||An online self-management intervention for adults with type 2 diabetes|
Friday, 26th October 2012
||1pm - 2pm (12.45 onwards for sandwiches)|
||Seminar Room 1, PCPH, Upper 3rd Floor, Royal Free Campus|
Diabetes affects over 200 million people worldwide, causing substantial morbidity and premature mortality. Structured education reduces the incidence of complications and, in the UK, the National Institute for Health and Clinical Excellence advises that all people with type 2 diabetes should have structured education at diagnosis with annual reinforcement. In 2006 only 11% of people with type 2 diabetes in the UK reported being offered such education.
Internet based self-management programmes have been shown to be effective for a number of long-term conditions, but it is unclear what are the essential or effective components of such programmes. If computer-based self-management interventions improve outcomes in type 2 diabetes, they could potentially provide a cost-effective option for reducing the burdens placed on patients and healthcare systems by this long-term condition.
The eHealth unit has been awarded an NIHR applied programme grant to fund the development of an online self-management intervention for adults with type 2 diabetes. This presentation will talk about 2 elements of work related to this project:
1. The results of a Cochrane systematic review on computer-based self-management interventions for adults with type 2 diabetes
2. The theoretical basis for developing the online self-management intervention
1. A Cochrane systematic review of computer-based self-management interventions for adults with type 2 diabetes.
To assess the effects on health status and health-related quality of life of computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus.
We searched six electronic bibliographic databases for published articles and conference proceedings and three online databases for theses (all up to November 2011). Reference lists of relevant reports and reviews were also screened.
Randomised controlled trials of computer-based self-management interventions for adults with type 2 diabetes, i.e. computer-based software applications that respond to user input and aim to generate tailored content to improve one or more self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders.
Data collection and analysis
Two authors independently screened the abstracts and extracted data. A taxonomy for behaviour change techniques was used to describe the active ingredients of the intervention
We identified 16 randomised controlled trials with 3578 participants that fitted our inclusion criteria. These studies included a wide spectrum of interventions covering clinic-based brief interventions, Internet-based interventions that could be used from home and mobile phone based interventions. The mean age of participants was between 46 to 67 years old and mean time since diagnosis was 6 to 13 years. The duration of the interventions varied between 1 to 12 months. There were three reported deaths out of 3578 participants and one participant withdrew because of anxiety. There were no other documented adverse effects. Two studies provided limited cost-effectiveness data - with one study suggesting costs per patient of less than $140 (in 1997) and another study showed no change in health behaviour and resource utilisation.
Computer-based diabetes self-management interventions currently have limited effectiveness. They appear to have small benefits on glycaemic control (pooled effect on glycosylated haemoglobin A1c (HbA1c): -2.3 mmol/mol or -0.2% (95% confidence interval (CI) -0.4 to -0.1, P = 0.009, 2637 participants, 11 trials). Mobile phones might be the most effective route for delivering these interventions (subgroup analysis: mean difference in HbA1c -5.46 mmol/mol or -0.5% (95% CI -0.7 to -0.3), P < 0.00001, 280 participants, three trials). Current interventions do not show adequate evidence for improving depression, health-related quality of life or weight. Four (out of 10) interventions showed beneficial effects on lipid profile. There was no evidence of significant adverse effects.
Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and this appears to be more effective if delivered over mobile phones. There is no evidence to show benefits in other biological outcomes or any cognitive, behavioural or emotional outcomes.
2. The theoretical basis for developing a computer-based self-management programme for adults with type 2 diabetes
Our research applied a rigorous theoretical framework to developing and evaluating this complex intervention. We used focus groups to explore user perspectives of essential and desirable features of computer-based self-management programme (SMP) and use 'participatory design' to develop an SMP which is linked with the electronic patient record but can also be accessed independently. The SMP will address recognized patient needs including information, emotional support and behaviour-change support and will facilitate communication between patients and health professionals.
Early deliverables include results from our focus groups and an understanding of essential and desirable characteristics of a computer-based SMP to inform the development of similar programmes in the future. The theoretical basis for the intervention design was based on a taxonomy of behaviour change techniques and a theory of implementation called the Normalization Process Theory.
Improving self-management of diabetes through patient empowerment and education with better use of communication technology is potentially a key tool in tackling the growing challenge of managing diabetes over the next few decades. Our programme offers a theoretically innovative approach to developing such interventions with a focus on user involvement.
Page last modified on 08 oct 12 14:40 by Maryanne Ogbogbo