title: Do Web-Based Interventions Improve Well-Being in Type 2 Diabetes? A Systematic Review and Meta-Analysis.
abstract: Poor diabetes self-care can have a negative impact on psychological well-being and quality of life. Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs, Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions. However, there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes.
  
  
  
  This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes.
  
  
  
  Searches were carried out in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library. Reference lists were hand-searched. A meta-analysis was conducted for depression and distress outcomes.
  
  
  
  A total of 16 randomized controlled studies met the inclusion criteria for the systematic review and 9 were included in the meta-analyses. Theories were applied to the majority of the interventions. The most common behavior change techniques were "General information" and "Tracking/monitoring." Interventions with a duration of 2-6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes. The pooled mean (95% confidence interval) difference between the intervention and control arms at follow-up on depression score was -0.31 (-0.73 to 0.11). The pooled mean difference on distress scores at follow-up was -0.11 (-0.38 to 0.16). No significant improvements in depression (P=.15) or distress (P=.43) were found following meta-analyses.
  
  
  
  While the meta-analyses demonstrated nonsignificant results for depression and distress scores, this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes. Further research is required to confirm the findings of this review.
authors: Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, United Kingdom. mh333@le.ac.uk.
authors: Michelle
authors: 0000-0003-2827-0988
authors: M
authors: Hadjiconstantinou
authors: Jo
authors: 0000-0001-9164-4677
authors: J
authors: Byrne
authors: Danielle H
authors: 0000-0002-2184-4865
authors: DH
authors: Bodicoat
authors: Noelle
authors: 0000-0003-1178-9230
authors: N
authors: Robertson
authors: Helen
authors: 0000-0002-6023-3661
authors: H
authors: Eborall
authors: Kamlesh
authors: 0000-0003-2343-7099
authors: K
authors: Khunti
authors: Melanie J
authors: 0000-0002-9987-9371
authors: MJ
authors: Davies
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D020407:Internet; D011788:Quality of Life; D012648:Self Care
keywords: Internet; Web-based intervention; meta-analysis; systematic review; type 2 diabetes; well-being