A Cochrane Systematic Review of Computer-Based Self-Management Interventions for Adults with Type 2 Diabetes
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Abstract
Background
Structured patient education programmes can reduce the risk of diabetes-related complications four-fold. However, people appear to have difficulties attending face-to-face education sessions as over 40% of people with diabetes in the USA have never received formal diabetes education. Computer-based self-management programmes have the potential to meet this need by providing cheaper interventions that could be more conveniently accessed by patients. Internet-based self-management programmes have been shown to be effective for several long-term conditions, though their effective components are unclear.
Objective
The aim of the review was to assess the effects of computer-based diabetes self-management interventions on health status, cardiovascular risk factors and quality of life of adults with type 2 diabetes and to define the active ingredients of successful interventions.
Methods
We retrieved 8715 abstracts from a systematic search of six electronic bibliographic databases. Three other databases were searched for conference proceedings and theses. The searches were run from inception to November 2011. Reference lists from relevant published studies were also screened and authors contacted for further information when required.
Study selection: Studies eligible for inclusion were randomized controlled clinical trials recruiting patients aged 18 and over with type 2 diabetes mellitus. Interventions eligible for inclusion were those that interacted with users to generate tailored content that aimed to improve one or more diabetes self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders. There were no language restrictions.
Data Extraction: Two authors independently extracted relevant data using standard data extraction templates.
Results
Sixteen randomised controlled trials with 3578 participants met the inclusion criteria. Interventions were delivered via clinics, the Internet, and mobile phones. Computer-based diabetes self-management interventions appear to have small benefits on glycaemic control: the pooled effect on HbA1c was -0.2% (-2.3 mmol/mol); 95% CI -0.4% to -0.1%; I² = 58%, (suggesting substantial heterogeneity). A sub-group analysis on mobile phone-based interventions showed a larger effect: the pooled effect on HbA1c from 3 studies was -0.50% (-5.46 mmol/mol); 95% CI -0.7% to -0.3%; I² = 0%, (suggesting low heterogeneity). Current interventions do not appear to be effective in improving depression, quality of life, blood pressure, serum lipids or weight. There was no evidence of significant adverse effects. In the interventions included in the review, prompting self-monitoring of behavioural outcome and providing feedback on performance were 2 techniques commonly used in the more effective interventions.
Conclusions
Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and this effect was larger in the mobile phone sub-group. There was no evidence of benefit for other biological, cognitive, behavioural or emotional outcomes.
Structured patient education programmes can reduce the risk of diabetes-related complications four-fold. However, people appear to have difficulties attending face-to-face education sessions as over 40% of people with diabetes in the USA have never received formal diabetes education. Computer-based self-management programmes have the potential to meet this need by providing cheaper interventions that could be more conveniently accessed by patients. Internet-based self-management programmes have been shown to be effective for several long-term conditions, though their effective components are unclear.
Objective
The aim of the review was to assess the effects of computer-based diabetes self-management interventions on health status, cardiovascular risk factors and quality of life of adults with type 2 diabetes and to define the active ingredients of successful interventions.
Methods
We retrieved 8715 abstracts from a systematic search of six electronic bibliographic databases. Three other databases were searched for conference proceedings and theses. The searches were run from inception to November 2011. Reference lists from relevant published studies were also screened and authors contacted for further information when required.
Study selection: Studies eligible for inclusion were randomized controlled clinical trials recruiting patients aged 18 and over with type 2 diabetes mellitus. Interventions eligible for inclusion were those that interacted with users to generate tailored content that aimed to improve one or more diabetes self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders. There were no language restrictions.
Data Extraction: Two authors independently extracted relevant data using standard data extraction templates.
Results
Sixteen randomised controlled trials with 3578 participants met the inclusion criteria. Interventions were delivered via clinics, the Internet, and mobile phones. Computer-based diabetes self-management interventions appear to have small benefits on glycaemic control: the pooled effect on HbA1c was -0.2% (-2.3 mmol/mol); 95% CI -0.4% to -0.1%; I² = 58%, (suggesting substantial heterogeneity). A sub-group analysis on mobile phone-based interventions showed a larger effect: the pooled effect on HbA1c from 3 studies was -0.50% (-5.46 mmol/mol); 95% CI -0.7% to -0.3%; I² = 0%, (suggesting low heterogeneity). Current interventions do not appear to be effective in improving depression, quality of life, blood pressure, serum lipids or weight. There was no evidence of significant adverse effects. In the interventions included in the review, prompting self-monitoring of behavioural outcome and providing feedback on performance were 2 techniques commonly used in the more effective interventions.
Conclusions
Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and this effect was larger in the mobile phone sub-group. There was no evidence of benefit for other biological, cognitive, behavioural or emotional outcomes.
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