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: PURPOSE It is unclear whether peer coaching is effective in minority population s living with diabetes in hard-to-reach , under-re source d areas such as the rural South . We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes . METHODS This was a community-engaged , cluster-r and omized , controlled trial with primary care practice s and their surrounding communities serving as clusters . The trial enrolled 424 participants , with 360 completing baseline and follow-up data collection ( 84.9 % retention ) . The primary outcomes were change in glycated hemoglobin ( HbA1c ) , systolic blood pressure ( BP ) , low density lipoprotein cholesterol ( LDL-C ) , body mass index ( BMI ) , and quality of life , with diabetes distress and patient activation as secondary outcomes . Peer coaches were trained for 2 days in community setting s ; the training emphasized motivational interviewing skills , diabetes basics , and goal setting . All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline . Intervention arm participants were also paired with peer coaches ; the protocol called for telephone interactions weekly for the first 8 weeks , then monthly for a total of 10 months . RESULTS Due to real-world constraints , follow-up was protracted , and intervention effects varied over time . The analysis that included the 68 % of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group . The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP ( P = .047 ) , BMI ( P = .02 ) , quality of life ( P = .003 ) , diabetes distress ( P = .004 ) , and patient activation ( P = .03 ) , but not in HbA1c ( P = .14 ) or LDL-C ( P = .97 ) . CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-re source d areas AIM To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China . METHODS We conducted a cluster r and omized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing . All participants received usual education for an average of 2 h each month from physicians , certified diabetes educators , dieticians , psychologists and podiatric nurses . Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month , as well as peer-to-peer communication . The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months . Secondary outcomes included fasting plasma glucose , 2-h postpr and ial glucose and HbA1c concentration . Outcome data were collected from all participants at baseline , 6 months and 12 months . RESULTS From 2012 to 2013 , there were 200 participants in each study arm at baseline . Compared with the usual education arm , the peer support with usual education arm had greater reductions in regimen-related distress ( 1.4 ± 0.6 vs 1.2 ± 0.4 ; P=0.004 ) and total distress ( 1.3 ± 0.4 vs 1.2 ± 0.3 ; P=0.038 ) at 6 months . At 12 months , the scores for emotional burden ( 1.2 ± 0.3 vs 1.4 ± 0.6 ; P=0.002 ) , physician-related distress ( 1.1 ± 0.3 vs 1.3 ± 0.4 ; P=0.001 ) and total scores ( 1.2 ± 0.3 vs 1.3 ± 0.4 ; P=0.002 ) were significantly lower in the peer support with usual education arm than in the usual education  arm . Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months ( 7.5 ± 1.95 vs 8.0 ± 2.2 ; P=0.044 ) and 12 months ( 7.0 ± 2.3 vs 7.6 ± 1.5 ; P=0.008 ) . CONCLUSIONS Beyond the benefits of usual education , peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus . ( Clinical Trials Registry no : NCT02119572 ) BACKGROUND Diabetes peer support , where one person with diabetes helps guide and support others , has been proposed as a way to improve diabetes management . We have tested whether different diabetes peer support strategies can improve metabolic and /or psychological outcomes . METHODS People with type 2 diabetes ( n = 1,299 ) were invited to participate as either '  peer ' or ' peer support facilitator '  ( PSF ) in a 2x2 factorial r and omised cluster controlled trial across rural communities ( 130 clusters ) in Engl and .  Peer support was delivered over 8 - 12 months by trained PSFs , supported by monthly meetings with a diabetes educator . Primary end point was HbA1c . Secondary outcomes included quality of life , diabetes distress , blood pressure , waist , total cholesterol and weight . Outcome assessors and investigators were masked to arm allocation . Main factors were 1:1 or group intervention . Analysis was by intention-to-treat adjusting for baseline . RESULTS The 4 arms were well matched ( Group n = 330 , 1:1(individual ) n = 325 , combined n = 322 , control n = 322 ) ; 1035 ( 79·7 % ) completed the mid-point postal question naire and 1064 ( 81·9 % ) had a final HbA1c . A limitation was that although 92.6 % PSFs and peers were in telephone contact , only 61.4 % of intervention participants attended a face to face session . Mean baseline HbA1c was 57 mmol/mol ( 7·4 % ) , with no significant change across arms . Follow up systolic blood pressure was 2·3 mm Hg ( 0.6 to 4.0 ) lower among those allocated group peer-support and 3·0 mm Hg ( 1.1 to 5.0 ) lower if the group support was attended at least once . There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication . CONCLUSIONS Group diabetes peer support over 8 - 12 months was associated with a small improvement in blood pressure but no other significant outcomes . Long term benefits should be investigated . TRIAL REGISTRATION IS RCT N.com IS RCT N6696362166963621 AIM To determine whether glycemic control is improved when motivational interviewing ( MI ) , a patient-centered behavior change strategy , is used with diabetes self management education ( DSME ) as compared to DSME alone . METHODS poorly controlled type 2 diabetes ( T2DM ) patients ( n=234 ) were r and omized into 4 groups : MI+DSME or DSME alone , with or without use of a computerized summary of patient self management barriers . We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change . RESULTS study patients attended the majority of the four intervention visits ( mean 3.4 ) , but drop-out rate was high at follow-up research visits ( 35 % ) . Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower ( less improved ) than those not receiving MI ( t=2.10 ; p=0.037 ) . Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress ; no between-group differences were found . CONCLUSIONS DSME improved blood glucose control , underlining its benefit for T2DM management . However , MI+DSME was less effective than DSME alone . Overall , weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators OBJECTIVE To compare a peer leader ( PL ) versus a community health worker ( CHW ) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education ( DSME ) program . RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and r and omized to 1 ) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or 2 ) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs . The primary outcome was HbA1c . Secondary outcomes were cardiovascular disease risk factors , diabetes distress , and diabetes social support . Assessment s were conducted at baseline , 6 , 12 , and 18 months . RESULTS After DSME , the PL group achieved a reduction in mean HbA1c ( 8.2–7.5 % or 66–58 mmol/mol , P < 0.0001 ) that was maintained at 18 months ( −0.6 % or −6.6 mmol/mol from baseline [ P = 0.009 ] ) . The CHW group also showed a reduction in HbA1c ( 7.8 vs. 7.3 % or 62 vs. 56 mmol/mol , P = 0.0004 ) post–6 month DSME ; however , it was attenuated at 18 months ( −0.3 % or −3.3 mmol/mol from baseline , within-group P = 0.234 ) . Only the PL group maintained improvements achieved in blood pressure at 18 months . At the 18-month follow-up , both groups maintained improvements in waist circumference , diabetes support , and diabetes distress , with no significant differences between groups . CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes , but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation Background Many type 2 diabetes mellitus patients face difficulties self-managing their illness , which can lead to high levels of diabetes-related distress . Diabetes distress may be decreased by peer support , as peers underst and and have dealt with similar problems , and can help motivate each other . A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions . This study describes the design of a trial evaluating the effectiveness of a group-based , peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients . Methods This is a parallel group r and omised controlled trial of a six session group-based peer support intervention , delivered by peer leaders and group psychotherapists , compared with one educational meeting on diabetes .  At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age , recruited via their general practitioner , will be r and omised to receive the peer support intervention or one educational meeting . The intervention is developed in line with three key stages of research development of the Medical Research Council framework . The primary outcome measure for this study is diabetes-related distress . Secondary outcomes include self-management behaviour , well-being and health-related quality of life . Perceived social support is a process measure . Outcomes will be measured one month before , and 6 , and 12 months after the intervention by means of self-reported question naires . Analysis will be on an intention-to-treat basis . Discussion This article contains a description of the design 
    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: PURPOSE It is unclear whether peer coaching is effective in minority population s living with diabetes in hard-to-reach , under-re source d areas such as the rural South . We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes . METHODS This was a community-engaged , cluster-r and omized , controlled trial with primary care practice s and their surrounding communities serving as clusters . The trial enrolled 424 participants , with 360 completing baseline and follow-up data collection ( 84.9 % retention ) . The primary outcomes were change in glycated hemoglobin ( HbA1c ) , systolic blood pressure ( BP ) , low density lipoprotein cholesterol ( LDL-C ) , body mass index ( BMI ) , and quality of life , with diabetes distress and patient activation as secondary outcomes . Peer coaches were trained for 2 days in community setting s ; the training emphasized motivational interviewing skills , diabetes basics , and goal setting . All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline . Intervention arm participants were also paired with peer coaches ; the protocol called for telephone interactions weekly for the first 8 weeks , then monthly for a total of 10 months . RESULTS Due to real-world constraints , follow-up was protracted , and intervention effects varied over time . The analysis that included the 68 % of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group . The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP ( P = .047 ) , BMI ( P = .02 ) , quality of life ( P = .003 ) , diabetes distress ( P = .004 ) , and patient activation ( P = .03 ) , but not in HbA1c ( P = .14 ) or LDL-C ( P = .97 ) . CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-re source d areas AIM To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China . METHODS We conducted a cluster r and omized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing . All participants received usual education for an average of 2 h each month from physicians , certified diabetes educators , dieticians , psychologists and podiatric nurses . Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month , as well as peer-to-peer communication . The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months . Secondary outcomes included fasting plasma glucose , 2-h postpr and ial glucose and HbA1c concentration . Outcome data were collected from all participants at baseline , 6 months and 12 months . RESULTS From 2012 to 2013 , there were 200 participants in each study arm at baseline . Compared with the usual education arm , the peer support with usual education arm had greater reductions in regimen-related distress ( 1.4 ± 0.6 vs 1.2 ± 0.4 ; P=0.004 ) and total distress ( 1.3 ± 0.4 vs 1.2 ± 0.3 ; P=0.038 ) at 6 months . At 12 months , the scores for emotional burden ( 1.2 ± 0.3 vs 1.4 ± 0.6 ; P=0.002 ) , physician-related distress ( 1.1 ± 0.3 vs 1.3 ± 0.4 ; P=0.001 ) and total scores ( 1.2 ± 0.3 vs 1.3 ± 0.4 ; P=0.002 ) were significantly lower in the peer support with usual education arm than in the usual education  arm . Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months ( 7.5 ± 1.95 vs 8.0 ± 2.2 ; P=0.044 ) and 12 months ( 7.0 ± 2.3 vs 7.6 ± 1.5 ; P=0.008 ) . CONCLUSIONS Beyond the benefits of usual education , peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus . ( Clinical Trials Registry no : NCT02119572 ) BACKGROUND Diabetes peer support , where one person with diabetes helps guide and support others , has been proposed as a way to improve diabetes management . We have tested whether different diabetes peer support strategies can improve metabolic and /or psychological outcomes . METHODS People with type 2 diabetes ( n = 1,299 ) were invited to participate as either '  peer ' or ' peer support facilitator '  ( PSF ) in a 2x2 factorial r and omised cluster controlled trial across rural communities ( 130 clusters ) in Engl and .  Peer support was delivered over 8 - 12 months by trained PSFs , supported by monthly meetings with a diabetes educator . Primary end point was HbA1c . Secondary outcomes included quality of life , diabetes distress , blood pressure , waist , total cholesterol and weight . Outcome assessors and investigators were masked to arm allocation . Main factors were 1:1 or group intervention . Analysis was by intention-to-treat adjusting for baseline . RESULTS The 4 arms were well matched ( Group n = 330 , 1:1(individual ) n = 325 , combined n = 322 , control n = 322 ) ; 1035 ( 79·7 % ) completed the mid-point postal question naire and 1064 ( 81·9 % ) had a final HbA1c . A limitation was that although 92.6 % PSFs and peers were in telephone contact , only 61.4 % of intervention participants attended a face to face session . Mean baseline HbA1c was 57 mmol/mol ( 7·4 % ) , with no significant change across arms . Follow up systolic blood pressure was 2·3 mm Hg ( 0.6 to 4.0 ) lower among those allocated group peer-support and 3·0 mm Hg ( 1.1 to 5.0 ) lower if the group support was attended at least once . There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication . CONCLUSIONS Group diabetes peer support over 8 - 12 months was associated with a small improvement in blood pressure but no other significant outcomes . Long term benefits should be investigated . TRIAL REGISTRATION IS RCT N.com IS RCT N6696362166963621 AIM To determine whether glycemic control is improved when motivational interviewing ( MI ) , a patient-centered behavior change strategy , is used with diabetes self management education ( DSME ) as compared to DSME alone . METHODS poorly controlled type 2 diabetes ( T2DM ) patients ( n=234 ) were r and omized into 4 groups : MI+DSME or DSME alone , with or without use of a computerized summary of patient self management barriers . We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change . RESULTS study patients attended the majority of the four intervention visits ( mean 3.4 ) , but drop-out rate was high at follow-up research visits ( 35 % ) . Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower ( less improved ) than those not receiving MI ( t=2.10 ; p=0.037 ) . Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress ; no between-group differences were found . CONCLUSIONS DSME improved blood glucose control , underlining its benefit for T2DM management . However , MI+DSME was less effective than DSME alone . Overall , weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators OBJECTIVE To compare a peer leader ( PL ) versus a community health worker ( CHW ) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education ( DSME ) program . RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and r and omized to 1 ) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or 2 ) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs . The primary outcome was HbA1c . Secondary outcomes were cardiovascular disease risk factors , diabetes distress , and diabetes social support . Assessment s were conducted at baseline , 6 , 12 , and 18 months . RESULTS After DSME , the PL group achieved a reduction in mean HbA1c ( 8.2–7.5 % or 66–58 mmol/mol , P < 0.0001 ) that was maintained at 18 months ( −0.6 % or −6.6 mmol/mol from baseline [ P = 0.009 ] ) . The CHW group also showed a reduction in HbA1c ( 7.8 vs. 7.3 % or 62 vs. 56 mmol/mol , P = 0.0004 ) post–6 month DSME ; however , it was attenuated at 18 months ( −0.3 % or −3.3 mmol/mol from baseline , within-group P = 0.234 ) . Only the PL group maintained improvements achieved in blood pressure at 18 months . At the 18-month follow-up , both groups maintained improvements in waist circumference , diabetes support , and diabetes distress , with no significant differences between groups . CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes , but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation Background Many type 2 diabetes mellitus patients face difficulties self-managing their illness , which can lead to high levels of diabetes-related distress . Diabetes distress may be decreased by peer support , as peers underst and and have dealt with similar problems , and can help motivate each other . A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions . This study describes the design of a trial evaluating the effectiveness of a group-based , peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients . Methods This is a parallel group r and omised controlled trial of a six session group-based peer support intervention , delivered by peer leaders and group psychotherapists , compared with one educational meeting on diabetes .  At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age , recruited via their general practitioner , will be r and omised to receive the peer support intervention or one educational meeting . The intervention is developed in line with three key stages of research development of the Medical Research Council framework . The primary outcome measure for this study is diabetes-related distress . Secondary outcomes include self-management behaviour , well-being and health-related quality of life . Perceived social support is a process measure . Outcomes will be measured one month before , and 6 , and 12 months after the intervention by means of self-reported question naires . Analysis will be on an intention-to-treat basis . Discussion This article contains a description of the design 
    Output:
    