Twelve-month outcomes of an Internet-based diabetes self-management support program

Patient Educ Couns. 2012 Apr;87(1):81-92. doi: 10.1016/j.pec.2011.07.024. Epub 2011 Sep 15.


Objective: Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs.

Methods: We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n=463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors.

Results: Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size=.09-.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants.

Conclusions: The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes.

Practice implications: Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Body Mass Index
  • Colorado
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin
  • Health Behavior*
  • Hispanic or Latino
  • Humans
  • Internet*
  • Life Style
  • Male
  • Middle Aged
  • Primary Health Care
  • Risk Reduction Behavior*
  • Self Care / methods*
  • Social Support
  • Socioeconomic Factors
  • Time Factors
  • Treatment Outcome


  • Glycated Hemoglobin A