Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support. Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS) for Diabetes The Effect of Diabetes Self-Management Education With Frequent Follow-Up on the Health Outcomes of African American Men The effects of a computer-tailored message on secondary prevention in type 2 diabetes: a randomized trial. Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project. Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial. A diabetes education multimedia program in the waiting room setting Twelve-month outcomes of an Internet-based diabetes self-management support program. Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Online Diabetes Self-Management Program Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: a survival analysis model. Assessment of the function and effect of diabetes education programs in Taiwan.
OBJECTIVE To determine if a patient-centered , computer-assisted diabetes care intervention increased perceived autonomy support , perceived competence ( from self-determination theory ) , and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes . DESIGN A r and omized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care setting s in Colorado . MAIN OUTCOME MEASURES Perceived autonomy support , perceived competence , patient satisfaction , glycemic control ( HbA1c ) , ratio of total to HDL cholesterol , diabetes distress , and depressive symptoms . RESULTS The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05 ) . Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids , diabetes distress , and depressive symptoms . The construct of autonomy support was found to be separate from that of patient satisfaction . CONCLUSIONS A patient-centered , computer-assisted intervention was effective in improving diabetes self-management outcomes , in part , because it increased patients ' perception that their autonomy was supported which changed perceived competence . These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes OBJECTIVE To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population . RESEARCH DESIGN AND METHODS Five public clinics in Chicago , Illinois , participated in the study with computer kiosks installed in waiting room areas . Two hundred forty-four subjects with diabetes were r and omized to receive either supplemental computer multimedia use ( intervention ) or st and ard of care only ( control ) . The intervention includes audio/video sequences to communicate information , provide psychological support , and promote diabetes self-management skills without extensive text or complex navigation .  HbA(1c ) ( A1C ) , BMI , blood pressure , diabetes knowledge , self-efficacy , self-reported medical care , and perceived susceptibility of complications were evaluated at baseline and 1 year . Computer usage patterns and implementation barriers were also examined . RESULTS Complete 1-year data were available for 183 subjects ( 75 % ) . Overall , there were no significant differences in change in A1C , weight , blood pressure , knowledge , self-efficacy , or self-reported medical care between intervention and control groups . However , there was an increase in perceived susceptibility to diabetes complications in the intervention group . This effect was greatest among subjects with lower health literacy . Within the intervention group , time spent on the computer was greater for subjects with higher health literacy . CONCLUSIONS Access to multimedia lessons result ed in an increase in perceived susceptibility to diabetes complications , particularly in subjects with lower health literacy . Despite measures to improve informational access for individuals with lower health literacy , there was relatively less use of the computer among these participants Background Lower socioeconomic status is associated with excess disease burden from diabetes .  Diabetes self-management support interventions are needed that are effective in engaging lower income patients , addressing competing life priorities and barriers to self-care , and facilitating behavior change . Objective To pilot test feasibility , acceptability , and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility . Design Two-arm r and omized controlled trial powered to detect a 0.50 % change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis . Participants Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar , blood pressure , or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization . Interventions A group , problem-based diabetes self-management training design ed for delivery in an intensive and a condensed program format . Three intensive and three condensed program groups were conducted during the trial . Main Measures Clinical ( A1C , systolic blood pressure [ SBP ] , diastolic blood pressure [ DBP ] , LDL and HDL cholesterol ) and behavioral ( knowledge , problem solving , self-management behavior ) data were measured at baseline , post-intervention , and 3 months post-intervention ( corresponding with 6–9 months following baseline ) . Results Adoption of both programs was high ( > 85 % attendance rates , 95 % retention ) . At 3 months post-intervention , the between-group difference in A1C change was −0.72 % ( p = 0.02 ) , in favor of the intensive program . A1C reduction was partially mediated by problem-solving skill at follow-up ( ß = −0.13 , p = 0.04 ) . Intensive program patients demonstrated within-group improvements in knowledge ( p < 0.001 ) , problem-solving ( p = 0.01 ) , and self-management behaviors ( p = 0.04 ) . Among the subsets of patients with suboptimal blood pressure or lipids at baseline , the intensive program yielded clinical ly significant individual improvements in SBP , DBP , and LDL cholesterol . Patient satisfaction and usability ratings were high for both programs . Conclusions A literacy-adapted , intensive , problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources Background Multiple r and omized controlled trials ( RCTs ) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease ( CVD ) outcomes . The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management ; however , evaluation of its impact in minority population s is limited . This study intends to provide early evidence of a theory-driven intervention , Tablet-Aided BehavioraL intervention EffecT on Self-management skills ( TABLETS ) , using real-time videoconferencing for education and skills training . We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American ( AA ) population with poorly controlled type 2 diabetes . Methods The study is a two-arm , pilot controlled trial that r and omizes 30 participants to the TABLETS intervention and 30 participants to a usual care group . Blinded outcome assessment s will be completed at baseline , 2.5 months ( immediate post-intervention ) , and 6.5 months ( follow-up ) . The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices , with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention material s via videoconferencing slides and a manual of supplementary material s. The primary outcomes are physical activity , diet , medication adherence , and self-monitoring behavior , whereas the secondary outcomes are HbA1c , low-density lipoprotein cholesterol ( LDL-C ) , BP , CVD risk , and quality of life . Discussion This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven , tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk , low-income AA population with an uncontrolled dyad or triad of CVD risk factors ( diabetes with or without hypertension or hyperlipidemia ) . The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management . The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a sub sample of patients with poor diabetes self-management . Trial registration The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier NCT02128854 ) , available online at : http:// clinical trials.gov/ct2/show/NCT02128854 PURPOSE This study was conducted to determine whether objective clinical , patient performance , quality -of-life , and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program . METHODS Prior to the diabetes self-management education program , 30 African American men with type 2 diabetes were r and omly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period . Information obtained at follow-up contact included HbA1c level , perception of general health , and present diabetes knowledge . In addition , daily foot care , dietary , exercise , and medication compliance measures were assessed postprogram . RESULTS There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical , patient performance , quality -of-life , and subjective outcomes . CONCLUSIONS This cross-sectional study showed that telephone follow-up at 3 month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up The purpose of this study was to test the effect of computer-generated , tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a scheduled physician visit . A st and -alone computer application was developed to provide tailored feedback aim ed at empowering patients to engage more actively in their diabetes management . Adults with type 2 diabetes ( n = 203 ) were r and omly assigned to groups receiving either efficacy ( positive ) messages ( n = 68 ) , risk ( negative ) messages ( n = 67 ) , or to a delayed treatment control group ( n = 68 ) . The intervention was delivered prior to a patient 's visit with his or her physician so that patients would have the opportunity to discuss the messages at the clinical appointment . Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups , we learned that more directive messaging may be needed to help patients effectively manage their diabetes . Patients may benefit from directive feedback , providing them with specific questions to ask their physician that can lead to improved care , rather than receiving general and educational informational messages Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels AIM Patient education that enhances one 's self-management ability is of utmost importance for improving patient outcomes in chronic diseases . We developed a 12 month self-management education program for type 2 diabetes , based on a previous 6 month program , and examined its efficacy . METHODS A r and omized controlled trial was carried out on out patients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate . They were r and omly divided into an intervention group that followed the program and a control group that followed usual clinical practise . The intervention group received < 30 min of monthly interviews based on the program 's textbook and biweekly telephone calls from a nurse educator throughout the 12 months . RESULTS Of the 50 participants in the intervention group and the 25 participants in the control group , 42 and 23 , respectively , completed the program ( a completion rate of 84.0 % ) . The body weight , HbA1c , self-efficacy , dietary and exercise stages , quality of life , diastolic blood pressure , and total cholesterol level were significant by two-way repeated- measures anova . As for changes over time within the groups , only the intervention group showed significant differences by Friedman 's test . The complication prevention behaviors showed a high implementation rate in the intervention group . The overall evaluation of this program by the participants was very high and , therefore , they highly recognized the need for this type of program . CONCLUSIONS Self-management education works successfully in relation to patients ' behavior modification skills , degree of goal attainment , and self-efficacy , consequently improving their health outcomes Introduction This study evaluated the impact of a waiting room-administered , low-literacy , computer multimedia diabetes education program on patient self-management and provider intensification of therapy . Methods In this r and omized , controlled trial , 129 participants either viewed a computer multimedia education program ( intervention group ) or read an educational brochure ( control group ) while in the waiting room . Participants were uninsured , primarily ethnic minority adults with type 2 diabetes receiving care from a county clinic in Chicago , Illinois . Wilcoxon test , t-test , and linear mixed model analyses evaluated changes in diabetes knowledge , self-efficacy , behaviors , medications prescribed , hemoglobin A1c ( HbA1c ) , and blood pressure levels over 3 months . Results During the study period , there was an increase in the number of oral diabetes medications prescribed over three months to multimedia users compared with those in the control group ( P=0.017 ) . HbA1c declined by 1.5 in the multimedia group versus 0.8 in the control group ( P=0.06 ) . There were no differences between groups in changes in blood pressure levels , self-efficacy , and most diabetes-related behaviors . Self-reported exercise increased in the control group compared with the multimedia group ( 0.9 days/week vs. 0.1 days/week , P=0.016 ) . Conclusion Multimedia users received a greater intensification of diabetes therapy , but demonstrated no difference in self-management in comparison with those receiving educational brochures . The availability of a computer multimedia program in the waiting room appears to be a novel and acceptable approach in providing diabetes education for underserved population OBJECTIVE Internet-based programs offer potential for practical , cost-effective chronic illness self-management programs . METHODS We report 12-month results of an Internet-based diabetes self-management program , with and without additional support , compared to enhanced usual care in a 3-arm practical r and omized trial . Patients ( n=463 ) were r and omized : 77.3 % completed 12-month follow-up . Primary outcomes were changes in health behaviors of healthy eating , physical activity , and medication taking . Secondary outcomes were hemoglobin A1c , body mass index , lipids , blood pressure , and psychosocial factors . RESULTS Internet conditions  improved health behaviors significantly vs. usual care over the 12-month period ( d for effect size=.09-.16 ) . All conditions improved moderately on biological and psychosocial outcomes .  Latinos , lower literacy , and higher cardiovascular disease risk patients improved as much as other participants . CONCLUSIONS The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact . However , 12-month magnitude of effects was small , suggesting that different or more intensive approaches are necessary to support long-term outcomes . Research is needed to underst and the linkages between intervention and maintenance processes and downstream outcomes . PRACTICE IMPLICATION S Automated self-management interventions should be tailored and integrated into primary care ; maintenance of patient self-management can be enhanced through links to community re sources OBJECTIVE To evaluate the efficacy of ongoing group based diabetes self-management education ( DSME ) for patients with type 2 diabetes . METHODS 146 patients were r and omised to either group education or waiting list control . Primary outcomes were A1C and patient activation measured with patient activation measure ( PAM ) . RESULTS There were no differences in the primary outcomes between the groups at 12 months , but the control group had an increase in A1C of 0.3 % points during follow-up . Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group . A sub group analysis was conducted for the quartile with the highest A1C at baseline ( > 7.7 , n=18 in both groups ) . There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control . CONCLUSIONS The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level . PRACTICE IMPLICATION S Locally developed programs may be less effective than programs developed for studies OBJECTIVE We hypothesized that people with type 2 diabetes in an online diabetes self-management program  , compared with usual-care control subjects , would 1 ) demonstrate reduced A1C at 6 and 18 months , 2 ) have fewer symptoms , 3 ) demonstrate increased exercise , and 4 ) have improved self-efficacy and patient activation . In addition , participants r and omized to listserve reinforcement would have better 18-month outcomes than participants receiving no reinforcement . RESEARCH DESIGN AND METHODS A total of 761 participants were r and omized to 1 ) the program  , 2 ) the program with e-mail reinforcement , or 3 ) were usual-care control subjects ( no treatment ) . This sample included 110 American Indians/Alaska Natives ( AI/ANs ) . Analyses of covariance models were used at the 6- and 18-month follow-up to compare groups . RESULTS At 6 months , A1C , patient activation , and self-efficacy were improved for program participants compared with usual care control subjects ( P < 0.05 ) . There were no changes in other health or behavioral indicators . The AI/AN program participants demonstrated improvements in health distress and activity limitation compared with usual-care control subjects . The subgroup with initial A1C > 7 % demonstrated stronger improvement in A1C ( P = 0.01 ) . At 18 months , self-efficacy and patient activation were improved for program participants . A1C was not measured . Reinforcement showed no improvement . CONCLUSIONS An online diabetes self-management program is acceptable for people with type 2 diabetes . Although the results were mixed they suggest 1 ) that the program may have beneficial effects in reducing A1C , 2 ) AI/AN population s can be engaged in and benefit from online interventions , and 3 ) our follow-up reinforcement appeared to have no value Background Given that patients provide the majority of their own diabetes care , patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care . However , participation in self management programs is low . In addition , the efficacy of current behavioural interventions wanes over time , reducing the impact of self-management interventions on patient health . Web-based interventions have the potential to bridge the gaps in diabetes care and self-management . Methods Our objective is to improve self-efficacy , quality of life , self-care , blood pressure , cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention . This study consists of five phases : ( 1 ) intervention development ; ( 2 ) feasibility testing ; ( 3 ) usability testing ; ( 4 ) intervention refinement ; and ( 5 ) intervention evaluation using mixed methods . We will employ evidence -based strategies and tools , using a theoretical framework of self-efficacy , then elicit user feedback through focus groups and individual user testing sessions . Using iterative re design the intervention will be refined . Once finalized , the impact of the website on patient self-efficacy , quality of life , self-care , HbA1c , LDL-cholesterol , blood pressure and weight will be assessed through a non-r and omized observational cohort study using repeated measures modeling and individual interviews . Discussion Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care . However , their full potential is hindered by limited knowledge regarding their effectiveness , poor usability , and high attrition rates . Our development and research agenda aims to address these limitations by improving usability , identifying characteristics associated with website use and attrition , and developing strategies to sustain patient use in order to maximize clinical outcomes Objective : There is a need for practical , efficient and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviours such as healthy eating and weight loss . The objective of this study was to evaluate such a computer-assisted intervention . Methods : Type 2 diabetes primary care patients ( n=335 ) from fee-for-service and health maintenance organization setting s were r and omized to social cognitive theory-based tailored self-management ( TSM ) or computer-aided enhanced usual care ( UC ) .  Intervention consisted of computer-assisted self-management assessment and feedback , tailored goal - setting , barrier identification , and problem-solving , followed by health counsellor interaction and follow-up calls . Outcomes were changes in dietary behaviours ( fat and fruit/vegetable intake ) , haemoglobin A1c ( HbA1c ) , lipids , weight , quality of life , and depression . Results : TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up . Among patients having elevated levels of HbA1c , lipids or depression at baseline , there were consistent directional trends favouring intervention , but these differences did not reach significance . The intervention proved feasible and was implemented successfully by a variety of staff . Conclusions : This relatively low-intensity intervention appealed to a large , generally representative sample of patients , was well implemented , and produced improvement in targeted behaviours . Implication s of this practical clinical trial for dissemination are discussed OBJECTIVE This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs ( DSMP ) . We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization . METHODS Electronic medical records ( EMR ) were obtained for 376 adults enrolled in a r and omized controlled trial ( RCT ) of Type 2 diabetes ( T2DM ) self-management programs . All study participants had uncontrolled diabetes and were r and omized into either : personal digital assistant ( PDA ) , Chronic Disease Self-Management Program ( CDSMP ) , combined PDA and CDSMP ( COM ) , or usual care ( UC ) groups . Subjects were followed for a maximum of two years . Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization . RESULTS Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization ( Hazard ratio : 0.10 ; p=0.002 ) when compared to subjects in the control arm . Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm . CONCLUSION CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM . PRACTICE IMPLICATION S Reducing unnecessary healthcare utilization , particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs . The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients A multi-center prospect i ve study was conducted to assess the function and impact of diabetic education programs on diabetic control . A total of 208 subjects with type 2 diabetes were recruited .  Diabetes self-care , assessed by question naire , was evaluated before , and 4 months after attending a diabetes education course . A total of 121 subjects who received advanced diabetes education courses  were design ated as the experimental group . A second group of 87 cases receiving a basic course  served as controls . In addition to basic knowledge , the advanced education programs included  dietary control , blood glucose monitoring , management of hypoglycemia , medication compliance , foot care and exercise . Diabetes self-care techniques were significantly improved in the experimental group . The overall score for diabetes self-care techniques improved in both groups at the 4th month over baseline values . The change was significant with the controls ' ( P < 0.001 ) . Multiple regression analysis confirmed the intensity of diabetic education was the only significant variable correlated with the decrease of fasting blood glucose and systolic blood pressure . In conclusion , integrated and intensive diabetes education program in diabetes education centers provides an effective method for improving diabetes self-care techniques and metabolic outcome
There was no evidence of improvement in depression , quality of life , blood pressure , serum lipids , or weight .
There was no evidence of significant adverse effects .
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 subgroup .
There was no evidence of benefit for other biological , cognitive , behavioral , or emotional outcomes
OBJECTIVE Structured patient education programs can reduce the risk of diabetes-related complications .
However , people appear to have difficulties attending face-to-face education and alternatives are needed .
This review looked at the impact of computer-based diabetes self-management interventions on health status , cardiovascular risk factors , and quality of life of adults with type 2 diabetes .