ( CCM ) on the reduction of cardiovascular disease risk in patients with diabetes . Design Controlled pre- and postintervention study . Patients / Participants Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites . Measurements and Main Results Ten-year risk of cardiovascular disease ; determined using a modified United Kingdom Prospect i ve Diabetes Study risk engine score . A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria . The baseline mean 10-year risk of cardiovascular disease was 31 % for both the intervention group and the control group . Participants in both groups had improved blood pressure , lipid levels , and HbA1c levels during the observation period . R and om intercept hierarchical regression models showed that the intervention group had a 2.1 % ( 95 % CI −3.7 % , −0.5 % ) greater reduction in predicted risk for future cardiovascular events when compared to the control group . This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention . Conclusions Over a 1-year interval , this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization ’s setting s. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent ( type 2 ) diabetic patients . The programme was aim ed at improving the overall treatment quality in these patients through measures involving self-care , diet , exercise and weight reduction . Four theoretical-practical teaching units were given once a week to group of 5–8 ambulatory patients by previously trained general practitioners .  Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment , but receiving no structured teaching before or during the survey period ( control group ) . The drop-out percentage in the intervention group ( 25 % ) was significantly lower than in the control group (45%),P<0.05 , suggesting an incentive toward greater compliance in the former . At the end of the 1-year follow-up , the mean differences observed in the control and in the intervention groups were : body weight loss −2.4±0.5 kg vs −0.4±0.5 ( P<0.001 ) ; haemoglobin HbA1 −0.2%±0.4 % vs + 0.8±0.4 % 
    Output:
    
agent
The most significant effect observed is with the change from baseline results .
Some evidence suggests post-intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe .
There is no evidence that group visits improve LDL cholesterol values of the group visit participants .
IMPLICATION S FOR PRACTICE The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs .
***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 study time course changes in knowledge , problem solving ability , and quality of life in patients with type 2 diabetes managed by group compared with individual care and education . RESEARCH DESIGN AND METHODS We conducted a 5-year r and omized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit . There were 120 patients with non-insulin-treated type 2 diabetes enrolled and r and omly allocated to group or individual care . Eight did not start and 28 did not complete the study . The main outcome measures were knowledge of diabetes , problem solving ability , quality of life , HbA1c , BMI , and HDL cholesterol . RESULTS Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects ( P<0.001 for both ) . Quality of life improved from year 2 with group care but worsened with individual care ( P<0.001 ) . HbA1c level progressively increased over 5 years among control subjects ( + 1.7 % , 95 % CI 1.1 - 2.2 ) but not group care patients ( + 0.1 % , -0.5 to 0.4 ) , in whom BMI decreased ( -1.4 , -2.0 to -0.7 ) and HDL cholesterol increased ( + 0.14 mmol/l , 0.07 - 0.22 ) . CONCLUSIONS Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and setting s tailored to their needs . Traditional one-to-one care , although delivered according to optimized criteria , is associated with progressive deterioration of knowledge , problem solving ability , and quality of life . Better cognitive and psychosocial results are associated with more favorable clinical outcomes Purpose The purpose of this study was to assess whether the VA-MEDIC ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction ) , a pharmacist-led group medical visit program , could improve achievement of target goals in hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to usual care . Methods This was a r and omized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors . VA-MEDIC consisted of a 40- to 60-minute educational component by nurse , nutritionist , physical therapist , or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions . Measures The attainment of target goals in hemoglobin A1C ( A1C ) , blood pressure , fasting lipids , and tobacco use recommended by the American Diabetes Association . Results Of 118 participants , 109 completed the study . VA-MEDIC ( n = 58 ) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors . After 4 months , a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7 % and a systolic blood pressure less than 130 mm Hg . No significant change was found in lipid control or tobacco use between the 2 study arms . Conclusion Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans . Social Cognitive Theory provided the framework for the study . Methods Twenty-two participants were recruited and r and omly assigned to either Group or Individual diabetes self-management ( DSME ) . Group DSME included story-telling , h and s-on activities , and problem-solving exercises . Individual DSME sessions focused on goal - setting and problem-solving strategies . Sessions were offered in an accessible community center over a 10-week period . Results Outcomes included glycosylated hemoglobin ( A1C ) , self-care actions , self-efficacy level , goal attainment , and satisfaction with DSME . Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities , A1C level , and goal attainment . Although differences were not statistically significant , trends indicate improved scores on dietary actions , foot care , goal attainment , and empowerment for those experiencing Group DSME . Conclusions The culturally tailored approach was well received by all participants . Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control . Additional testing among more participants over a longer time period is recommended Background Current guidelines recommend education , physical activity and changes in diet for type 2 diabetes patients , yet the composition and organization of non-pharmacological care are still controversial . Therefore , it is very important that programmes aim ing to improve non-pharmacological treatment of type 2 diabetes are developed and evaluated . The Copenhagen Type 2 Diabetes Rehabilitation Project aims to evaluate the effectiveness of a new group-based lifestyle rehabilitation programme in a Health Care Centre in primary care . Methods / Design The group-based diabetes rehabilitation programme consists of empowerment-based education , supervised exercise and dietary intervention . The effectiveness of this multi-disciplinary intervention is compared with conventional individual counselling in a Diabetes Outpatient Clinic and evaluated in a prospect i ve and r and omized controlled trial . During the recruitment period of 18 months 180 type 2 diabetes patients will be r and omized to the intervention group and the  control group . Effects on glycaemic control , quality of life , self-rated diabetes symptoms , body composition , blood pressure , lipids , insulin resistance , beta-cell function and physical fitness will be examined after 6 , 12 and 24 months . Discussion The Copenhagen Type 2 Diabetes Rehabilitation Project evaluates a multi-disciplinary non-pharmacological intervention programme in a primary care setting and provides important information about how to organize non-pharmacological care for type 2 diabetes patients .Trail Registration Clinical Trials.gov registration number : NCT00284609 Aim : To verify if Group Care , a model to manage Type 2 diabetes ( T2DM ) by systemic continuing group education , can be administered by nurses and dieticians under pedagogic guidance , and improve metabolic control , quality of life , Locus of Control , and insulin resistance . Material and subjects : Twenty-five patients with non-insulin-treated T2DM were r and omized to Group Care and 24 to continued habitual individual care and education delivered by a diabetes specialist and pedagogist , respectively . Six nurses and 1 dietician received training by an accredited programme , a detailed operating manual and pedagogical supervision throughout the study . Follow-up was for 2 yr and included measurements of fasting blood glucose , glycated hemoglobin ( HbA1c ) , body mass index , waist circumference , lipids , creatinine , blood pressure , serum insulin , homeostasis model assessment ( HOMA ) index of insulin resistance , health behaviors , quality of life , state and trait anxiety , and Locus of Control . Results : One patient on Group Care and 3 controls dropped out . At the end of study , the patients on Group Care had lower HbA1c ( 7.6± 0.8 vs 8.4± 1.3 , p<0.05 ) , insulin ( 18.0± 9.6 vs 24.3± 13.7 , p<0.001 ) , HOMA index ( 6.9± 5.4 vs 9.2± 6.6 , p<0.05 ) , and fatalistic attitude ( 17.2± 5.9 vs 24.9± 4.2 , p<0.001 ) and better quality of life ( 65.0± 11.0 vs 78.4± 19.6 , p<0.001 ) than controls . Conclusions : Group Care delivered by trained nurses and dietitan is associated with better outcomes than those obtained by a medically and pedagogically qualified team . It may offer a model for health operators to re-organize clinical practice and for patients to improve lifestyle and strengthen the therapeutic alliance with their carers OBJECTIVE To implement an educational program in 10 Latin American countries and to evaluate its effect on the clinical , biochemical , and therapeutic aspects as well as the economic cost of diabetes . RESEARCH DESIGN AND METHODS Educators from each participating country were previously trained to implement the educational model .  The patient population included 446 individuals with type 2 diabetes ; all patients were < 65 years of age , did not require insulin for metabolic control , did not have severe complications of diabetes or life-limiting illnesses , and had not previously participated in diabetes education courses .  Clinical and therapeutic data and the cost of their pharmacological treatment were collected 6 months before participation in the educational program ( -6 months ) , on entry into the program ( time 0 ) , and at 4 , 8 , and 12 months after initiation of the program . RESULTS All parameters measured had improved significantly ( P < 0.001 ) by 1 year : fasting blood glucose ( mean + /- SD ) 10.6 + /- 3.5 vs. 8.7 + /- 3.0 mmol/l ; HbA(1c ) 9.0 + /- 2.0 vs. 7.8 + /- 1.6 % ; body weight 84.6 + /- 14.7 vs. 81.2 + /- 15.2 kg ; systolic blood pressure 149.6 + /- 33.6 vs. 142.9 + /- 18.8 mmHg ; total cholesterol 6.1 + /- 1.1 vs. 5.4 + /- 1.0 mmol/l ; and triglycerides 2.7 + /- 1.8 vs. 2.1 + /- 1.2 mmol/l . At 12 months , the decrease in pharmacotherapy required for control of diabetes , hypertension , and hyperlipidemia represented a 62 % decrease in the annual cost of treatment ( $ 107,939.99 vs. $ 41,106.30 [ U.S. ] ) . After deducting the additional cost of glucosuria monitoring ( $ 30,604 ) , there was still a 34 % annual savings . CONCLUSIONS The beneficial results of this educational model , implemented in 10 Latin American countries , reinforce the value of patient education as an essential part of diabetes care . They also suggest that an educational approach promoting healthy lifestyle habits and patient empowerment is an effective strategy with the potential to decrease the development of complications related to diabetes as well as the socioeconomic costs of the disease Background There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes . Objective We examine the impact of participation in a collaborative implementing the chronic care model ( CCM ) on the reduction of cardiovascular disease risk in patients with diabetes . Design Controlled pre- and postintervention study . Patients / Participants Persons with diabetes receiving care at 13 health care organizations exposed to the CCM collaborative and controls receiving care in nonexposed sites . Measurements and Main Results Ten-year risk of cardiovascular disease ; determined using a modified United Kingdom Prospect i ve Diabetes Study risk engine score . A total number of 613 patients from CCM intervention sites and 557 patients from usual care control sites met the inclusion criteria . The baseline mean 10-year risk of cardiovascular disease was 31 % for both the intervention group and the control group . Participants in both groups had improved blood pressure , lipid levels , and HbA1c levels during the observation period . R and om intercept hierarchical regression models showed that the intervention group had a 2.1 % ( 95 % CI −3.7 % , −0.5 % ) greater reduction in predicted risk for future cardiovascular events when compared to the control group . This would result in a reduced risk of one cardiovascular disease event for every 48 patients exposed to the intervention . Conclusions Over a 1-year interval , this collaborative intervention using the CCM lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization ’s setting s. Further work could enhance the impact of this promising multifactorial intervention on cardiovascular disease risk reduction The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent ( type 2 ) diabetic patients . The programme was aim ed at improving the overall treatment quality in these patients through measures involving self-care , diet , exercise and weight reduction . Four theoretical-practical teaching units were given once a week to group of 5–8 ambulatory patients by previously trained general practitioners .  Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment , but receiving no structured teaching before or during the survey period ( control group ) . The drop-out percentage in the intervention group ( 25 % ) was significantly lower than in the control group (45%),P<0.05 , suggesting an incentive toward greater compliance in the former . At the end of the 1-year follow-up , the mean differences observed in the control and in the intervention groups were : body weight loss −2.4±0.5 kg vs −0.4±0.5 ( P<0.001 ) ; haemoglobin HbA1 −0.2%±0.4 % vs + 0.8±0.4 % 
    Output:
    