Online Diabetes Self-Management Program: A randomized study

• Published in: Diabetes care Vol. 33; no. 6; pp. 1275 - 1281
• Main Authors: Lorig, Kate, Ritter, Philip L, Laurent, Diana D, Plant, Kathryn, Green, Maurice, Jernigan, Valarie Blue Bird, Case, Siobhan
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.06.2010
• Subjects: Adult; Alaska Natives; American Indians; Biological and medical sciences; Care and treatment; covariance; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Disease Management; distress; e-mail; Electronic Mail; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; exercise; Female; Glycated Hemoglobin; Glycated Hemoglobin A - metabolism; Humans; Internet; Male; Medical sciences; Metabolic diseases; metabolism; Methods; Middle Aged; Miscellaneous; noninsulin-dependent diabetes mellitus; Online health care information services; Original Research; Outcome Assessment, Health Care; Patient outcomes; patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Self-care, Health; self-efficacy; therapy; Type 2 diabetes; Young Adult; United States; Endocrinopathy; Human; Randomization; Program; Selfcare; Nutrition; Diabetes mellitus; Metabolic diseases; Endocrinology
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc09-2153

OBJECTIVE: We hypothesized that people with type 2 diabetes in an online diabetes self-management program, compared with usual-care control subjects, would 1) demonstrate reduced A1C at 6 and 18 months, 2) have fewer symptoms, 3) demonstrate increased exercise, and 4) have improved self-efficacy and patient activation. In addition, participants randomized to listserve reinforcement would have better 18-month outcomes than participants receiving no reinforcement. RESEARCH DESIGN AND METHODS: A total of 761 participants were randomized to 1) the program, 2) the program with e-mail reinforcement, or 3) were usual-care control subjects (no treatment). This sample included 110 American Indians/Alaska Natives (AI/ANs). Analyses of covariance models were used at the 6- and 18-month follow-up to compare groups. RESULTS: At 6 months, A1C, patient activation, and self-efficacy were improved for program participants compared with usual care control subjects (P < 0.05). There were no changes in other health or behavioral indicators. The AI/AN program participants demonstrated improvements in health distress and activity limitation compared with usual-care control subjects. The subgroup with initial A1C >7% demonstrated stronger improvement in A1C (P = 0.01). At 18 months, self-efficacy and patient activation were improved for program participants. A1C was not measured. Reinforcement showed no improvement. CONCLUSIONS: An online diabetes self-management program is acceptable for people with type 2 diabetes. Although the results were mixed they suggest 1) that the program may have beneficial effects in reducing A1C, 2) AI/AN populations can be engaged in and benefit from online interventions, and 3) our follow-up reinforcement appeared to have no value.