Twelve-month outcomes of an internet-based diabetes self-management support program
Objective: Internet-based programs offer great potential for practical and cost-effective chronic illness self-management programs.
Methods: We report 12-month results of an Internet-based diabetes self-management program (minimal and moderate contact versions) compared to enhanced usual care. Patients (n= 463) were randomized and 77.3% completed 12-month follow-up. Primary outcomes were changes in healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors.
Results: Internet conditions improved behavioral outcomes vs. usual care over the 12-month period. All conditions improved moderately on biological and psychosocial outcomes. Moderation analyses indicated that Latinos, lower literacy patients, and those at higher risk of cardiovascular disease improved as much as other participants.
Conclusions: The Internet intervention meets several criteria for public health impact, reaching and being feasible for a wide range of participants. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and outcomes.
Practice Implications: Automated self-managementinterventions should be linked in to primary care in customized ways, and for long-term maintenance, enhanced engagement in self- management and community resources may be necessary.