Twelve-month outcomes of an internet-based diabetes self-management support program

Objective: Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs.

Methods:We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial.  Patients (n= 463) were randomized: 77.3%completed 12-month follow-up.  Primary outcomes were changes in health behaviors of 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 health behaviors significantly vs. usual care over the 12-month period (d for effect size = .09 - .16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants.

Conclusions:The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. 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 downstream outcomes.

Practice Implications: Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.

KEY WORDS: diabetes, self-management, RCT, Internet intervention, pragmatic trial, multiple behavior change

 




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