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.
RCT Entities:
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.
Authors: Russell E Glasgow; Lisa A Strycker; Deanna Kurz; Andrew Faber; Hillary Bell; Jennifer M Dickman; Eve Halterman; Paul A Estabrooks; Diego Osuna Journal: Ann Behav Med Date: 2010-08
Authors: Russell E Glasgow; Paul A Nutting; Diane K King; Candace C Nelson; Gary Cutter; Bridget Gaglio; Alanna Kulchak Rahm; Holly Whitesides; Hilarea Amthauer Journal: J Gen Intern Med Date: 2004-12 Impact factor: 5.128
Authors: Bonnie Leeman-Castillo; Brenda Beaty; Silvia Raghunath; John Steiner; Sheana Bull Journal: Am J Public Health Date: 2009-12-17 Impact factor: 9.308
Authors: Russell E Glasgow; Lawrence Fisher; Lisa A Strycker; Danielle Hessler; Deborah J Toobert; Diane K King; Tom Jacobs Journal: Transl Behav Med Date: 2014-03 Impact factor: 3.046
Authors: Alexander P Cotter; Nefertiti Durant; April A Agne; Andrea L Cherrington Journal: J Diabetes Complications Date: 2013-12-12 Impact factor: 2.852
Authors: Russell E Glasgow; Deanna Kurz; Diane King; Jennifer M Dickman; Andrew J Faber; Eve Halterman; Tim Woolley; Deborah J Toobert; Lisa A Strycker; Paul A Estabrooks; Diego Osuna; Debra Ritzwoller Journal: Patient Educ Couns Date: 2011-09-15
Authors: Russell E Glasgow; Deanna Kurz; Jennifer M Dickman; Diego Osuna; Lisa Strycker; Diane K King Journal: Transl Behav Med Date: 2012-09 Impact factor: 3.046
Authors: Joni L Strom Williams; Rebekah J Walker; Brittany L Smalls; Jennifer A Campbell; Leonard E Egede Journal: Diabetes Manag (Lond) Date: 2014-01-01