title: Computer-based interventions to improve self-management in adults with type 2 diabetes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Structured patient education programs can reduce the risk of diabetes-related complications. However, people appear to have difficulties attending face-to-face education and alternatives are needed. This review looked at the impact of computer-based diabetes self-management interventions on health status, cardiovascular risk factors, and quality of life of adults with type 2 diabetes.
  
  
  METHODS
  We searched The Cochrane Library, Medline, Embase, PsycINFO, Web of Science, and CINAHL for relevant trials from inception to November 2011. Reference lists from relevant published studies were screened and authors contacted for further information when required. Two authors independently extracted relevant data using standard data extraction templates.
  
  
  RESULTS
  Sixteen randomized controlled trials with 3,578 participants met the inclusion criteria. Interventions were delivered via clinics, the Internet, and mobile phones. Computer-based diabetes self-management interventions appear to have small benefits on glycemic control: the pooled effect on HbA1c was -0.2% (-2.3 mmol/mol [95% CI -0.4 to -0.1%]). A subgroup analysis on mobile phone-based interventions showed a larger effect: the pooled effect on HbA1c from three studies was -0.50% (-5.46 mmol/mol [95% CI -0.7 to -0.3%]). There was no evidence of improvement in depression, quality of life, blood pressure, serum lipids, or weight. There was no evidence of significant adverse effects.
  
  
  CONCLUSIONS
  Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control, and this effect was larger in the mobile phone subgroup. There was no evidence of benefit for other biological, cognitive, behavioral, or emotional outcomes.
authors.affiliation: UCL Research Department of Primary Care and Population Health, University College London, London, U.K. k.pal@ucl.ac.uk.
authors.forename: Kingshuk
authors.initials: K
authors.lastname: Pal
authors.affiliation: International Centre for Circulatory Health, Imperial College, London, U.K.
authors.forename: Sophie V
authors.initials: SV
authors.lastname: Eastwood
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, U.K.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
authors.affiliation: Department of Diabetes, The Whittington Hospital NHS Trust, London, U.K.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Barnard
authors.affiliation: Archway Healthcare Library, London, U.K.
authors.forename: Richard
authors.initials: R
authors.lastname: Peacock
authors.affiliation: Diabetes Self-Management Program (DSMP), Co-creating Health, London, U.K.
authors.forename: Bindie
authors.initials: B
authors.lastname: Wood
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, London, U.K.
authors.forename: Phil
authors.initials: P
authors.lastname: Edwards
authors.affiliation: UCL Research Department of Primary Care and Population Health, University College London, London, U.K.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin