Journal of General Internal Medicine

, Volume 25, Issue 12, pp 1315–1322

Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program

Authors

    • Institute for Health Research, Kaiser Permanente Colorado
  • Deanna Kurz
    • Institute for Health Research, Kaiser Permanente Colorado
  • Diane King
    • Institute for Health Research, Kaiser Permanente Colorado
  • Jennifer M. Dickman
    • Institute for Health Research, Kaiser Permanente Colorado
  • Andrew J. Faber
    • Institute for Health Research, Kaiser Permanente Colorado
  • Eve Halterman
    • Institute for Health Research, Kaiser Permanente Colorado
  • Tim Wooley
    • InterVision Media
  • Deborah J. Toobert
    • Oregon Research Institute
  • Lisa A. Strycker
    • Oregon Research Institute
  • Paul A. Estabrooks
    • Virginia Polytechnic Institute, State University
  • Diego Osuna
    • Institute for Health Research, Kaiser Permanente Colorado
  • Debra Ritzwoller
    • Institute for Health Research, Kaiser Permanente Colorado
Original Research

DOI: 10.1007/s11606-010-1480-0

Cite this article as:
Glasgow, R.E., Kurz, D., King, D. et al. J GEN INTERN MED (2010) 25: 1315. doi:10.1007/s11606-010-1480-0

Abstract

OBJECTIVE

Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition.

RESEARCH DESIGN AND METHODS

A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care. A heterogeneous sample of 463 type 2 patients was randomized and 82.5% completed a 4-month follow-up. Primary outcomes were behavior changes in healthy eating, physical activity, and medication taking. Secondary outcomes included hemoglobin A1c, body mass index, lipids, and blood pressure.

RESULTS

The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes (effect sizes [d] for healthy eating = 0.32; fat intake = 0.28; physical activity= 0.19) in both intent-to-treat and complete-cases analyses. These changes did not translate into differential improvements in biological outcomes during the 4-month study period. Added contact did not further enhance outcomes beyond the minimal contact intervention.

CONCLUSIONS

The Internet intervention meets several of the RE-AIM criteria for potential public health impact, including reaching a large number of persons, and being practical, feasible, and engaging for participants, but with mixed effectiveness in improving outcomes, and consistent results across different subgroups. Additional research is needed to evaluate longer-term outcomes, enhance effectiveness and cost-effectiveness, and understand the linkages between intervention processes and outcomes.

KEY WORDS

internet diabetes self-management RCT health disparities behavior change practical trial

Supplementary material

11606_2010_1480_MOESM1_ESM.doc (143 kb)
Table A1 Track My Progress (DOC 143 kb)
11606_2010_1480_MOESM2_ESM.doc (158 kb)
Table A2 Your Food Choices Action Plan (DOC 158 kb)

Copyright information

© Society of General Internal Medicine 2010