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 Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation 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 Objective To test the effectiveness of  peer support  for patients with type 2 diabetes . Design Cluster r and omised controlled . Setting 20 general practice s in the east of the Republic of Irel and . Participants 395 patients ( 192 in intervention group , 203 in control group ) and 29 peer supporters with type 2 diabetes . Intervention All practice s introduced a st and ardised diabetes care system . The peer support intervention ran over a two year period and contained four elements : the recruitment and training of peer supporters , nine group meetings led by peer supporters in participant ’s own general practice , and a retention plan for the peer supporters . Main outcome measures HbA1c ; cholesterol concentration ; systolic blood pressure ; and wellbeing score . Results There was no difference between intervention and control patients at baseline . All practice s and 85 % ( 337 ) of patients were followed up . At two year follow-up , there were no significant differences in HbA1c ( mean difference −0.08 % , 95 % confidence interval −0.35 % to 0.18 % ) , systolic blood pressure ( −3.9 mm Hg , −8.9 to 1.1 mm Hg ) , total cholesterol concentration ( −0.03 mmol/L , −0.28 to 0.22 mmol/L ) , or wellbeing scores ( −0.7 , −2.3 to 0.8 ) . While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up , particularly for systolic blood pressure ( 52 % ( 87/166 ) > 130 mm Hg in intervention v 61 % ( 103/169 ) > 130 mm Hg in control ) , these changes were not significant . The process evaluation indicated that the intervention was generally delivered as intended , though 18 % ( 35 ) of patients in the intervention group never attended any group meetings . Conclusions A group based peer support intervention is feasible in general practice setting s , but the intervention was not effective when targeted at all patients with type 2 diabetes . While there was a trend towards improvements of clinical outcomes , the results do not support the widespread adoption of peer support . Trial registration Current Controlled Trials IS RCT N42541690 Background The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries . The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services . This study is an evaluation of a “ real world ” peer support program aim ed at improving the control and management of type 2 diabetes ( T2DM ) in Australia . Methods The trial used a r and omised cluster design with a peer support intervention and routine care control arms and 12-month follow up . Participants in both arms received a st and ardised session of self-management education at baseline . The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community re sources and supports related to diabetes .  Clinical , behavioural and other measures were collected at baseline , 6 and 12 months . The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Risk Equation at 12 months . Secondary outcomes included clinical measures , quality of life , measures of support , psychosocial functioning and lifestyle measures . Results Eleven of 12 planned groups were successfully implemented in the intervention arm . Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months . There were some small positive changes in self-management behaviours . Conclusions The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk , possibly because approximately half of the study participants already had quite well controlled T2DM at baseline . Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of re sources and supports to improve metabolic control and associated clinical outcomes .Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) ACTRN12609000469213 . Registered 16 June 2009 The aim of this study was to explore predictors of health related quality of life ( HRQoL ) among men and women with type 2 diabetes . This cross-sectional descriptive study consisted of a r and om sample of 300 adults with type 2 diabetes in a selected public hospital .  Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010 . Schooling and ability to manage positively were highly significant predictors of quality of life ( QoL ) among women as compared to men . Age , prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men . Findings demonstrate that 30.6 % ( versus 35.7 % ) of the variance in the total QoL and 14 % ( versus 23 % ) of the variance in health state could be explained by personal and clinical characteristics among women and men , respectively . The study underlines the importance for nurse educators to assess HRQoL among men and women and to develop effective self-care management strategies based on personal and clinical characteristics 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 The prevalence of type 2 diabetes is increasing in Malaysia , and people with diabetes have been reported to suffer from depression and diabetes distress which influences their self-efficacy in performing diabetes self-care practice s. This interviewer administered , cross sectional study , conducted in the district of Hulu Selangor , Malaysia , involving 371 r and omly selected patients with type 2 diabetes , recruited from 6 health clinics , aim ed to examine a conceptual model regarding the association between depression , diabetes distress and self-efficacy with diabetes self-care practice s using the partial least square approach of structural 
    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 Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation 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 Objective To test the effectiveness of  peer support  for patients with type 2 diabetes . Design Cluster r and omised controlled . Setting 20 general practice s in the east of the Republic of Irel and . Participants 395 patients ( 192 in intervention group , 203 in control group ) and 29 peer supporters with type 2 diabetes . Intervention All practice s introduced a st and ardised diabetes care system . The peer support intervention ran over a two year period and contained four elements : the recruitment and training of peer supporters , nine group meetings led by peer supporters in participant ’s own general practice , and a retention plan for the peer supporters . Main outcome measures HbA1c ; cholesterol concentration ; systolic blood pressure ; and wellbeing score . Results There was no difference between intervention and control patients at baseline . All practice s and 85 % ( 337 ) of patients were followed up . At two year follow-up , there were no significant differences in HbA1c ( mean difference −0.08 % , 95 % confidence interval −0.35 % to 0.18 % ) , systolic blood pressure ( −3.9 mm Hg , −8.9 to 1.1 mm Hg ) , total cholesterol concentration ( −0.03 mmol/L , −0.28 to 0.22 mmol/L ) , or wellbeing scores ( −0.7 , −2.3 to 0.8 ) . While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up , particularly for systolic blood pressure ( 52 % ( 87/166 ) > 130 mm Hg in intervention v 61 % ( 103/169 ) > 130 mm Hg in control ) , these changes were not significant . The process evaluation indicated that the intervention was generally delivered as intended , though 18 % ( 35 ) of patients in the intervention group never attended any group meetings . Conclusions A group based peer support intervention is feasible in general practice setting s , but the intervention was not effective when targeted at all patients with type 2 diabetes . While there was a trend towards improvements of clinical outcomes , the results do not support the widespread adoption of peer support . Trial registration Current Controlled Trials IS RCT N42541690 Background The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries . The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services . This study is an evaluation of a “ real world ” peer support program aim ed at improving the control and management of type 2 diabetes ( T2DM ) in Australia . Methods The trial used a r and omised cluster design with a peer support intervention and routine care control arms and 12-month follow up . Participants in both arms received a st and ardised session of self-management education at baseline . The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community re sources and supports related to diabetes .  Clinical , behavioural and other measures were collected at baseline , 6 and 12 months . The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Risk Equation at 12 months . Secondary outcomes included clinical measures , quality of life , measures of support , psychosocial functioning and lifestyle measures . Results Eleven of 12 planned groups were successfully implemented in the intervention arm . Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months . There were some small positive changes in self-management behaviours . Conclusions The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk , possibly because approximately half of the study participants already had quite well controlled T2DM at baseline . Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of re sources and supports to improve metabolic control and associated clinical outcomes .Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) ACTRN12609000469213 . Registered 16 June 2009 The aim of this study was to explore predictors of health related quality of life ( HRQoL ) among men and women with type 2 diabetes . This cross-sectional descriptive study consisted of a r and om sample of 300 adults with type 2 diabetes in a selected public hospital .  Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010 . Schooling and ability to manage positively were highly significant predictors of quality of life ( QoL ) among women as compared to men . Age , prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men . Findings demonstrate that 30.6 % ( versus 35.7 % ) of the variance in the total QoL and 14 % ( versus 23 % ) of the variance in health state could be explained by personal and clinical characteristics among women and men , respectively . The study underlines the importance for nurse educators to assess HRQoL among men and women and to develop effective self-care management strategies based on personal and clinical characteristics 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 The prevalence of type 2 diabetes is increasing in Malaysia , and people with diabetes have been reported to suffer from depression and diabetes distress which influences their self-efficacy in performing diabetes self-care practice s. This interviewer administered , cross sectional study , conducted in the district of Hulu Selangor , Malaysia , involving 371 r and omly selected patients with type 2 diabetes , recruited from 6 health clinics , aim ed to examine a conceptual model regarding the association between depression , diabetes distress and self-efficacy with diabetes self-care practice s using the partial least square approach of structural 
    Output:
    