Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80237-8066, USA.
J Gen Intern Med. 2010 Dec;25(12):1315-22. doi: 10.1007/s11606-010-1480-0. Epub 2010 Aug 17.
Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition.
A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care. A heterogeneous sample of 463 type 2 patients was randomized and 82.5% completed a 4-month follow-up. Primary outcomes were behavior changes in healthy eating, physical activity, and medication taking. Secondary outcomes included hemoglobin A1c, body mass index, lipids, and blood pressure.
The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes (effect sizes [d] for healthy eating = 0.32; fat intake = 0.28; physical activity= 0.19) in both intent-to-treat and complete-cases analyses. These changes did not translate into differential improvements in biological outcomes during the 4-month study period. Added contact did not further enhance outcomes beyond the minimal contact intervention.
The Internet intervention meets several of the RE-AIM criteria for potential public health impact, including reaching a large number of persons, and being practical, feasible, and engaging for participants, but with mixed effectiveness in improving outcomes, and consistent results across different subgroups. Additional research is needed to evaluate longer-term outcomes, enhance effectiveness and cost-effectiveness, and understand the linkages between intervention processes and outcomes.
互联网和其他基于交互技术的程序为实用、有效且具有成本效益的糖尿病自我管理（DSM）计划提供了巨大的潜力，这些计划能够覆盖大量患者。本研究评估了基于互联网的糖尿病自我管理计划的最小支持和中等支持版本，与增强的常规护理条件相比。
进行了一项三臂实用随机试验，以评估英语和西班牙语提供的基于互联网的糖尿病自我管理计划的最小接触和中等接触版本，与增强的常规护理相比。对 463 名 2 型患者进行了异质随机分组，82.5%完成了 4 个月的随访。主要结局是健康饮食、身体活动和服药行为的变化。次要结局包括血红蛋白 A1c、体重指数、血脂和血压。
与增强的常规护理条件相比，基于互联网的干预在四个行为结局中的三个（健康饮食的效应大小[d]为 0.32；脂肪摄入量= 0.28；身体活动= 0.19）在意向治疗和完全案例分析中均产生了显著更大的改善。在 4 个月的研究期间，这些变化并没有转化为生物结局的差异改善。与最小接触干预相比，增加接触并不能进一步提高结果。
互联网干预符合潜在公共卫生影响的 RE-AIM 标准的几个标准，包括覆盖大量人群，并且对参与者来说是实用、可行和吸引人的，但改善结果的效果混合，并且在不同亚组中结果一致。需要进一步研究来评估长期结果、提高效果和成本效益，并了解干预过程与结果之间的联系。
