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

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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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Acknowledgments

This study was supported by grant #DK35524 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO, 80237-8066, USA

    Russell E. Glasgow PhD, Deanna Kurz BA, CCRP, Diane King PhD, Jennifer M. Dickman MSW, Andrew J. Faber BA, Eve Halterman MBA, Diego Osuna MD & Debra Ritzwoller PhD

  2. Oregon Research Institute, Eugene, OR, USA

    Deborah J. Toobert PhD & Lisa A. Strycker MA

  3. InterVision Media, Eugene, OR, USA

    Tim Wooley BS

  4. Virginia Polytechnic Institute, State University, Roanoke, VA, USA

    Paul A. Estabrooks PhD

Authors
  1. Russell E. Glasgow PhD
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  2. Deanna Kurz BA, CCRP
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  11. Diego Osuna MD
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  12. Debra Ritzwoller PhD
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Corresponding author

Correspondence to Russell E. Glasgow PhD.

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Glasgow, R.E., Kurz, D., King, D. et al. Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program. J GEN INTERN MED 25, 1315–1322 (2010). https://doi.org/10.1007/s11606-010-1480-0

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