Exploring the use of computer based patient education resources to enable diabetic patients from underserved populations to self-manage their disease

Abstract

This pilot randomized prospective controlled pilot study looked at computer based health information resources and their impact on control of diabetes. The study site was a large urban community health center with many Spanish-speaking patients. Both the intervention (n = 58) and control (n = 50) groups of the study received standard of care diabetes treatment. The intervention group received additional computer based diabetes education in either English or Spanish from the Medline-Plus.gov website. Clinical measures and survey results were followed in both groups. In patients with diabetes, the Hemoglobin A 1c is a lab test that measures the level of blood sugar control over the past three months; a higher level is associated with increased diabetes-related complications. LDL cholesterol is the type of cholesterol that is most relevant as a clinical indicator in diabetes. The intervention group had a small decline in Hemoglobin A 1c (−0.3%), and LDL cholesterol (−9.9 mg/dl), two important clinical indicators, while the control group had a small increase in both Hemoglobin A 1c (+0.1%) and LDL cholesterol (+0.5 mg/dl). The discussion also explores the benefits and challenges of introducing computer-based patient education resources into a low-literacy population.

A 3-Month Randomized Controlled Pilot Trial of a Patient-Centered, Computer-Based Self-Monitoring System for the Care of Type 2 Diabetes Mellitus and Hypertension

“…Finally, the system might have given patients a sense of reassurance or responsibility to remain healthy, thereby resulting in increased motivation to adhere to treatments and a healthy lifestyle. Our study and a number of others [24][25][26] found no significant benefits of CHITs over a control group for control of glycemia in patients with diabetes. However, previous reviews have reported that the use of CHITs was generally associated with a decline in the HbA1c level [5,8,9].…”

“…However, previous reviews have reported that the use of CHITs was generally associated with a decline in the HbA1c level [5,8,9]. One possible explanation for the inconsistency may be that those empirical studies [24][25][26] (and this study) had a short study period to allow for possible changes in the HbA1c level. A recent metaanalysis showed that CHITs implemented over a longer period showed a more pronounced decrease in the HbA1c level than those with a short period (−0.33; 95 % CI, −0.50 to −0.17 for 12 months or more; −0.38; 95 % CI, −0.58 to −0.19 for 4 to 11 months; −0.23; 95 % CI, −0.38 to −0.08 for 3 months or less) [9].…”

The Effect of Health Education on Clinical and Self-Reported Outcomes of Diabetes in a Medical Practice

“…self-reported perceptions of poor health and functional capacity as measured by reliable, validated survey instruments) or objective such as glycated hemoglobin (A1C) (UKPDS Trial, 2002) and low-density lipoprotein cholesterol (Zyskind, Jones, Pomerantz, & Barker, 2009).…”