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 assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year Abstract Background : The global epidemic of diabetes calls for innovative interventions . This study evaluated the effectiveness of the Project Dulce model , with and without wireless technology , on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico . Subjects and Methods : Adults with type 2 diabetes and a glycated hemoglobin A1c ( HbA1c ) level of ≥8 % were recruited from Family Medical Unit # 27 of the Instituto Mexicano del Seguro Social ( IMSS ) in Tijuana , México , and r and omly assigned to one of three groups : Project Dulce – only ( PD ) ; Project Dulce technology-enhanced with mobile tools ( PD-TE ) ; or IMSS st and ard of care/control group ( CG )  . Clinical and self-reported outcomes were assessed at baseline , Month 4 , and Month 10 . Time-by-group interactions and within-group changes were analyzed . Results : HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE ( −3.0 % [ −33 mmol/mol ] ) and PD ( −2.6 % [ −28.7 mmol/mol ] ) compared with CG ( −1.3 % [ −14.2 mmol/mol ] ) ( P = 0.009 and 0.001 , respectively ) . PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG ( P < 0.05 for both ) . No statistically significant differences were detected between PD and PD-TE on these indicators ( P = 0.54 and 0.86 , respectively ) . Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups . Conclusions : Project Dulce with and without wireless technology  substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit , suggesting that integrating peer-led education , nurse coordination , and 3 G wireless technology is an effective approach for improving diabetes outcomes in high-risk population Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants ( KAIs ) with type 2 diabetes . Methods A r and omized controlled pilot trial with 2 parallel arms ( intervention vs control ) with a delayed intervention design was used . A total of 79 KAIs , recruited from the Baltimore-Washington area , completed baseline , 18-week , and 30-week follow-ups ( intervention , n = 40 ; control , n = 39 ) . All participants had uncontrolled type 2 diabetes ( hemoglobin A1C ≥7.5 % ) at baseline . The authors ’ comprehensive , self-help intervention program for type 2 diabetes management ( SHIP-DM ) consisted of a 6-week structured psychobehavioral education , home glucose monitoring with teletransmission , and bilingual nurse telephone counseling for 24 weeks . The primary outcome of the study was A1C level , and secondary outcomes included an array of psychobehavioral variables . Results Using analysis of covariance , the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample . Specifically , the amount of reduction in A1C among intervention group participants was 1.19 % at 18 weeks and 1.31 % at 30 weeks , with 10 % and 15.5 % of the participants achieving the suggested goal of A1C < 7 % at 18 and 30 weeks of follow-up , respectively . Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program , self-monitoring , and follow-up counseling , in terms of maintaining the improved intervention effects obtained and in terms of glucose control Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control . We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes . Methods and Findings We performed a r and omized , parallel , investigator-blind controlled trial with central ized r and omization in family practice s in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin ( HbA1c ) > 58 mmol/mol . The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group . The control group received usual care , with at least annual review and more frequent review s for  people with poor glycemic or blood pressure control .  HbA1c assessed at 9 mo was the primary outcome . Intention-to-treat analyses were performed . 160 people were r and omized to the intervention group and 161 to the usual care group between June 6 , 2011 , and July 19 , 2013 .  HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group . The mean ( SD ) HbA1c at follow-up was 63.0 ( 15.5 ) mmol/mol in the intervention group and 67.8 ( 14.7 ) mmol/mol in the usual care group . For primary analysis , adjusted mean HbA1c was 5.60 mmol/mol / 0.51 % lower ( 95 % CI 2.38 to 8.81 mmol/mol/ 95 % CI 0.22 % to 0.81 % , p = 0·0007 ) . For secondary analyses , adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower ( 95 % CI 0.56–5.56 mmHg , p = 0.017 ) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower ( 95 % CI 0.62–3.72 , p = 0.006 ) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata . No significant differences were identified between groups in weight , treatment pattern , adherence to medication , or quality of life in secondary analyses . There were few adverse events and these were equally distributed between the intervention and control groups . In secondary analysis , there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group ( rate ratio 7.50 ( 95 % CI 4.45–12.65 , p < 0.0001 ) but no other significant differences between groups in use of health services were identified between groups . Key limitations include potential lack of representativeness of trial participants , inability to blind participants and health professionals , and uncertainty about the mechanism , the duration of the effect , and the optimal length of the intervention . Conclusions Supported telemonitoring result ed in clinical ly important improvements in control of glycaemia in patients with type 2 diabetes in family practice . Current Controlled Trials , registration number IS RCT N71674628 . Trial Registration Current Controlled Trials IS RCT N Background Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality . We evaluated the efficacy of a consultation-based intervention to support objective ly-assessed adherence to oral glucose lowering medication ( OGLM ) compared to usual care among people with type 2 diabetes . Methods This was a parallel group r and omised trial in adult patients with type 2 diabetes and HbA1c≥7.5 % ( 58 mmol/mol ) , prescribed at least one OGLM . Participants were allocated to a clinic nurse delivered , innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans , or to usual care . The primary outcome was the percentage of days on which the prescribed dose of medication was taken , measured objective ly over 12 weeks with an electronic medication-monitoring device ( TrackCap , Aardex , Switzerl and ) . The primary analysis was intention-to-treat . Results 211 patients were r and omised between July 1 , 2006 and November 30 , 2008 in 13 British general practice s ( primary care clinics ) . Primary outcome data were available for 194 participants ( 91.9 % ) . Mean ( sd ) percentage of adherent days was 77.4 % ( 26.3 ) in the intervention group and 69.0 % ( 30.8 ) in st and ard care ( mean difference between groups 8.4 % , 95 % confidence interval 0.2 % to 16.7 % , p = 0.044 ) . There was no significant adverse impact on functional status or treatment satisfaction . Conclusions This well-specified , theory based intervention delivered in a single session of 30 min in primary care increased objective ly measured medication adherence , with no adverse effect on treatment satisfaction . These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time , with clinical and cost-effectiveness outcomes to inform clinical practice .Trial registration Current Controlled Trials IS RCT ABSTRACT BACKGROUND Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases , but daily engagement rates among these patients may be low . OBJECTIVE To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes . DESIGN R and omized , controlled trial . ( Clinical trials.gov Identifier : NCT01282957 ) . PARTICIPANTS Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System . INTERVENTIONS Twelve weeks of daily home-monitoring of blood glucose , blood pressure , and weight ( control group ; n = 28 ) ; a lottery incentive with 
    Output:
    
agent
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
***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 assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year Abstract Background : The global epidemic of diabetes calls for innovative interventions . This study evaluated the effectiveness of the Project Dulce model , with and without wireless technology , on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico . Subjects and Methods : Adults with type 2 diabetes and a glycated hemoglobin A1c ( HbA1c ) level of ≥8 % were recruited from Family Medical Unit # 27 of the Instituto Mexicano del Seguro Social ( IMSS ) in Tijuana , México , and r and omly assigned to one of three groups : Project Dulce – only ( PD ) ; Project Dulce technology-enhanced with mobile tools ( PD-TE ) ; or IMSS st and ard of care/control group ( CG )  . Clinical and self-reported outcomes were assessed at baseline , Month 4 , and Month 10 . Time-by-group interactions and within-group changes were analyzed . Results : HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE ( −3.0 % [ −33 mmol/mol ] ) and PD ( −2.6 % [ −28.7 mmol/mol ] ) compared with CG ( −1.3 % [ −14.2 mmol/mol ] ) ( P = 0.009 and 0.001 , respectively ) . PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG ( P < 0.05 for both ) . No statistically significant differences were detected between PD and PD-TE on these indicators ( P = 0.54 and 0.86 , respectively ) . Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups . Conclusions : Project Dulce with and without wireless technology  substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit , suggesting that integrating peer-led education , nurse coordination , and 3 G wireless technology is an effective approach for improving diabetes outcomes in high-risk population Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants ( KAIs ) with type 2 diabetes . Methods A r and omized controlled pilot trial with 2 parallel arms ( intervention vs control ) with a delayed intervention design was used . A total of 79 KAIs , recruited from the Baltimore-Washington area , completed baseline , 18-week , and 30-week follow-ups ( intervention , n = 40 ; control , n = 39 ) . All participants had uncontrolled type 2 diabetes ( hemoglobin A1C ≥7.5 % ) at baseline . The authors ’ comprehensive , self-help intervention program for type 2 diabetes management ( SHIP-DM ) consisted of a 6-week structured psychobehavioral education , home glucose monitoring with teletransmission , and bilingual nurse telephone counseling for 24 weeks . The primary outcome of the study was A1C level , and secondary outcomes included an array of psychobehavioral variables . Results Using analysis of covariance , the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample . Specifically , the amount of reduction in A1C among intervention group participants was 1.19 % at 18 weeks and 1.31 % at 30 weeks , with 10 % and 15.5 % of the participants achieving the suggested goal of A1C < 7 % at 18 and 30 weeks of follow-up , respectively . Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program , self-monitoring , and follow-up counseling , in terms of maintaining the improved intervention effects obtained and in terms of glucose control Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control . We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes . Methods and Findings We performed a r and omized , parallel , investigator-blind controlled trial with central ized r and omization in family practice s in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin ( HbA1c ) > 58 mmol/mol . The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group . The control group received usual care , with at least annual review and more frequent review s for  people with poor glycemic or blood pressure control .  HbA1c assessed at 9 mo was the primary outcome . Intention-to-treat analyses were performed . 160 people were r and omized to the intervention group and 161 to the usual care group between June 6 , 2011 , and July 19 , 2013 .  HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group . The mean ( SD ) HbA1c at follow-up was 63.0 ( 15.5 ) mmol/mol in the intervention group and 67.8 ( 14.7 ) mmol/mol in the usual care group . For primary analysis , adjusted mean HbA1c was 5.60 mmol/mol / 0.51 % lower ( 95 % CI 2.38 to 8.81 mmol/mol/ 95 % CI 0.22 % to 0.81 % , p = 0·0007 ) . For secondary analyses , adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower ( 95 % CI 0.56–5.56 mmHg , p = 0.017 ) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower ( 95 % CI 0.62–3.72 , p = 0.006 ) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata . No significant differences were identified between groups in weight , treatment pattern , adherence to medication , or quality of life in secondary analyses . There were few adverse events and these were equally distributed between the intervention and control groups . In secondary analysis , there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group ( rate ratio 7.50 ( 95 % CI 4.45–12.65 , p < 0.0001 ) but no other significant differences between groups in use of health services were identified between groups . Key limitations include potential lack of representativeness of trial participants , inability to blind participants and health professionals , and uncertainty about the mechanism , the duration of the effect , and the optimal length of the intervention . Conclusions Supported telemonitoring result ed in clinical ly important improvements in control of glycaemia in patients with type 2 diabetes in family practice . Current Controlled Trials , registration number IS RCT N71674628 . Trial Registration Current Controlled Trials IS RCT N Background Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality . We evaluated the efficacy of a consultation-based intervention to support objective ly-assessed adherence to oral glucose lowering medication ( OGLM ) compared to usual care among people with type 2 diabetes . Methods This was a parallel group r and omised trial in adult patients with type 2 diabetes and HbA1c≥7.5 % ( 58 mmol/mol ) , prescribed at least one OGLM . Participants were allocated to a clinic nurse delivered , innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans , or to usual care . The primary outcome was the percentage of days on which the prescribed dose of medication was taken , measured objective ly over 12 weeks with an electronic medication-monitoring device ( TrackCap , Aardex , Switzerl and ) . The primary analysis was intention-to-treat . Results 211 patients were r and omised between July 1 , 2006 and November 30 , 2008 in 13 British general practice s ( primary care clinics ) . Primary outcome data were available for 194 participants ( 91.9 % ) . Mean ( sd ) percentage of adherent days was 77.4 % ( 26.3 ) in the intervention group and 69.0 % ( 30.8 ) in st and ard care ( mean difference between groups 8.4 % , 95 % confidence interval 0.2 % to 16.7 % , p = 0.044 ) . There was no significant adverse impact on functional status or treatment satisfaction . Conclusions This well-specified , theory based intervention delivered in a single session of 30 min in primary care increased objective ly measured medication adherence , with no adverse effect on treatment satisfaction . These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time , with clinical and cost-effectiveness outcomes to inform clinical practice .Trial registration Current Controlled Trials IS RCT ABSTRACT BACKGROUND Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases , but daily engagement rates among these patients may be low . OBJECTIVE To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes . DESIGN R and omized , controlled trial . ( Clinical trials.gov Identifier : NCT01282957 ) . PARTICIPANTS Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System . INTERVENTIONS Twelve weeks of daily home-monitoring of blood glucose , blood pressure , and weight ( control group ; n = 28 ) ; a lottery incentive with 
    Output:
    