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 Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost . Objective We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention . Methods We recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent , a behavior-change in-person group program for African Americans with diabetes or pre-diabetes . The program is social cognitive theory – guided , evidence -based , and culturally tailored . Participants were r and omized to participate in the program via virtual world ( Second Life ) or face-to-face , both delivered by a single intervention team . Blinded assessors conducted in-person clinical ( HbA1c ) , behavioral , and psychosocial measurements at baseline and 4-month follow-up . Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests ( two-sided and intention-to-treat analyses for all comparisons ) . Results Participants ( N=89 ) were an average of 52 years old ( SD 10 ) , 60 % had ≤high school , 82 % had household incomes < US $ 30,000 , and computer experience was variable . Overall session attendance was similar across the groups ( 6.8/8 sessions , P=.90 ) . Compared to face-to-face , virtual world was slightly superior for total activity , light activity , and inactivity ( P=.05 , P=.07 , and P=.025 , respectively ) . HbA1c reduction was significant within face-to-face ( −0.46 , P=02 ) but not within virtual world ( −0.31 , P=.19 ) , although there were no significant between group differences in HbA1c ( P=.52 ) . In both groups , 14 % fewer patients had post-intervention HbA1c ≥9 % ( virtual world P=.014 ; face-to-face P=.002 ) , with no significant between group difference ( P=.493 ) . Compared to virtual world , face-to-face was marginally superior for reducing depression symptoms ( P=.051 ) . The virtual world intervention costs were US $ 1117 versus US $ 931 for face-to-face . Conclusions It is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds , and outcomes may be comparable to those of face-to-face interventions . Further effectiveness research is warranted . Trial Registration Clinical Trials.gov NCT01340079 ; http:// clinical trials.gov/show/NCT01340079 ( Archived by WebCite at http://www.webcitation.org/6T2aSvmka ) OBJECTIVE To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support ( DSME/S ) . METHODS We r and omized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education . The primary outcome was change in HbA1C over 6 months . RESULTS At 6 months , HbA1C improved within the plate method [ -0.83 % ( -1.29 , -0.33 ) , P<0.001 ] and carbohydrate counting [ -0.63 % ( -1.03 , -0.18 ) , P=0.04 ] groups but not the control group [ P=0.34 ] . Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months ( carbohydrate counting , P=0.36 ; modified plate method , P=0.08 ) . In a pre-specified subgroup analysis of patients with a baseline HbA1C 7 - 10 % , change in HbA1C from baseline improved in the carbohydrate counting [ -0.86 % ( -1.47 , -0.26 ) , P=0.006 ] and plate method groups [ -0.76 % ( -1.33 , -0.19 ) , P=0.01 ] compared to controls . CONCLUSION CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10 % . PRACTICE IMPLICATION S Both carbohydrate counting and the modified plate method improve glycemic control as part of AIMS We evaluated a theoretically-derived family-oriented intervention aim ed to improve self-efficacy , self-management , glycemic control and quality of life in individuals living with Type 2 diabetes in Thail and . METHODS In a single-blinded r and omized controlled trial , 140 volunteer individuals with Type 2 diabetes , recruited from a diabetes clinic in rural Thail and , were r and omly allocated to intervention and control arms . Those in the intervention arm received routine care plus a family-oriented program that included education classes , group discussion s , a home visit , and a telephone follow-up while the control arm only received routine care . Improvement in outcomes over time ( baseline , Week 3 , and Week 13 following intervention ) was evaluated using Generalized Estimating Equations multivariable analyses . RESULTS Except for age , no between-group significant differences were observed in all other baseline characteristics . Diabetes self-efficacy , self-management , and quality of life improved in the intervention arm but no improvement was observed in the controls . In the risk-adjusted multivariable models , compared to the controls , the intervention arm had significantly better self-efficacy , self-management , outcome expectations , and diabetes knowledge ( p<0.001 , in each ) . Participation in the intervention increased the diabetes self-management score by 14.3 points ( β=14.3 , ( 95 % CI 10.7 - 17.9 ) , p<0.001 ) . Self-management was better in leaner patients and in females . No between-group differences were seen in quality of life or glycemic control , however , in the risk-adjusted multivariable models , higher self-management scores were associated with significantly decreased HbA1c levels ( p<0.001 ) and improved patient quality of life ( p<0.05 ) ( irrespective of group membership ) . CONCLUSIONS Our family-oriented program improved patients ' self-efficacy and self-management , which in turn could decrease HbA1c levels Introduction Diabetes self-management education ( DSME ) is a fundamental element of type 2 diabetes care . Although 75 % of adults with diabetes worldwide live in low-income and middle-income countries ( LMICs ) , limited DSME research has been conducted in LMICs . The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala . Methods We conducted a prospect i ve study of a DSME intervention using a quasi-experimental , single-group pretest – posttest design . We enrolled 90 participants in the intervention , which consisted of 6 home visits ( May 2014–July 2016 ) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan population s. Primary outcomes were changes in mean hemoglobin A1c ( HbA1c ) and mean systolic and diastolic blood pressure at baseline and at 12 months . Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion . Results HbA1c decreased significantly from baseline to 12 months ( absolute mean change , −1.5 % ; 95 % confidence interval [ CI ] , −1.9 % to −1.0 % ; P < .001 ) . Systolic blood pressure also improved significantly at 12 months ( −6.2 mm Hg ; 95 % CI , −10.1 to −2.2 mm Hg ; P = .002 ) ; changes in diastolic blood pressure were not significant ( −1.6 mm Hg ; 95 % CI , −3.9 to −0.7 mm Hg ; P = .17 ) . We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion . Conclusion DSME interventions can be successfully delivered in a setting with an underre source d health system , high poverty rate , and unique cultural characteristics like Mayan Guatemala . Our findings point to the need for more DSME research in re source -limited setting s globally Background Type 2 diabetes ( T2D ) is a significant public health problem , with U.S. Pacific Isl and er communities — such as the Marshallese — bearing a disproportionate burden . Using a community-based participatory approach ( CBPR ) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D . Objectives Led by a collaborative community-academic partnership , the Family Model of Diabetes Self-Management Education ( DSME ) aim ed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family . Design To test the Family Model of DSME , a r and omized , controlled , comparative effectiveness trial with 240 primary participants was implemented . Half of the primary participants were r and omly assigned to the St and ard DSME and half were r and omly assigned to the Family Model DSME . Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period . Methods The Family Model DSME was a cultural adaptation of DSME , whereby the intervention focused on engaging family support for the primary participant with T2D . The St and ard DSME was delivered to the primary participant in a community-based group format . Primary participants and participating family members were assessed at baseline and immediate post-intervention , and will also be assessed at 6 and 12 months . Summary The Family Model of DSME aim ed to improve glycemic control in Marshallese with T2D . The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention 's success and sustainability Purpose . The purpose of this study was to assess the feasibility of the  Spanish Diabetes Self-Management Program ( SDSMP )  in the primary care setting of the Basque Health Service and offer initial estimations of the r and omized controlled trial ( RCT ) effects . Methods . Ten health centers ( HCs ) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012 . Recruitment was performed via invitation letters , health professionals , and the local media . Each intervention group consisted of 8–15 people . The ability of each HC in forming up to 2 groups , participants ' compliance with the course , and coordination and data collection issues were evaluated . Glycated haemoglobin ( HbA1c ) was the main outcome variable . Secondary outcomes were cardiovascular risk factors , drugs consumption , medical visits , quality of life , self-efficacy , physical exercise , and diet . Results . Two HCs did not organize a course . A total of 173 patients initiated the program , 2 dropped out without baseline data , and 90 % completed it . No pre-post HbA1c differences existed . Certain improvements were observed in blood pressure control , self-efficacy , physical activity , and some dietary habits . Conclusion . The SDSMP is feasible in our setting . Our experience can be of interest when planning and conducting this program in similar health setting s. The trial is registered with Clinical Trials.gov identifier NCT01642394 Aims : This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients . This 10-month group intervention targeting patients and significant others aim ed to improve self-management by stimulating social support and diminishing social influences that hinder self-management . Methods : This intervention was evaluated in a quasi-experimental study using a mixed methods approach . Of 131 socioeconomically deprived patients with suboptimal glycaemic control , 69 were assigned to the  intervention  group and 62 to the  control group ( st and ard diabetes education ) . 27 qualitative in-depth interviews with the participants and 24 with their group leaders were held to study the subjective impact of the intervention . Further , self-management behaviours ( medication adherence , diet and physical activity ) were assessed at baseline , 10 and 16 months . Data were analysed using framework analyses and a linear mixture model . Results : Qualitative data showed that the intervention group had a better underst and ing of the way self-management influences diabetes . The intervention group showed more complex self-management behaviours , such as planning ahead , seeking adequate food and physical activity alternatives , and consistently taking their diabetes into consideration when making choices . In participants with complete follow-up data , we found a significant increase in physical activity in the intervention group ( 3.78 vs. 4.83 days ) and no changes in medication adherence and diet . Conclusions : This study indicates that an intensive support group and simultaneously involving significant others might improve diabetes self-management behaviours among socioeconomically deprived patients . More studies are needed to justify further implementation of the intervention . This study is registered in the Dutch Trial Register NTR1886 . http://www.trialregister.nl/trialreg/admin/ rct Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues , improving eating regulation and dietary patterns , reducing symptoms of depression and anxiety , and promoting weight loss . Diabetes self-management education ( DSME ) , which addresses knowledge , self-efficacy , and outcome expectations for improving food choices , also may be an effective intervention for diabetes self-care . Yet few 
    Output:
    
agent
***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 Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost . Objective We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention . Methods We recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent , a behavior-change in-person group program for African Americans with diabetes or pre-diabetes . The program is social cognitive theory – guided , evidence -based , and culturally tailored . Participants were r and omized to participate in the program via virtual world ( Second Life ) or face-to-face , both delivered by a single intervention team . Blinded assessors conducted in-person clinical ( HbA1c ) , behavioral , and psychosocial measurements at baseline and 4-month follow-up . Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests ( two-sided and intention-to-treat analyses for all comparisons ) . Results Participants ( N=89 ) were an average of 52 years old ( SD 10 ) , 60 % had ≤high school , 82 % had household incomes < US $ 30,000 , and computer experience was variable . Overall session attendance was similar across the groups ( 6.8/8 sessions , P=.90 ) . Compared to face-to-face , virtual world was slightly superior for total activity , light activity , and inactivity ( P=.05 , P=.07 , and P=.025 , respectively ) . HbA1c reduction was significant within face-to-face ( −0.46 , P=02 ) but not within virtual world ( −0.31 , P=.19 ) , although there were no significant between group differences in HbA1c ( P=.52 ) . In both groups , 14 % fewer patients had post-intervention HbA1c ≥9 % ( virtual world P=.014 ; face-to-face P=.002 ) , with no significant between group difference ( P=.493 ) . Compared to virtual world , face-to-face was marginally superior for reducing depression symptoms ( P=.051 ) . The virtual world intervention costs were US $ 1117 versus US $ 931 for face-to-face . Conclusions It is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds , and outcomes may be comparable to those of face-to-face interventions . Further effectiveness research is warranted . Trial Registration Clinical Trials.gov NCT01340079 ; http:// clinical trials.gov/show/NCT01340079 ( Archived by WebCite at http://www.webcitation.org/6T2aSvmka ) OBJECTIVE To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support ( DSME/S ) . METHODS We r and omized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education . The primary outcome was change in HbA1C over 6 months . RESULTS At 6 months , HbA1C improved within the plate method [ -0.83 % ( -1.29 , -0.33 ) , P<0.001 ] and carbohydrate counting [ -0.63 % ( -1.03 , -0.18 ) , P=0.04 ] groups but not the control group [ P=0.34 ] . Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months ( carbohydrate counting , P=0.36 ; modified plate method , P=0.08 ) . In a pre-specified subgroup analysis of patients with a baseline HbA1C 7 - 10 % , change in HbA1C from baseline improved in the carbohydrate counting [ -0.86 % ( -1.47 , -0.26 ) , P=0.006 ] and plate method groups [ -0.76 % ( -1.33 , -0.19 ) , P=0.01 ] compared to controls . CONCLUSION CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10 % . PRACTICE IMPLICATION S Both carbohydrate counting and the modified plate method improve glycemic control as part of AIMS We evaluated a theoretically-derived family-oriented intervention aim ed to improve self-efficacy , self-management , glycemic control and quality of life in individuals living with Type 2 diabetes in Thail and . METHODS In a single-blinded r and omized controlled trial , 140 volunteer individuals with Type 2 diabetes , recruited from a diabetes clinic in rural Thail and , were r and omly allocated to intervention and control arms . Those in the intervention arm received routine care plus a family-oriented program that included education classes , group discussion s , a home visit , and a telephone follow-up while the control arm only received routine care . Improvement in outcomes over time ( baseline , Week 3 , and Week 13 following intervention ) was evaluated using Generalized Estimating Equations multivariable analyses . RESULTS Except for age , no between-group significant differences were observed in all other baseline characteristics . Diabetes self-efficacy , self-management , and quality of life improved in the intervention arm but no improvement was observed in the controls . In the risk-adjusted multivariable models , compared to the controls , the intervention arm had significantly better self-efficacy , self-management , outcome expectations , and diabetes knowledge ( p<0.001 , in each ) . Participation in the intervention increased the diabetes self-management score by 14.3 points ( β=14.3 , ( 95 % CI 10.7 - 17.9 ) , p<0.001 ) . Self-management was better in leaner patients and in females . No between-group differences were seen in quality of life or glycemic control , however , in the risk-adjusted multivariable models , higher self-management scores were associated with significantly decreased HbA1c levels ( p<0.001 ) and improved patient quality of life ( p<0.05 ) ( irrespective of group membership ) . CONCLUSIONS Our family-oriented program improved patients ' self-efficacy and self-management , which in turn could decrease HbA1c levels Introduction Diabetes self-management education ( DSME ) is a fundamental element of type 2 diabetes care . Although 75 % of adults with diabetes worldwide live in low-income and middle-income countries ( LMICs ) , limited DSME research has been conducted in LMICs . The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala . Methods We conducted a prospect i ve study of a DSME intervention using a quasi-experimental , single-group pretest – posttest design . We enrolled 90 participants in the intervention , which consisted of 6 home visits ( May 2014–July 2016 ) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan population s. Primary outcomes were changes in mean hemoglobin A1c ( HbA1c ) and mean systolic and diastolic blood pressure at baseline and at 12 months . Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion . Results HbA1c decreased significantly from baseline to 12 months ( absolute mean change , −1.5 % ; 95 % confidence interval [ CI ] , −1.9 % to −1.0 % ; P < .001 ) . Systolic blood pressure also improved significantly at 12 months ( −6.2 mm Hg ; 95 % CI , −10.1 to −2.2 mm Hg ; P = .002 ) ; changes in diastolic blood pressure were not significant ( −1.6 mm Hg ; 95 % CI , −3.9 to −0.7 mm Hg ; P = .17 ) . We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion . Conclusion DSME interventions can be successfully delivered in a setting with an underre source d health system , high poverty rate , and unique cultural characteristics like Mayan Guatemala . Our findings point to the need for more DSME research in re source -limited setting s globally Background Type 2 diabetes ( T2D ) is a significant public health problem , with U.S. Pacific Isl and er communities — such as the Marshallese — bearing a disproportionate burden . Using a community-based participatory approach ( CBPR ) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D . Objectives Led by a collaborative community-academic partnership , the Family Model of Diabetes Self-Management Education ( DSME ) aim ed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family . Design To test the Family Model of DSME , a r and omized , controlled , comparative effectiveness trial with 240 primary participants was implemented . Half of the primary participants were r and omly assigned to the St and ard DSME and half were r and omly assigned to the Family Model DSME . Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period . Methods The Family Model DSME was a cultural adaptation of DSME , whereby the intervention focused on engaging family support for the primary participant with T2D . The St and ard DSME was delivered to the primary participant in a community-based group format . Primary participants and participating family members were assessed at baseline and immediate post-intervention , and will also be assessed at 6 and 12 months . Summary The Family Model of DSME aim ed to improve glycemic control in Marshallese with T2D . The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention 's success and sustainability Purpose . The purpose of this study was to assess the feasibility of the  Spanish Diabetes Self-Management Program ( SDSMP )  in the primary care setting of the Basque Health Service and offer initial estimations of the r and omized controlled trial ( RCT ) effects . Methods . Ten health centers ( HCs ) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012 . Recruitment was performed via invitation letters , health professionals , and the local media . Each intervention group consisted of 8–15 people . The ability of each HC in forming up to 2 groups , participants ' compliance with the course , and coordination and data collection issues were evaluated . Glycated haemoglobin ( HbA1c ) was the main outcome variable . Secondary outcomes were cardiovascular risk factors , drugs consumption , medical visits , quality of life , self-efficacy , physical exercise , and diet . Results . Two HCs did not organize a course . A total of 173 patients initiated the program , 2 dropped out without baseline data , and 90 % completed it . No pre-post HbA1c differences existed . Certain improvements were observed in blood pressure control , self-efficacy , physical activity , and some dietary habits . Conclusion . The SDSMP is feasible in our setting . Our experience can be of interest when planning and conducting this program in similar health setting s. The trial is registered with Clinical Trials.gov identifier NCT01642394 Aims : This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients . This 10-month group intervention targeting patients and significant others aim ed to improve self-management by stimulating social support and diminishing social influences that hinder self-management . Methods : This intervention was evaluated in a quasi-experimental study using a mixed methods approach . Of 131 socioeconomically deprived patients with suboptimal glycaemic control , 69 were assigned to the  intervention  group and 62 to the  control group ( st and ard diabetes education ) . 27 qualitative in-depth interviews with the participants and 24 with their group leaders were held to study the subjective impact of the intervention . Further , self-management behaviours ( medication adherence , diet and physical activity ) were assessed at baseline , 10 and 16 months . Data were analysed using framework analyses and a linear mixture model . Results : Qualitative data showed that the intervention group had a better underst and ing of the way self-management influences diabetes . The intervention group showed more complex self-management behaviours , such as planning ahead , seeking adequate food and physical activity alternatives , and consistently taking their diabetes into consideration when making choices . In participants with complete follow-up data , we found a significant increase in physical activity in the intervention group ( 3.78 vs. 4.83 days ) and no changes in medication adherence and diet . Conclusions : This study indicates that an intensive support group and simultaneously involving significant others might improve diabetes self-management behaviours among socioeconomically deprived patients . More studies are needed to justify further implementation of the intervention . This study is registered in the Dutch Trial Register NTR1886 . http://www.trialregister.nl/trialreg/admin/ rct Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues , improving eating regulation and dietary patterns , reducing symptoms of depression and anxiety , and promoting weight loss . Diabetes self-management education ( DSME ) , which addresses knowledge , self-efficacy , and outcome expectations for improving food choices , also may be an effective intervention for diabetes self-care . Yet few 
    Output:
    