Improved diabetic prognosis following telecommunication and graphical processing of diabetic data. Improved care of patients with diabetes through telecommunications. Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol Computerized management of diabetes: a synthesis of controlled trials Qualitative evaluation of a mobile phone and web-based collaborative care intervention for patients with type 2 diabetes. Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Web-based care management in patients with poorly controlled diabetes. The effectiveness of nurse‐led care in general practice on clinical outcomes in adults with type 2 diabetes Presenting risk information to people with diabetes: evaluating effects and preferences for different formats by a web-based randomised controlled trial. Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial Increasing efficacy of primary care-based counseling for diabetes prevention: Rationale and design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) trial [Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings]. Participant experiences in a smartphone-based health coaching intervention for type 2 diabetes: A qualitative inquiry Sources of evidence for systematic reviews of interventions in diabetes. Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.
The thesis that an integrated telecommunications/reporting system would affect diabetic prognosis was tested . Over fifteen months a double crossover study compared traditional diaries versus graphical display of telecommunicated blood glucose data . Significant drops in glycohemoglobin were observed in both groups during the telecommunications period , while no significant drops were observed in the groups while diaries were employed This project tested the importance of enhanced information transfer of home monitoring results to health care providers . The study tested whether computer-assisted communication of medical information between the chronic care patient and the physician can result in health care benefit . The information tools were constructed/adapted as a test of this hypothesis for diabetes mellitus . Patients connected a glucometer to an intelligent modem weekly for six to nine months . Graphical and mathematical tools extracted and emphasized the information content of the home monitoring data arriving at the central site . Data smoothing , trend analysis , and calculation of quality control statistics were incorporated into a graphical time series oriented report that was used by the health care provider during an outpatient visit . The integrated home monitoring system was tested on 20 patients with diabetes in a double cross-over design over a 15-month period . A significant improvement in serum glucose control as measured by glycated hemoglobin was shown in the study group , but not in the control group 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 Computerized management of diabetes is the use of information technology to improve diabetic patient outcomes . The computer can be used to provide educational information to patients and facilitate the storage and transmittal of clinical data between patients and clinicians . The objective of this paper was to evaluate computerized management of diabetes in changing the health outcomes . Clinical trial reports were identified through systematic electronic data base and manual search es . Four eligibility criteria were applied : diabetes clinical area ; prospect i ve , contemporaneously controlled clinical trial with r and om assignment of the intervention ;  computer generated information for patients in the intervention group and no similar intervention in the control group ; and measurement of effect on the outcome of care ( health status , social functioning , patient/family satisfaction ) . Data were abstract ed using a st and ardized abstract ion form and the quality of methodology was scored . Of 15 eligible clinical trials , 12 ( 80 % ) reported positive outcomes or significant benefits . A total of 48 outcome measures were reported , an average of 3.2/ study . Significantly improved clinical outcomes included Hemoglobin A1c ( HbA1c ) , blood glucose , and hypoglycemic events .  Patient-computer interaction appears to be a valuable supplement to interaction with clinicians . Considering the need to enhance patient participation in the care of chronic illnesses , initial evidence indicates computers can play a more significant role in the future BACKGROUND Drawing on previous web-based diabetes management programs based on the Chronic Care Model , we exp and ed an intervention to include care management through mobile phones and a game console web browser . METHODS The pilot intervention enrolled eight diabetes patients from the University of Washington in Seattle into a collaborative care program : connecting them to a care provider specializing in diabetes , providing access to their full electronic medical record , allowing wireless glucose uploads and e-mail with providers , and connecting them to the program 's web services through a game system . To evaluate the study , we conducted qualitative thematic analysis of semistructured interviews . RESULTS Participants expressed frustrations with using the cell phones and the game system in their everyday lives , but liked the wireless system for collaborating with a provider on uploaded glucoses and receiving automatic feedback on their blood sugar trends . A majority of participants also expressed that their participation in the trial increased their health awareness . DISCUSSION Mobile communication technologies showed promise within a web-based collaborative care program for type 2 diabetes . Future intervention design should focus on integrating easy-to-use applications within mobile technologies already familiar to patients and ensure the system allows for sufficient collaboration with a care provider Background To improve quality of care and patient outcomes , health system decision-makers need to identify and implement effective interventions . An increasing number of systematic review s document the effects of quality improvement programs to assist decision-makers in developing new initiatives . However , limitations in the reporting of primary studies and current meta- analysis methods ( including approaches for exploring heterogeneity ) reduce the utility of existing syntheses for health system decision-makers . This study will explore the role of innovative meta- analysis approaches and the added value of enriched and up date d data for increasing the utility of systematic review s of complex interventions . Methods / Design We will use the data set from our recent systematic review of 142 r and omized trials of diabetes quality improvement programs  to evaluate novel approaches for exploring heterogeneity . These will include exploratory methods , such as multivariate meta-regression analyses and all-subsets combinatorial meta- analysis . We will then up date our systematic review to include new trials and enrich the data set by surveying authors of all included trials . In doing so , we will explore the impact of variables not , reported in previous publications , such as details of study context , on the effectiveness of the intervention . We will use innovative analytical methods on the enriched and up date d data set to identify key success factors in the implementation of  quality improvement interventions  for diabetes . Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results . Discussion This study will inform future systematic review s of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta- analysis . It will also result in an up date d comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes . Systematic review registration PROSPERO registration no. 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 OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes . RESEARCH DESIGN AND METHODS For this study , 104 patients with diabetes and HbA(1c ) ( A1C ) > or = 9.0 % who received their care at a Department of Veterans Affairs medical center were recruited . All participants completed a  diabetes education class  and were r and omized to continue with their usual care ( n = 52 ) or receive web-based care management ( n = 52 ) . The web-based group received a notebook computer , glucose and blood pressure monitoring devices , and access to a care management website . The website provided educational modules , accepted uploads from monitoring devices , and had an internal messaging system for patients to communicate with the care manager . RESULTS Participants receiving web-based care management had lower A1C over 12 months ( P < 0.05 ) when compared with education and usual care . Persistent website users had greater improvement in A1C when compared with intermittent users ( -1.9 vs. -1.2 % ; P = 0.051 ) or education and usual care ( -1.4 % ; P < 0.05 ) . A larger number of website data uploads was associated with a larger decline in A1C ( highest tertile -2.1 % , lowest tertile -1.0 % ; P < 0.02 ) . Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure ( P < 0.01 ) . HDL cholesterol rose and triglycerides fell in the web-based group ( P < 0.05 ) . CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes Background In Australia , diabetes was identified as a national health priority area in 1996 ; nevertheless the prevalence of type 2 diabetes has increased dramatically since then . Nurses have been working within Australian general practice s for several decades but only in recent years has the role of the practice nurse in primary health care increased . Objectives This review aims to identify the effectiveness of nurse‐led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes . Inclusion criteria Types of participants Participants were adults ( aged > 18 years ) , with diabetes type 2 attending a general/family practice . Types of intervention Interventions of interest include nurse‐led care in general practice in which the nurse is identified as taking a lead role in the care of patients with type 2 diabetes compared to general practitioner‐led care . Types of studies To evaluate the effectiveness of nurse‐led diabetes care in general practice , this review sought r and omised controlled trials as the study design of choice . Other research design s such as controlled clinical trials , interrupted time series and controlled before and after design s were also considered . Types of outcomes The outcomes of interest were clinical outcomes including changes in systolic and diastolic blood pressure , body mass index , cholesterol levels , HbA1c ( glycated haemoglobin ) and fasting blood glucose . Search strategy A three step literature search was conducted for English language articles from January 1990 to December 2011 . Method ological quality Quantitative papers selected for retrieval were assessed by two independent review ers for method ological validity prior to inclusion in the review using st and ardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument . Data collection Quantitative data was extracted from papers included in the review using the st and ardised data extraction tool from the Joanna Briggs Institute . The data extracted included specific details about the interventions , population s , study methods and outcomes of significance to the review question and specific objectives . Data synthesis Data from quantitative papers , where possible , were pooled in statistical meta‐ analysis using the Meta‐ Analysis of Statistics Assessment and Review Instrument . Additionally , RevMan 5 was used for presenting forest plots of the meta‐ analysis . Results The electronic search yielded 804 potentially relevant papers of which 49 papers appeared to satisfy the criteria for inclusion and full texts of these papers were assessed against the inclusion criteria by two independent review ers . From these papers , five were included in the review , four r and omised control trials and one quasi‐experimental study . These articles provided evidence that nurse‐led care improves blood pressure and cholesterol levels for patients with type 2 diabetes attending a general practice . Conclusions There is some evidence to support the use of nurse‐led care in general practice for patients with type 2 diabetes . Implication s for Practice If nurse‐led care is implemented in the care of people with type 2 diabetes consideration needs to be given to the use of clinical algorithms , goal setting , individualised care plans , self management and follow up of lifestyle risk factors . Implication for Research More r and omised controlled trials are required to assess the efficacy of nurse‐led care including cost effectiveness OBJECTIVE Web-based patient information is widespread and information on the benefits and risks of treatments is often difficult to underst and . We therefore evaluated different risk presentation formats - numerical , graphical and others - addressing the pros and cons of tight control versus usual treatment approaches for diabetes . METHOD DESIGN R and omised controlled trial . SETTING Online . Publicity disseminated via Diabetes UK . PARTICIPANTS People with diabetes or their carers . INTERVENTIONS Control group information based on British Medical Journal ' Best Treatments ' . Four intervention groups received enhanced information re sources : ( 1 ) detailed numerical information ( absolute/relative risk , numbers-needed-to-treat ) ; ( 2 ) ' anchoring ' to familiar risks or descriptions ; ( 3 ) graphical ( bar charts , thermometer scales , crowd figure formats ) ; ( 4 ) combination of 1 - 3 .  OUTCOMES Decision conflict scale ( DCS , a measure of uncertainty ) ; satisfaction with information ; further free text responses for qualitative content analysis . RESULTS Seven hundred and ten people visited the website and were r and omised . Five hundred and eight completed the question naire for quantitative data . Mean DCS scores ranged from 2.12 to 2.24 for the five r and omisation groups , indicating neither clear delay or vacillation about decisions ( usually DCS>2.5 ) nor tending to make decisions ( usually DCS<2.0 ) . There were no statistically significant effects of the interventions on DCS , or satisfaction with information .  Two hundred and fifty-six participants provided responses for qualitative analysis : most found graphical representations helpful , specifically bar chart formats ; many found other graphic formats ( thermometer style , crowd figures/smiley faces ) and ' anchoring ' information unhelpful , and indicated information overload . Many negative experiences with healthcare indicate a challenging context for effective information provision and decision support . CONCLUSION Online evaluation of different risk representation formats was feasible . There was a lack of intervention effects on quantitative outcomes , perhaps reflecting already well-informed participants from the Diabetes UK patient organisation . The large qualitative data set included many comments about what participants found helpful as formats for communicating risk information . PRACTICE IMPLICATION S These findings assist the design of online decision aids and the representation of risk information . The challenge is to provide more information , in appropriate and clear formats , but without risking information overload . Interactive web design s hold much promise to achieve this Abstract Background : Overseeing proper insulin initiation and titration remains a challenging task in diabetes care . Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers ( HCPs ) . We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with st and ard clinical practice . Material s and Methods : This was a 12 ± 2-week r and omized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control . The control group ( n = 20 ) received st and ard face-to-face care and phone follow-up as needed in a tertiary center , whereas the intervention group ( n = 20 ) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools , shared decision-making interfaces , secure text messages , and virtual visits ( audio , video , and shared screen control ) instead of office visits . Results : By intention-to-treat analysis , the intervention group achieved a greater hemoglobin A1c decline compared with the control group ( 3.2 ± 1.5 % vs. 2.0 % ± 2.0 % ; P = 0.048 ) . The Diabetes Treatment Satisfaction Question naire showed a significant improvement in the intervention group compared with the control group ( an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points ; P = 0.01 ) . HCPs spent less time with patients in the intervention group compared with those in the control group ( 65.9 min per subject vs. 81.6 min per subject ) . However , the intervention group required additional training time to use the mobile device . Conclusions : Mobile health technology could be an effective tool in sharing data , enhancing communication , and improving glycemic control while enabling collaborative decision making in diabetes care Background Mobile phone technologies including SMS ( short message service ) have been used to improve the delivery of health services in many countries . However , data on the effects of mobile health technology on patient outcomes in re source -limited setting s are limited . The aim of this study therefore is to measure the impact of a mobile phone SMS service  on treatment success of newly diagnosed type 2 diabetes in an urban area of Bangladesh . Methods / design This is a single-centred r and omized controlled intervention trial ( prospect i ve ) comparing st and ard-of-care with st and ard-of-care plus a mobile phone-based SMS intervention for 6 months . A total of 216 participants with newly diagnosed type 2 diabetes will be recruited . Data will be collected at the outpatient department of Bangladesh Institute of Health Science ( BIHS ) hospital at baseline and after 6 months . The primary outcome measure will be change in HbA1c between baseline and 6 months . The secondary outcome measures are self-reported medication adherence , clinic attendance , self-reported adoption of healthy behaviours , diabetes knowledge , quality of life and cost effectiveness of the SMS intervention .  The inclusion criteria will be as follows : diagnosed as patients with type 2 diabetes by the BIHS physician , using oral medication therapy , living in Dhaka city , registered with the BIHS hospital , using a mobile phone , willing to return for follow up after 6 months and providing written informed consent . Participants will be allocated to control and intervention arms after recruitment using a r and omization software . Data will be collected on socio-demographic and economic information , mobile phone use and habits , knowledge of prevention , management and complications of diabetes , self-perceived quality of life assessment , self-reported diseases , medical history , family history of diseases , medication history , medication adherence , health seeking behaviour , tobacco use , physical activity , diet , mental health status , life events and disability , anthropometric measurements of weight , height , blood pressure and blood tests for HbA1c . Discussion Mobile phone SMS services have the potential to communicate with diabetes patients and to build awareness about the disease , improve self-management and avoid complications also in re source -limited setting . If this intervention proves to be efficient and cost-effective in the current trial , large-scale implementation could be undertaken . Trial registration DRKS00005188 Background Studies have shown that lifestyle  behavior changes are most effective to prevent onset of diabetes in high-risk patients . Primary care providers are charged with encouraging behavior change among their patients at risk for diabetes , yet the practice environment and training in primary care often do not support effective provider counseling . The goal of this study is to develop an electronic health record-embedded tool to facilitate shared patient-provider goal setting to promote behavioral change and prevent diabetes . Methods The ADAPT ( Avoiding Diabetes Thru Action Plan Targeting ) trial leverages an innovative system that integrates evidence -based interventions for behavioral change with already-existing technology to enhance primary care providers ' effectiveness to counsel about lifestyle behavior changes . Using principles of behavior change theory , the multidisciplinary design team utilized in-depth interviews and in vivo usability testing to produce a prototype diabetes prevention counseling system embedded in the electronic health record . Results The core element of the tool is a streamlined , shared goal - setting module within the electronic health record system . The team then conducted a series of innovative , " near-live " usability testing simulations to refine the tool and enhance workflow integration . The system also incorporates a pre-encounter survey to elicit patients ' behavior-change goals to help tailor patient-provider goal setting during the clinical encounter and to encourage shared decision making . Lastly , the patients interact with a website that collects their longitudinal behavior data and allows them to visualize their progress over time and compare their progress with other study members . The finalized ADAPT system is now being piloted in a small r and omized control trial of providers using the system with prediabetes patients over a six-month period . Conclusions The ADAPT system combines the influential powers of shared goal setting and feedback , tailoring , modeling , contracting , reminders , and social comparisons to integrate evidence -based behavior-change principles into the electronic health record to maximize provider counseling efficacy during routine primary care clinical encounters . If successful , the ADAPT system may represent an adaptable and scalable technology-enabled behavior-change tool for all primary care providers . Trial Registration Clinical Trials.gov Identifier UNLABELLED This review should be cited as : Renders CM , Valk GD , Griffin S. Wagner EH , Eijk JThM van , Assendelft WJJ . Interventions to improve the management of  diabetes mellitus  in primary care , outpatient and community setting s ( Cochrane Review ) . In : The Cochrane Library , Issue 2 , 2001 . Oxford : Up date Software . A substantive amendment to this systematic review was last made on 29 June 2000 . Cochrane review s are regularly checked and up date d if necessary . BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care . Different systems have been proposed to manage diabetes care . OBJECTIVES To assess the effects of different interventions , targeted at health professionals or the structure in which they deliver care , on the management of patients with diabetes in primary care , outpatient and community setting s. SEARCH STRATEGY We search ed the Cochrane Effective Practice and Organisation of Care Group specialised register , the Cochrane Controlled Trials Register ( Issue 4 1999 ) , MEDLINE ( 1966 - 1999 ) , EMBASE ( 1980 - 1999 ) , Cinahl ( 1982 - 1999 ) , and reference lists of articles . SELECTION CRITERIA R and omised trials ( RCTs ) , controlled clinical trials ( CCTs ) , controlled before and after studies ( CBAs ) and interrupted time series ( ITS ) analyses of professional , financial and organisational strategies aim ed at improving care for people with Type 1 or Type 2 diabetes . The participants were health care professionals , including physicians , nurses and pharmacists . The outcomes included objective ly measured health professional performance or patient outcomes , and self-report measures with known validity and reliability . DATA COLLECTION AND ANALYSIS Two review ers independently extracted data and assessed study quality . MAIN RESULTS Forty-one studies were included involving more than 200 practice s and 48,000 patients . Twenty-seven studies were RCTs , 12 were CBAs , and two were ITS . The studies were heterogeneous in terms of interventions , participants , setting s and outcomes . The method ological quality of the studies was often poor . In all studies the intervention strategy was multifaceted . In 12 studies the interventions were targeted at health professionals , in nine they were targeted at the organization of care , and 20 studies targeted both . In 15 studies patient education was added to the professional and organisational interventions . A combination of professional interventions improved process outcomes . The effect on patient outcomes remained less clear as these were rarely assessed . Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes . Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes . REVIEW ERS ' CONCLUSION : Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .  Organisational interventions that improve regular prompted recall and review of patients  ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management . The addition of patient-oriented interventions can lead to improved patient health outcomes . Nurses can play an important role in patient-oriented interventions , through patient education or facilitating adherence to treatment Introduction We investigated the experience of individuals diagnosed with type 2 diabetes mellitus ( T2DM ) who participated in an intervention in which the key elements were the provision of a smartphone and self-monitoring software .  The interviews focused on use of a smartphone and the effects on motivation for health behavior change . Methods This was a qualitative evaluation of participants in a larger T2DM self-management r and omized controlled trial ( RCT ) conducted at the Black Creek Community Health Centre ( BCCHC ) in Toronto , Canada ( Clinical Trials.gov Identifier : NCT02036892 ) . The study is based on semi-structured interviews ( n = 11 ) that were audio taped and analyzed with a thematic analytic approach . The RCT compared the effectiveness of six months of smartphone-based self-monitoring and health coaching with a control group who received health coaching without internet or smartphone-based assistance . Results Qualitative data analyses result ed in derivation of four major themes that describe participant experience : ( a ) ‘ smartphone and software ’ , describes smartphone use in relation to health behavior change ; ( b ) ‘ health coach ’ describes how client/health coach relationships were assisted by smartphone use ; ( c ) ‘ overall experience ’ describes perceptions of the overall intervention ; and ( d ) ‘ frustrations in managing chronic conditions ’ describes difficulties with the complexities of T2DM management from a patient perspective . Discussion Findings suggest that interventions with T2DM assisted by smartphone software and health coaches actively engage individuals in improved hemoglobin A1c ( HbA1c ) control AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced 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
The narrative synthesis provided mixed effects of CHITs on other clinical , psychosocial , behavioral , and knowledge outcomes .
Conclusions The use of CHITs appears to be more effective than usual care in improving glycemic control for patients with diabetes .
However , their effectiveness did not remain consistent over time and in other patient outcomes .
Objective To reveal the effects of consumer-oriented health information technologies ( CHITs ) on patient outcomes in diabetes management over time through systematic review and meta- analysis .