Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care

Abstract

ObjectiveTo determine the effectiveness of a web-based self-management programme for people with type 2 diabetes in improving glycaemic control and reducing diabetes-related distress.Methods and designIndividually randomised two-arm controlled trial.Setting21 general practices in England.ParticipantsAdults aged 18 or over with a diagnosis of type 2 diabetes registered with participating general practices.Intervention and comparatorUsual care plus either Healthy Living for People with Diabetes (HeLP-Diabetes), an interactive, theoretically informed, web-based self-management programme or a simple, text-based website containing basic information only.Outcomes and data collectionJoint primary outcomes were glycated haemoglobin (HbA1c) and diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) scale, collected at 3 and 12 months after randomisation, with 12 months the primary outcome point. Research nurses, blind to allocation collected clinical data; participants completed self-report questionnaires online.AnalysisThe analysis compared groups as randomised (intention to treat) using a linear mixed effects model, adjusted for baseline data with multiple imputation of missing values.ResultsOf the 374 participants randomised between September 2013 and December 2014, 185 were allocated to the intervention and 189 to the control. Final (12 month) follow-up data for HbA1c were available for 318 (85%) and for PAID 337 (90%) of participants. Of these, 291 (78%) and 321 (86%) responses were recorded within the predefined window of 10–14 months. Participants in the intervention group had lower HbA1c than those in the control (mean difference −0.24%; 95% CI −0.44 to −0.049; p=0.014). There was no significant overall difference between groups in the mean PAID score (p=0.21), but prespecified subgroup analysis of participants who had been more recently diagnosed with diabetes showed a beneficial impact of the intervention in this group (p = 0.004). There were no reported harms.ConclusionsAccess to HeLP-Diabetes improved glycaemic control over 12 months.Trial registration numberISRCTN02123133.

The Importance of Information and Communication Technologies (Ict) to Promote Information, Self-Care and Empowerment in Patients With Chronic Diseases

“…The majority of previous studies with ICT have demonstrated positive changes in health status, and sometimes increase quality of life in patients with crhonic diseases [22] which corroborates a study that we selected [19]. Also, describing that ICT increased the opportunities to patients for accessing information that disease's self-management [15], [16], [17], [18], [19], the management of symptoms, the identification of exacerbations and therapeutic management [15], [16], [19].…”

“…We verified that the ICT's were identical in the different studies, the web intervention provided throughout the informative platforms and of registration as well as of e-learning where the more evidenced. It was possible to identify that the ICT's have positive effects in the patients with chronic diseases, which was verified that these have effects in the promotion of self-care and in selfmanagement of their health [15], [16], [17], [18], [19]. One of the results of the studies was the improvement of the overall increase of the patient's heath status, linked with a bigger knowledge and information about the control of symptoms and therapeutic regime [16] that allowed a better selfmanagement of their condition, decreasing the visits to the hospital [15].…”

Linkages to HIV confirmatory testing and antiretroviral therapy after online, supervised, HIV self‐testing among Thai men who have sex with men and transgender women

“…In terms of study retention, we found that MSM and TGW in the Offline group who were not offered an online tool to self‐manage their appointments and communicate any concerns with study staff in between scheduled study visits did more poorly than those who were offered. Online self‐management represents a promising strategy for preventing and treating chronic conditions, such as diabetes and mental health disorders, as individuals are empowered to actively identify challenges and solve problems associated with their health conditions . Many ongoing studies are exploring the online self‐management concept for HIV testing, PrEP and ART use among MSM and TGW .…”

What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

“…Table 4 and Table 5 summarises data related specifically to SES and disparity, including the theory behind the SM intervention (or study question for participation/attrition studies), intervention description, SES adaptations made, SES status of population, results in relation to SES, dropout rates and overall impact on SES disparity. Related papers were retrieved to provide additional data about the population or intervention as needed [31][32][33][34][35][36][37][38]. Quality analysis was undertaken using the Joanna Briggs Institute checklists [30] for randomised controlled trials (RCTs) and observational studies, and the Sun/ Oxman criteria [27,28] for subgroup analyses.…”