title: Twelve-month outcomes of an Internet-based diabetes self-management support program.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA. glasgowre@mail.nih.gov
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Deanna
authors.initials: D
authors.lastname: Kurz
authors.forename: Diane
authors.initials: D
authors.lastname: King
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Dickman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Faber
authors.forename: Eve
authors.initials: E
authors.lastname: Halterman
authors.forename: Tim
authors.initials: T
authors.lastname: Woolley
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Toobert
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Strycker
authors.forename: Paul A
authors.initials: PA
authors.lastname: Estabrooks
authors.forename: Diego
authors.initials: D
authors.lastname: Osuna
authors.forename: Debra
authors.initials: D
authors.lastname: Ritzwoller
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003120:Colorado; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods*; D012944:Social Support; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin