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: BACKGROUND Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes . METHODS A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a r and omized , controlled trial aim ed at investigating the effects of telehome monitoring . The experimental group ( n = 50 ) received an in-home wireless glucose monitor and transmitter , whereas the control group ( n = 50 ) was instructed to follow the conventional arrangement . RESULTS There was an overall reduction in HbA1c values in both experimental and control groups after 6 months . A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients ( decline from 6.95 % ± 0.82 % to 6.66 % ± 0.86 % in IB vs. 7.21 % ± 2.02 % to 7.2 % ± 1.86 % in IIB ; p = 0.02 ) . The experimental group reported considerably less hyperglycemic and hypoglycemic events . The profile of the patient who benefited the most from telemonitoring consisted of older , more educated patient who had acquired the disease relatively recently , and who spends most of the time at home . The experimental group had higher overall scores on quality of life measures and sense of control over diabetes . There was a positive association between educational attainment and ability to use the telemonitoring system without help ( p = 0.045 ) . CONCLUSIONS Although not conclusive because of the small sample and short observation period , the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes , we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare ( u-healthcare ) service , which is an individualized health management system using advanced medical information technology . RESEARCH DESIGN AND METHODS We conducted a 6-month r and omized , controlled clinical trial involving 144 patients aged > 60 years . Participants were r and omly assigned to receive routine care ( control , n = 48 ) , to the self-monitored blood glucose ( SMBG  , n = 47 ) group , or to the u-healthcare group ( n = 49 ) . The primary end point was the proportion of patients achieving A1C < 7 % without hypoglycemia at 6 months . U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient ’s mobile phone . Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server . Once the data are transferred to the server , an automated system , the CDSS rule engine , generates and sends patient-specific messages by mobile phone . RESULTS After 6 months of follow-up , the mean A1C level was significantly decreased from 7.8 ± 1.3 % to 7.4 ± 1.0 % ( P < 0.001 ) in the u-healthcare group and from 7.9 ± 1.0 % to 7.7 ± 1.0 % ( P = 0.020 ) in the SMBG group , compared with 7.9 ± 0.8 % to 7.8 ± 1.0 % ( P = 0.274 ) in the control group . The proportion of patients with A1C < 7 % without hypoglycemia was 30.6 % in the u-healthcare group , 23.4 % in the SMBG group ( 23.4 % ) , and 14.0 % in the control group ( P < 0.05 ) . CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients Introduction The role of mobile technology in patient-reported outcomes ( PRO ) and glycemic control in adults with type 1 diabetes ( T1D ) needs further evaluation . Methods The single-center , prospect i ve , 6-month , open-label , investigator-initiated study r and omized 100 subjects with T1D in a 1:1 fashion to a  control group using self-monitoring of blood glucose ( SMBG ) with Accu-Chek Nano ® and an intervention group using SMBG with iPhone plus glucose meter ( iBGStar ® ) . The primary endpoint was the change in PRO ( hypoglycemia fear score , behavior and worry subscores ) . Secondary outcomes were the improvement in glycemic variability indices and the reduction in A1c values . Results Baseline demographics and glycosylated hemoglobin ( A1c ) values were similar in the two groups . There was a significant decrease in A1c value at 6 months in iBGStar ® group compared to the control group ( −0.16 vs. −0.51 , p = 0.04 ) . The total insulin dose increased significantly in the iBGStar ® group at 3 months but did not change at 6 months . The hypoglycemia fear scale ( PRO ) improved in both groups at 6 months ( −1.4 ± 10.0 vs. −3.9 ± 12.5 , p = 0.32 ) . Conclusion The use of iBGStar ® result ed in better glycemic control and improvement in some PRO ( hypoglycemia fear and behavior scores ) compared to the control group at 6 months with no increased risk of hypoglycemia . Clinical trial registration Clinical Trials.gov : NCT01825382 . Funding Sanofi BACKGROUND Basal insulin titration in the real world is often unsuccessful . LTHome , a web tool , applies a rules engine-based algorithm providing insulin titration advice directly to the patient . METHODS This pilot , r and omized trial evaluates basal insulin glargine titration by LTHome compared to enhanced usual therapy ( [EUT]-diabetes education program ) over 12 weeks . Important inclusion criteria : 18 - 75 years , type 2 diabetes , computer literacy , and HbA1c > 7.0 % . Trial protocol was approved by ethics board . RESULTS We r and omized 139 subjects . The achievement of primary composite outcome ( four out of seven fasting plasma glucose [ FPG ] within 5 - 7.2 mmol/L + mean for three consecutive FPG within 5 - 7.2 mmol/L + no severe hypoglycemia ) was 15 % in LTHome versus 41 % in EUT ( noninferiority not met , P-value = 0.92 ) . Other outcomes were similar between the LTHome and EUT arms : alternate composite outcome achievement ( last five FPG mean within the range of 5 - 7.2 mmol/L + no hypoglycemia , 47 % and 51 % , P = 0.73 ) ; A1c reduction ( -1.0 % and -1.1 % , P = 0.66 ) ; proportion achieving A1c ≤7 % ( 14 % and 20 % , P = 0.36 ) ; and hypoglycemia incidence ( 31 % and 37 % , P = 0.4 ) , respectively . Patient satisfaction score improvements were greater in LTHome versus EUT ( change in fear of hypoglycemia score P = 0.04 and change in diabetes distress score P = 0.04 ) . The mean number of additional healthcare provider visits was 0.13 for LTHome and 1.22 for EUT ( P < 0.01 ) . CONCLUSION INNOVATE trial suggests clinical utility of LTHome compared to EUT in real-life setting s. Further research is needed to evaluate the efficacy and safety of automated insulin titration algorithms BACKGROUND We compared telecare and conventional self-monitored blood glucose ( SMBG ) programs for titrating the addition of one bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for ≥3 months who were first titrated with basal insulin glargine . METHODS This r and omized , multicenter , parallel-group study included 241 patients ( mean screening glycosylated hemoglobin [ HbA(1c ) ] , 8.8 % [ 73 mmol/mol ] ) . In the run-in phase , any antidiabetes medication , except for metformin , was discontinued . Metformin was then up-titrated to 2 g/day ( 1 g twice daily ) until study completion . Following run-in , all patients started glargine for 8 - 16 weeks , targeting fasting plasma glucose ( FPG ) ≤5.6 mmol/L using conventional SMBG . Patients with FPG ≤7 mmol/L added a glulisine dose at the meal with the highest postpr and ial plasma glucose excursion , titrated to target 2-h postpr and ial plasma glucose level < 7.8 mmol/L using telecare or SMBG for 24 weeks . Patients with FPG > 7 mmol/L at week 16 were withdrawn from the study . RESULTS After glargine titration , 224 patients achieved FPG ≤7 mmol/L , without any difference between telecare and SBMG groups ( mean±SD , 6.2±0.8 vs. 6.0±0 . 9 mmol/L , respectively ) . HbA(1c ) levels were lower following titration and were similar for telecare and SMBG ( 7.9±0.9 % vs. 7.8±0.9 % [ 63 vs. 62 mmol/mol ] , respectively ) . Adding glulisine  further reduced HbA(1c ) in both groups ( -0.7 % vs. -0.7 % ) ; 45.2 % and 54.8 % ( P=0.14 ) , respectively , of patients achieved HbA(1c ) ≤7.0 % ( ≤53 mmol/mol ) . Weight change and hypoglycemia were similar between groups . CONCLUSIONS Patients adding one dose of glulisine at the meal with the highest postpr and ial plasma glucose excursion to titrated basal glargine achieved comparable improvements in glycemic control irrespective of traditional or telecare blood glucose monitoring OBJECTIVE To determine the functional health status and treatment satisfaction in patients with type 2 diabetes from the Evaluation of Lantus Effect ON Optimization of use of single dose Rapid insulin ( ELEONOR ) study that investigated whether a telecare program helps optimization of basal insulin glargine with one bolus injection of insulin glulisine . RESEARCH DESIGN AND METHODS Functional health status and treatment satisfaction were investigated using the 36-Item Short-Form ( SF-36 ) Health Survey , the World Health Organization Well-Being Question naire ( WBQ ) , and the Diabetes Treatment Satisfaction Question naire . RESULTS Of 291 r and omized patients , 238 completed the study ( telecare : 114 ; self-monitoring blood glucose : 124 ) . Significant improvements were detected in most SF-36 domains , in WBQ depression and anxiety scores , and in treatment satisfaction , without differences between study groups . CONCLUSIONS An insulin regimen that substantially improves metabolic control , while minimizing the risk of hypoglycemia , can positively affect physical and psychologic well-being and treatment satisfaction irrespective of the educational support system used The relationship between a prolonged QT interval and an increased risk of sudden death has been extensively explored in familial long QT syndrome , sudden infant death , and ischemic heart disease ( 1–3 ) . Several recent studies also describe the relation between corrected QT interval ( QTc ) prolongation , diabetes complications , and an increased mortality in adults ( 4,5 ) . We recently described QTc prolongation and a larger QT dispersion in a cohort of children and adolescents with type 1 diabetes ( 6 ) . The influence of changes in glycemia on the length of the QT or QTc remains a controversial issue . Experimental hypoglycemia and , just recently , spontaneous clinical episodes of hypoglycemia proved to lead to QTc lengthening ( 7–9 ) . There is some evidence that prolonged cardiac repolarization contributes to sudden death associated with nocturnal hypoglycemia in young people with diabetes ( 10–13 ) . On the other h and , a relation between hyperglycemia and abnormal cardiac repolarization has also been described ( 14 ) . We therefore simultaneously recorded QT and QTc values  using 24-h Holter registration and glucose levels with a continuous glucose monitoring system in children and adolescents with type 1 diabetes . Nine children and adolescents with stable type 1 diabetes ( five males and four females aged 9–19 years ) were prospect ively recruited from the patient population that regularly attends the Diabetes Clinic for BACKGROUND Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention .  We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes . METHODS We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes , using Cox proportional-hazards models with adjustment for covariates measured at baseline and after r and omization . RESULTS During a median follow-up period of 
    Output:
    
agent
Discussion Compared to usual care , the use of telemedicine was found to improve HbA1c and reduce the risk of moderate hypoglycaemia  in diabetic patients , but without significant difference in BMI
***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: BACKGROUND Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes . METHODS A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a r and omized , controlled trial aim ed at investigating the effects of telehome monitoring . The experimental group ( n = 50 ) received an in-home wireless glucose monitor and transmitter , whereas the control group ( n = 50 ) was instructed to follow the conventional arrangement . RESULTS There was an overall reduction in HbA1c values in both experimental and control groups after 6 months . A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients ( decline from 6.95 % ± 0.82 % to 6.66 % ± 0.86 % in IB vs. 7.21 % ± 2.02 % to 7.2 % ± 1.86 % in IIB ; p = 0.02 ) . The experimental group reported considerably less hyperglycemic and hypoglycemic events . The profile of the patient who benefited the most from telemonitoring consisted of older , more educated patient who had acquired the disease relatively recently , and who spends most of the time at home . The experimental group had higher overall scores on quality of life measures and sense of control over diabetes . There was a positive association between educational attainment and ability to use the telemonitoring system without help ( p = 0.045 ) . CONCLUSIONS Although not conclusive because of the small sample and short observation period , the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes , we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare ( u-healthcare ) service , which is an individualized health management system using advanced medical information technology . RESEARCH DESIGN AND METHODS We conducted a 6-month r and omized , controlled clinical trial involving 144 patients aged > 60 years . Participants were r and omly assigned to receive routine care ( control , n = 48 ) , to the self-monitored blood glucose ( SMBG  , n = 47 ) group , or to the u-healthcare group ( n = 49 ) . The primary end point was the proportion of patients achieving A1C < 7 % without hypoglycemia at 6 months . U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient ’s mobile phone . Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server . Once the data are transferred to the server , an automated system , the CDSS rule engine , generates and sends patient-specific messages by mobile phone . RESULTS After 6 months of follow-up , the mean A1C level was significantly decreased from 7.8 ± 1.3 % to 7.4 ± 1.0 % ( P < 0.001 ) in the u-healthcare group and from 7.9 ± 1.0 % to 7.7 ± 1.0 % ( P = 0.020 ) in the SMBG group , compared with 7.9 ± 0.8 % to 7.8 ± 1.0 % ( P = 0.274 ) in the control group . The proportion of patients with A1C < 7 % without hypoglycemia was 30.6 % in the u-healthcare group , 23.4 % in the SMBG group ( 23.4 % ) , and 14.0 % in the control group ( P < 0.05 ) . CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients Introduction The role of mobile technology in patient-reported outcomes ( PRO ) and glycemic control in adults with type 1 diabetes ( T1D ) needs further evaluation . Methods The single-center , prospect i ve , 6-month , open-label , investigator-initiated study r and omized 100 subjects with T1D in a 1:1 fashion to a  control group using self-monitoring of blood glucose ( SMBG ) with Accu-Chek Nano ® and an intervention group using SMBG with iPhone plus glucose meter ( iBGStar ® ) . The primary endpoint was the change in PRO ( hypoglycemia fear score , behavior and worry subscores ) . Secondary outcomes were the improvement in glycemic variability indices and the reduction in A1c values . Results Baseline demographics and glycosylated hemoglobin ( A1c ) values were similar in the two groups . There was a significant decrease in A1c value at 6 months in iBGStar ® group compared to the control group ( −0.16 vs. −0.51 , p = 0.04 ) . The total insulin dose increased significantly in the iBGStar ® group at 3 months but did not change at 6 months . The hypoglycemia fear scale ( PRO ) improved in both groups at 6 months ( −1.4 ± 10.0 vs. −3.9 ± 12.5 , p = 0.32 ) . Conclusion The use of iBGStar ® result ed in better glycemic control and improvement in some PRO ( hypoglycemia fear and behavior scores ) compared to the control group at 6 months with no increased risk of hypoglycemia . Clinical trial registration Clinical Trials.gov : NCT01825382 . Funding Sanofi BACKGROUND Basal insulin titration in the real world is often unsuccessful . LTHome , a web tool , applies a rules engine-based algorithm providing insulin titration advice directly to the patient . METHODS This pilot , r and omized trial evaluates basal insulin glargine titration by LTHome compared to enhanced usual therapy ( [EUT]-diabetes education program ) over 12 weeks . Important inclusion criteria : 18 - 75 years , type 2 diabetes , computer literacy , and HbA1c > 7.0 % . Trial protocol was approved by ethics board . RESULTS We r and omized 139 subjects . The achievement of primary composite outcome ( four out of seven fasting plasma glucose [ FPG ] within 5 - 7.2 mmol/L + mean for three consecutive FPG within 5 - 7.2 mmol/L + no severe hypoglycemia ) was 15 % in LTHome versus 41 % in EUT ( noninferiority not met , P-value = 0.92 ) . Other outcomes were similar between the LTHome and EUT arms : alternate composite outcome achievement ( last five FPG mean within the range of 5 - 7.2 mmol/L + no hypoglycemia , 47 % and 51 % , P = 0.73 ) ; A1c reduction ( -1.0 % and -1.1 % , P = 0.66 ) ; proportion achieving A1c ≤7 % ( 14 % and 20 % , P = 0.36 ) ; and hypoglycemia incidence ( 31 % and 37 % , P = 0.4 ) , respectively . Patient satisfaction score improvements were greater in LTHome versus EUT ( change in fear of hypoglycemia score P = 0.04 and change in diabetes distress score P = 0.04 ) . The mean number of additional healthcare provider visits was 0.13 for LTHome and 1.22 for EUT ( P < 0.01 ) . CONCLUSION INNOVATE trial suggests clinical utility of LTHome compared to EUT in real-life setting s. Further research is needed to evaluate the efficacy and safety of automated insulin titration algorithms BACKGROUND We compared telecare and conventional self-monitored blood glucose ( SMBG ) programs for titrating the addition of one bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for ≥3 months who were first titrated with basal insulin glargine . METHODS This r and omized , multicenter , parallel-group study included 241 patients ( mean screening glycosylated hemoglobin [ HbA(1c ) ] , 8.8 % [ 73 mmol/mol ] ) . In the run-in phase , any antidiabetes medication , except for metformin , was discontinued . Metformin was then up-titrated to 2 g/day ( 1 g twice daily ) until study completion . Following run-in , all patients started glargine for 8 - 16 weeks , targeting fasting plasma glucose ( FPG ) ≤5.6 mmol/L using conventional SMBG . Patients with FPG ≤7 mmol/L added a glulisine dose at the meal with the highest postpr and ial plasma glucose excursion , titrated to target 2-h postpr and ial plasma glucose level < 7.8 mmol/L using telecare or SMBG for 24 weeks . Patients with FPG > 7 mmol/L at week 16 were withdrawn from the study . RESULTS After glargine titration , 224 patients achieved FPG ≤7 mmol/L , without any difference between telecare and SBMG groups ( mean±SD , 6.2±0.8 vs. 6.0±0 . 9 mmol/L , respectively ) . HbA(1c ) levels were lower following titration and were similar for telecare and SMBG ( 7.9±0.9 % vs. 7.8±0.9 % [ 63 vs. 62 mmol/mol ] , respectively ) . Adding glulisine  further reduced HbA(1c ) in both groups ( -0.7 % vs. -0.7 % ) ; 45.2 % and 54.8 % ( P=0.14 ) , respectively , of patients achieved HbA(1c ) ≤7.0 % ( ≤53 mmol/mol ) . Weight change and hypoglycemia were similar between groups . CONCLUSIONS Patients adding one dose of glulisine at the meal with the highest postpr and ial plasma glucose excursion to titrated basal glargine achieved comparable improvements in glycemic control irrespective of traditional or telecare blood glucose monitoring OBJECTIVE To determine the functional health status and treatment satisfaction in patients with type 2 diabetes from the Evaluation of Lantus Effect ON Optimization of use of single dose Rapid insulin ( ELEONOR ) study that investigated whether a telecare program helps optimization of basal insulin glargine with one bolus injection of insulin glulisine . RESEARCH DESIGN AND METHODS Functional health status and treatment satisfaction were investigated using the 36-Item Short-Form ( SF-36 ) Health Survey , the World Health Organization Well-Being Question naire ( WBQ ) , and the Diabetes Treatment Satisfaction Question naire . RESULTS Of 291 r and omized patients , 238 completed the study ( telecare : 114 ; self-monitoring blood glucose : 124 ) . Significant improvements were detected in most SF-36 domains , in WBQ depression and anxiety scores , and in treatment satisfaction , without differences between study groups . CONCLUSIONS An insulin regimen that substantially improves metabolic control , while minimizing the risk of hypoglycemia , can positively affect physical and psychologic well-being and treatment satisfaction irrespective of the educational support system used The relationship between a prolonged QT interval and an increased risk of sudden death has been extensively explored in familial long QT syndrome , sudden infant death , and ischemic heart disease ( 1–3 ) . Several recent studies also describe the relation between corrected QT interval ( QTc ) prolongation , diabetes complications , and an increased mortality in adults ( 4,5 ) . We recently described QTc prolongation and a larger QT dispersion in a cohort of children and adolescents with type 1 diabetes ( 6 ) . The influence of changes in glycemia on the length of the QT or QTc remains a controversial issue . Experimental hypoglycemia and , just recently , spontaneous clinical episodes of hypoglycemia proved to lead to QTc lengthening ( 7–9 ) . There is some evidence that prolonged cardiac repolarization contributes to sudden death associated with nocturnal hypoglycemia in young people with diabetes ( 10–13 ) . On the other h and , a relation between hyperglycemia and abnormal cardiac repolarization has also been described ( 14 ) . We therefore simultaneously recorded QT and QTc values  using 24-h Holter registration and glucose levels with a continuous glucose monitoring system in children and adolescents with type 1 diabetes . Nine children and adolescents with stable type 1 diabetes ( five males and four females aged 9–19 years ) were prospect ively recruited from the patient population that regularly attends the Diabetes Clinic for BACKGROUND Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention .  We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes . METHODS We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes , using Cox proportional-hazards models with adjustment for covariates measured at baseline and after r and omization . RESULTS During a median follow-up period of 
    Output:
    