Psychological family intervention for poorly controlled type 2 diabetes. Web-based cognitive behavioural therapy (W-CBT) for diabetes patients with co-morbid depression: Design of a randomised controlled trial Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol The Effects of a Web-Based Intervention on Psychosocial Well-Being Among Adults Aged 60 and Older With Diabetes The development and feasibility of a web-based intervention with diaries and situational feedback via smartphone to support self-management in patients with diabetes type 2. Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes Changing illness perceptions in patients with poorly controlled type 2 diabetes, a randomised controlled trial of a family-based intervention: protocol and pilot study A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH Efficacy of a Web-Based Intervention With Mobile Phone Support in Treating Depressive Symptoms in Adults With Type 1 and Type 2 Diabetes: A Randomized Controlled Trial Implementation and evaluation of a low-literacy diabetes education computer multimedia application. Diabetes Learning in Virtual Environments: Testing the Efficacy of Self-Management Training and Support in Virtual Environments (Randomized Controlled Trial Protocol). Utility of a Web-based Intervention for Individuals With Type 2 Diabetes: The Impact on Physical Activity Levels and Glycemic Control Development and reach of a web-based cognitive behavioural therapy programme to reduce symptoms of depression and diabetes-specific distress. Enhancing health literacy and behavioural change within a tele‐care education and support intervention for people with type 2 diabetes Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes.
OBJECTIVE To evaluate the effectiveness of a psychological , family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes . METHODS This study was a r and omized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes . Recruitment and follow-up occurred at specialist diabetes clinics . Patients were r and omly allocated to an  intervention group ( n=60 ) or a control group ( n=61 ) . Poor control was defined as at least 2 of the patient 's last 3 glycated hemoglobin (  A1C  )  readings at > 8.0 % . The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient 's home , with a third session involving a 15-minute follow-up telephone call . RESULTS At 6-month follow-up , the intervention group reported significantly lower mean A1C levels than the control group ( 8.4 % [ SD=0.99 % ] vs 8.8 % [ SD=1.36 % ] ; P=.04 ) . The intervention was most effective in those with the poorest control at baseline ( A1C>9.5 % ) ( intervention 8.7 % [ SD=1.16 % , n=15 ] vs control 9.9 % [ SD=1.31 % , n=15 ] ; P=.01 ) . The intervention group also reported statistically significant improvements in beliefs about diabetes , psychological well-being , diet , exercise , and family support . CONCLUSIONS After participating in a family-based intervention targeting negative and /or inaccurate illness perceptions , patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes . Our results suggest that adding a psychological , family-based component to usual diabetes care may help improve diabetes management Background Depression is common among people with diabetes , negatively affecting quality of life , treatment adherence and diabetes outcomes . In routine clinical care , diabetes patients have limited access to mental health services and depression therefore often remains untreated . Web-based therapy could potentially be an effective way to improve the reach of psychological care for diabetes patients , at relatively low costs . This study seeks to test the effectiveness of a web-based self-help depression programme for people with diabetes and co-morbid depression . Methods / Design The effectiveness of a web-based self-help course for adults with diabetes with co-morbid depression will be tested in a r and omised trial , using a wait-list controlled design . The intervention consists of an 8-week , moderated self-help course that is tailored to the needs of persons living with diabetes and is offered on an individual basis . Participants receive feedback on their homework assignments by e-mail from their coach .  We aim to include 286 patients ( 143/143 ) , as power analyses showed that this number is needed to detect an effect size of 0.35 , with measurements at baseline , directly after completing the web-based intervention and at 1 , 3 , 4 and 6 months follow-up . Patients in the control condition are placed on a waiting list , and follow the course 12 weeks after r and omisation . Primary outcomes are depressive symptoms and diabetes-specific emotional distress . Secondary outcomes are satisfaction with the course , perceived health status , self-care behaviours , glycaemic control , and days in bed/absence from work . Question naires are administered via the Internet . Discussion The intervention being trialled is expected to help improve mood and reduce diabetes-specific emotional distress in  diabetes patients with depression , with subsequent beneficial effects on diabetes self-care and glycaemic outcomes . When proven efficacious , the intervention could be disseminated to reach large groups of patients with diabetes and concurrent depressive symptoms . Trial registration Current Controlled Trials IS RCT 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 Purpose The purpose of this study is to investigate the impact of a 6-month Web-based intervention on the psychosocial well-being of older adults with diabetes . Methods This study was a r and omized controlled trial ( N = 62 ) comparing the effects of a 6-month Web-based intervention plus usual care with usual care alone among adults aged 60 years or older with diabetes . The outcomes included quality of life , depression , social support , and self-efficacy . Results The intervention group showed significant improvement , F(4.48 ) = 4.03 P = .007 , when compared with the control group on measures of depression , quality of life , social support , and self-efficacy when controlling for all baseline outcome variables ( age , gender , and number of years with diabetes ) . Conclusions These findings provide support for the conclusion that a Web-based intervention is effective in improving the psychosocial well-being of participants at a 6-month follow-up . Future research needs to investigate the long-term effectiveness of Web-based interventions for sustaining psychosocial well-being , including factors that may affect quality of life , such as diabetes-specific beliefs , attitudes , social support , and disease-specific coping skills AIMS The aim of the study was to develop and test the feasibility of a three months web-based intervention , delivered by a smartphone to support self-management in patients with type 2 diabetes . METHODS The intervention included use of a smartphone enabling access to daily web-based diaries and individualized written situational feedback . The participants registered their eating behavior , medication taking , physical activities and emotions three times daily using the mobile device . They also registered their fasting blood glucose level in the morning diary . A therapist had immediate access to su bmi tted diaries and used the situational information to formulate a personalized feedback based on Acceptance Commitment Therapy . The purpose of the diaries and the situational feedback was to stimulate self-management . RESULTS Eleven of the fifteen participants included in the study completed the intervention , which was evaluated as supportive and meaningful . Most of the participants reported positive life style changes . The response rate to the daily registration entries was good and few technical problems were encountered . CONCLUSIONS The described intervention is feasible and should be tested out in a large-scale study . The developed smartphone application seems a promising tool for supporting patients with type 2 diabetes to make important life style changes 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 Brief , cost-effective interventions to promote diabetes self-management are needed . This study evaluated the effects of a brief , regular , proactive , telephone “ coaching ” intervention delivered by paraprofessionals on diabetes adherence , glycemic control , diabetes-related medical symptoms , and depressive symptoms . Therapeutic mechanisms underlying the intervention ’s effect on the primary outcomes were also examined . Adults diagnosed with type 2 diabetes ( N = 62 ) were r and omly assigned to receive the “ coaching ” intervention and treatment as usual , or only treatment as usual . The intervention increased frequency of exercise and feet inspection , improved diet , reduced diabetes medical symptoms , and lowered depressive symptoms . Self-efficacy , reinforcement , and awareness of self-care goals mediated the treatment effect on depression , exercise , and feet inspection , respectively . A brief telephone intervention delivered by paraprofessionals had positive effects on type 2 diabetes patients Background This paper presents the pilot study and protocol for a r and omised controlled trial to test the effectiveness of a psychological , family-based intervention to improve outcomes in those with poorly controlled type 2 diabetes . The intervention has been design ed to change the illness perceptions of patients with poorly controlled type 2 diabetes , and their family members . It is a complex psychological intervention , developed from the Self-Regulatory Model of Illness Behaviour . The important influence the family context can have in psychological interventions and diabetes management is also recognised , by the inclusion of patients ' family members . Methods / design We aim to recruit 122 patients with persistently poorly controlled diabetes . Patients are deemed to have persistent poor control when at least two out of their last three HbA1c readings are 8.0 % or over . Patients nominate a family member to participate with them , and this patient/family member dyad is r and omly allocated to either the intervention or control group . Participants in the control group receive their usual care . Participants in the intervention group participate , with their family members , in three intervention sessions . Sessions one and two are delivered in the participant 's home by a health psychologist . Session one takes place approximately one week after session two , with the third session , a follow-up telephone call , one week later . The intervention is based upon clarifying the illness perceptions of both the patient and the family member , examining how they influence self-management behaviours , improving the degree of similarity of patient and family member perceptions in a positive direction and developing personalized action plans to improve diabetes management . Discussion This study is the first of its kind to incorporate the evidence from illness perceptions research into developing and applying an intervention for people with poorly controlled diabetes and their families . This study also acknowledges the important role of family members in effective diabetes care . Trial registration IS RCT Background Self-management support for people with type 2 diabetes is essential in diabetes care . Thus , mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management . Objectives The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application ( FTA ) diabetes diary with or without health counseling improved glycated hemoglobin ( HbA1c ) levels , self-management , behavioral change , and health-related quality of life , and to describe the sociodemographic , clinical , and lifestyle characteristics of the participants after 4 months . Methods A 3-armed r and omized controlled trial was conducted in Norway during 2011 - 2013 . In the 2 intervention groups , participants were given a mobile phone for 1 year , which provided access to the FTA diary , a self-help tool that recorded 5 elements : blood glucose , food habits , physical activity , personal goal setting , and a look-up system for diabetes information . One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline . Both intervention groups and the  control group were provided usual care according to the national guidelines . Adults with type 2 diabetes and HbA1c ≥7.1 % were included ( N=151 ) . There were 3 assessment points : baseline , 4 months , and 1 year . We report the short-term findings after 4 months . HbA1c was the primary outcome and the secondary outcomes were self-management ( Health Education Impact Question naire , heiQ ) , behavioral change ( diet and physical activity ) , and health-related quality of life ( SF-36 question naire ) . The data were analyzed using univariate methods ( ANOVA ) , multivariate linear , and logistic regression . Results Data were analyzed from 124 individuals ( attrition rate was 18 % ) . The groups were well balanced at baseline . There were no differences in HbA1c between groups after 4 months , but there was a decline in all groups . There were changes in self-management measured using the health service navigation item in the heiQ , with improvements in the FTA group compared to the control group ( P=.01 ) and in the FTA with health counseling group compared with both other groups ( P=.04 ) . This may indicate an improvement in the ability of patients to communicate health needs to their health care providers . Furthermore , the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group ( P=.02 ) . There were no significant changes in any of the domains of the SF-36 . Conclusions The primary outcome , HbA1c , did not differ between groups after 4 months . Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition OBJECTIVE Depression is common in diabetes and linked to adverse health outcomes . This study evaluated the efficacy of a guided web-based intervention in reducing  depression in adults with type 1 and type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 260 participants with diabetes and elevated depressive symptoms ( Center for Epidemiologic Studies Depression Scale [ CES-D ≥23 ] ) were r and omly assigned to the GET.ON  Mood Enhancer Diabetes ( a guided self-help intervention , n = 130 ) or a brief online unguided psychoeducation program for depression ( n = 130 ) . The primary outcome was depressive symptoms severity ( CES-D ) . The secondary outcomes included diabetes-specific emotional distress ( Problem Areas in Diabetes [ PAID ] scale ) and participant satisfaction ( adaption CSQ-8 ) . Data were collected at baseline and 2 months after r and omization . To identify differences in outcome between the groups , we used analyses of covariance with the baseline CES-D score as covariate on both intent-to-treat ( ITT ) and per- protocol ( PP ) basis . RESULTS Compared with the control group , the intervention group showed significantly less depressive symptom severity at posttreatment based on ITT ( d = 0.89 ) and PP analyses ( d = 1.00 ) . The intervention participants displayed a significantly larger reduction in diabetes-specific emotional distress ( d = 0.58 , ITT ) . The intervention appeared to be acceptable to the participants ; 95 % ( n = 121 ) would recommend the training to a friend with diabetes in need of psychological help . CONCLUSIONS A guided , web-based intervention to reduce depression in adults with type 1 and type 2 diabetes  is effective in reducing both depressive symptoms and diabetes-specific emotional distress 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 Ongoing self-management improves outcomes for those with Type 2 diabetes ( T2D ) ; however , there are many barriers to patients receiving assistance in this from the healthcare system and peers . Findings from our pilot study showed that a virtual diabetes community on the Internet with real-time interaction among peers with T2D- and with healthcare professionals-is feasible and has the potential to influence clinical and psychosocial outcomes . OBJECTIVE The purpose of this article is to present the protocol for the Diabetes Learning in Virtual Environments ( LIVE ) trial . PROTOCOL Diabetes LIVE is a two-group , r and omized controlled trial to compare effects of a virtual environment and traditional Web site on diet and physical activity . Our secondary aims will determine the effects on metabolic outcomes ; effects of level of engagement and social network formation in LIVE on behavioral outcomes ; potential mediating effects of changes in self-efficacy ; and diabetes knowledge , diabetes-related distress , and social support on behavior change and metabolic outcomes . We will enroll 300 subjects at two sites ( Duke University/Raleigh-Durham , NC and New York University/New York , NY ) who have T2D and do not have serious complications or comorbidities . Those r and omly assigned to the intervention group have access to the LIVE site where they can find information , synchronous classes with diabetes educators , and peer support to enhance self-management . Those in the control group have access to the same informational and educational content in a traditional asynchronous Web format . Measures of self-management , clinical outcomes , and psychosocial outcomes are assessed at baseline and 3 , 6 , 12 , and 18 months . DISCUSSION Should LIVE prove effective in improved self-management of diabetes , similar interventions could be applied to other prevalent chronic diseases . Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of self-management training and support Despite the numerous benefits of physical activity for patients with diabetes , most healthcare providers in busy clinical setting s rarely find time to counsel their patients about it . A Web-based program for healthcare providers can be used as an effective counseling tool , when strategies are outlined for specific stages of readiness for physical activity . Seventy-three adults with type 2 diabetes were r and omly assigned to Web-based intervention , printed- material intervention , or usual care . After 12 weeks , the effects of the interventions on physical activity , fasting blood sugar , and glycosylated hemoglobin were evaluated . Both Web-based and printed material intervention , compared with usual care , were effective in increasing physical activity ( P < .001 ) and decreasing fasting blood sugar ( P<.01 ) and glycosylated hemoglobin ( P < .01 ) . Post hoc analysis for change scores indicated significant differences between Web-based intervention and usual care and between printed material intervention and usual care , but not between web-based and printed material intervention . The findings of this study support the value of Web-based and printed material interventions in healthcare counseling . With increasing Web access , the effectiveness of Web-based programs offered directly to patients needs to be tested OBJECTIVES There is an urgent need for more effective and efficient depression treatments in diabetes . We developed a diabetes-specific version of the Dutch web-based ' Coping with Depression ' ( CWD ) course . Here , we report on the development , reach , patients ' reasons for choosing our intervention and their characteristics . METHODS The CWD programme was amended for use in diabetes patients with co-morbid depression . Data were collected using a telephone interview , self-report question naires , and medical records . RESULTS Adding diabetes-specific topics to an effective web-based depression programme result ed in an 8-lesson intervention ( " www.diabetergestemd.nl " ) , with minimal guidance by coaches . In the framework of a r and omised trial , the intervention attracted serious interest of 540 patients . After screening , 255 depressed diabetes patients were enrolled . Less than half had a history of depression treatment ; 80 % reported the diabetes-specific approach to be an important reason for signing up . CONCLUSION We successfully developed a diabetes-specific version of the web-based CWD course , which attracted a large group of patients . Our results affirm the importance of addressing diabetes-specific issues in the context of depression treatment . PRACTICE IMPLICATION S Our intervention could be implemented on a large scale at low costs , and may serve as a model on how to develop other illness-specific online self-help interventions Abstract Background Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making . Health literacy provides an additional , potentially powerful explanatory framework to guide research and practice . Objective To examine the changes in the depth and detail of diabetes‐related knowledge and confidence for persons with type 2 diabetes . Design Two‐year , prospect i ve , observational study , using question naire data at two time points ( baseline and 2 years later ) and in‐depth interviews with a theoretically selected sub sample . Setting and participants A total of 319 patients initially recruited from a deprived urban area in north‐west Engl and Intervention Dedicated tele‐carer education and support , tailored to the individual circumstances of the patient . Main outcome measures Perceptions of confidence , levels of empowerment , learning for self‐care and most helpful aspects of the intervention . Results Over 90 % expressed confidence in keeping their blood sugar controlled , and high levels of perceived empowerment ( mean = 4.25 ; 95 % CI , 4.17–4.33 ) were found . Changes in the depth and detail of diabetes‐related knowledge and confidence , from the specific to the more general , were observed and enhanced competence in translating knowledge into practice . Discussion and conclusions The intervention , built within a developed working partnership between tele‐carer and patient , operated at two levels : health literacy , enhancing knowledge , developing personal skills and enabling self‐control ; and socio‐psychological behavioural change , tailored to individuals within their socio‐economic environments , enabling increased motivation and supportive problem‐solving . Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data Background Many type 2 diabetes mellitus patients face difficulties self-managing their illness , which can lead to high levels of diabetes-related distress . Diabetes distress may be decreased by peer support , as peers underst and and have dealt with similar problems , and can help motivate each other . A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions . This study describes the design of a trial evaluating the effectiveness of a group-based , peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients . Methods This is a parallel group r and omised controlled trial of a six session group-based peer support intervention , delivered by peer leaders and group psychotherapists , compared with one educational meeting on diabetes .  At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age , recruited via their general practitioner , will be r and omised to receive the peer support intervention or one educational meeting . The intervention is developed in line with three key stages of research development of the Medical Research Council framework . The primary outcome measure for this study is diabetes-related distress . Secondary outcomes include self-management behaviour , well-being and health-related quality of life . Perceived social support is a process measure . Outcomes will be measured one month before , and 6 , and 12 months after the intervention by means of self-reported question naires . Analysis will be on an intention-to-treat basis . Discussion This article contains a description of the design of a study that will investigate the effect of a group-based , peer support intervention on diabetes-related distress in type 2 diabetes patients . The intervention was developed in recognition of the limited evidence , and the importance of a theoretical foundation and its implementation . Findings will contribute to knowledge in the field of peer support and patient-important outcomes in type 2 diabetes patients .Trial registration Dutch Trial Registry : OBJECTIVE The objective of this observational open label trial was to characterize changes in diabetes self-management and psychological distress associated with a mobile health ( mHealth ) interactive voice response ( IVR ) self-management support program . METHODS For 3 - 6 months , 301 patients with diabetes received weekly IVR calls assessing health status and self-care  and providing tailored pre-recorded self-management support messages . Patients could participate together with an informal caregiver who received suggestions on self-management support , and patients ' clinicians were notified automatically when patients reported significant problems . RESULTS Patients completed 84 % of weekly calls , providing 5682 patient-weeks of data . Thirty-nine percent participated with an informal caregiver . Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre-post improvement in medication adherence , physical functioning , depressive symptoms , and diabetes-related distress ( all p values < 0.001 ) . Analyses of self-management problems indicated that as the intervention proceeded , there were significant improvements in patients ' IVR-reported frequency of weekly medication adherence , SMBG performance , checking feet , and frequency of abnormal self-monitored blood glucose readings ( all p values < 0.001 ) . CONCLUSIONS We conclude that the combined program of automated telemonitoring , clinician notification , and informal caregiver involvement was associated with consistent improvements in medication adherence , diabetes self-management behaviors , physical functioning , and psychological distress . A r and omized controlled trial is needed to verify these encouraging findings
Interventions with a duration of 2 - 6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes .
While the meta-analyses demonstrated nonsignificant results for depression and distress scores , this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes .
BACKGROUND Poor diabetes self-care can have a negative impact on psychological well-being and quality of life .
Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs , Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions .
However , there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes .
OBJECTIVE This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes .