title: Feasibility of an internet-based intervention for improving diabetes outcomes among low-income patients with a high risk for poor diabetes outcomes followed in a community clinic.
abstract: The purpose of this study was to determine the feasibility of an Internet-based intervention, targeting very low-income minority patients with a high risk for not engaging in diabetes self-management, to increase diabetes self-management and improve diabetes outcomes.
  
  
  
  Patients with diabetes followed in a community clinic were enrolled in the 13-month trial. Participants were requested to test blood sugar and upload glucometer data every day and login to the program at least once every second day. Feasibility data included process measures; diabetes outcomes consisted of changes from baseline to follow-up for levels of glycosylated hemoglobin (A1C), LDL, HDL, triglyceride and total cholesterol, and health-related quality of life using the SF-36.
  
  
  
  Only 22% of participants had health insurance. Participants had an average of 4.39 comorbidities and 7.06 prescriptions. Participants uploaded glucometer data at least twice each week and logged into the application at least once each week. Participants demonstrated reductions statistically or clinically important changes in A1C, LDL cholesterol, total cholesterol, and triglyceride levels. Participants engaging in more frequent chat messages and interactive activities demonstrated greater reductions in LDL cholesterol levels; however, engaging in more frequent chat messages also was associated with increased triglyceride levels. Participants rated fewer role limitations from physical health problems at follow-up.
  
  
  
  The intervention produced good outcomes; however, an alternative platform may be a less expensive approach.
authors.affiliation: Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA (Dr Ryan, Dr Schwartz, Mr Fedders, Ms Vittoria)
authors.forename: John G
authors.initials: JG
authors.lastname: Ryan
authors.affiliation: Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA (Dr Ryan, Dr Schwartz, Mr Fedders, Ms Vittoria)
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: Private Practice, Healing Hooves Psychotherapy, Davie, FL, USA (Dr Jennings)
authors.forename: Terri
authors.initials: T
authors.lastname: Jennings
authors.affiliation: Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA (Dr Ryan, Dr Schwartz, Mr Fedders, Ms Vittoria)
authors.forename: Mark
authors.initials: M
authors.lastname: Fedders
authors.affiliation: Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL, USA (Dr Ryan, Dr Schwartz, Mr Fedders, Ms Vittoria)
authors.forename: Isabel
authors.initials: I
authors.lastname: Vittoria
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005240:Feasibility Studies; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010349:Patient Compliance; D010353:Patient Education as Topic; D011203:Poverty; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods; D014280:Triglycerides / Q000097:blood; D014584:User-Computer Interface
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human