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01-12-2010 | Original Research

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

Authors: Russell E. Glasgow, PhD, Deanna Kurz, BA, CCRP, Diane King, PhD, Jennifer M. Dickman, MSW, Andrew J. Faber, BA, Eve Halterman, MBA, Tim Wooley, BS, Deborah J. Toobert, PhD, Lisa A. Strycker, MA, Paul A. Estabrooks, PhD, Diego Osuna, MD, Debra Ritzwoller, PhD

Published in: Journal of General Internal Medicine | Issue 12/2010

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.

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Title: Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program
Authors: Russell E. Glasgow, PhD
Deanna Kurz, BA, CCRP
Diane King, PhD
Jennifer M. Dickman, MSW
Andrew J. Faber, BA
Eve Halterman, MBA
Tim Wooley, BS
Deborah J. Toobert, PhD
Lisa A. Strycker, MA
Paul A. Estabrooks, PhD
Diego Osuna, MD
Debra Ritzwoller, PhD
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 12/2010
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-010-1480-0

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OBJECTIVE

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RESULTS

CONCLUSIONS

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