Review
Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence

https://doi.org/10.1016/j.ijmedinf.2011.02.002Get rights and content

Abstract

Introduction

The Internet has emerged as a potentially effective medium for information exchange. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases such as diabetes mellitus. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus.

Method

Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PsycINFO, Web of Science and Cochrane Library to retrieve articles published between 2000 and June 2010 which fulfilled all inclusion criteria. Methodological quality assessment and data synthesis were then performed.

Results

Twenty articles representing 13 different studies were reviewed. None of the studies were ranked as low in the methodological quality. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background, use of other technologies and longer duration of intervention were proven to be successful strategies as well.

Conclusion

The web-based interventions have demonstrated some level of favourable outcomes, provided they are further enhanced with proper e-research strategies.

Highlights

► We reviewed 13 web-based behavioural interventions for the management of type 2 diabetes. ► Goal-setting, personalisation, interactivity and peer support were successful approaches. ► We find the use of other technologies, theory and longer study duration to be good strategies. ► We suggest these approaches and strategies to be applied in future web-based interventions.

Introduction

Diabetes mellitus (DM) is a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both [1]. There are two common conditions of DM: type 1 and type 2. Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and is characterized by disorders of insulin action and insulin secretion, either of which may be the predominant feature.

DM is an increasingly important medical and public health issue. The prevalence of diabetes in adults worldwide is estimated to rise from 171 million in the year 2000 to 366 million in the year 2030 [2]. The major part of this increase is expected to occur in developing countries, with the greatest absolute increase expected to be seen in India. Similarly, the number of diabetic patients in the United States is expected to rise from 17.7 million in the year 2000 to 30.3 million 30 years later, given the increasing incidence of obesity [3].

Being a progressive disease, T2DM is one of the chronic conditions, which favours a focus on behavioural intervention. Lifestyle intervention has been the forefront runner in the prevention and management of T2DM [4]. Besides, a wide range of interventions aimed at improving the provision of diabetes care and achieving better metabolic control for patients with diabetes have been implemented [5].

The Internet holds promise for a wide-scale promotion of behavioural change to facilitate the prevention and management of T2DM, besides being an important source of health information and thus may be an appropriate delivery medium for health behaviour change interventions. The Internet's potential has been recognised and web-based education programmes have been steadily adopted in recent years in preventing and managing chronic diseases [6], [7], [8], [9]. Unlike face-to-face interventions, website-delivered interventions can potentially reach broad populations as it is available 24 h, and could be hosted by both government and non-governmental agencies.

This review provides a descriptive discussion of web-based behavioural interventions in patients with T2DM. For each intervention studied here, objective, targeted outcome, characteristics of the study, the major content of the intervention and most important findings were assessed.

Section snippets

Search strategy and data sources

Systematic literature searches were performed using MEDLINE, EMBASE, PUBMED, PSYCINFO, Web of Science and Cochrane Library according to the PRISMA guidelines [10]. The completed checklist is available from the authors upon request. We retrieved articles written in English relating to Internet based interventions for self-monitoring/self-management, physical activity, dietary behaviours, or weight loss among adults for the management of T2DM (Table 1). As this review aims to evaluate the recent

Study selection and characteristics

Fig. 1 shows the PRISMA flow chart of the article selection process. The search resulted in 145 articles and another 42 articles were found through cross-referencing. We assessed 70 full-text articles for eligibility after excluding 72 duplicates and 45 articles which did not address the topic. Fifty articles were excluded at the final stage of eligibility assessment and the remaining 20 articles were included in this review. However, these 20 articles represent only 13 intervention studies, as

Self-monitoring

Self-management or self-monitoring is a well-researched segment in the management of this disease. Despite the fact that they were not designed based on behavioural theories, self-management e-interventions [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] have all shown to be successful. These studies had almost similar self-monitoring method in the intervention, where the participants were required to log in to enter their blood glucose readings daily or weekly. Patients then

Limitations of the review

There are several limitations which should be considered while interpreting the results presented in this review. There is a possibility of publication bias as only published studies using the English language were considered. The review only took the recent peer-reviewed publications into consideration. Searches were carefully conducted using major databases and cross-referencing method, yet there is a chance for some publications not to be included in the search due to the inclusion criteria.

Conclusions and recommendation

The evolution of e-interventions seems to be inevitable at this era. Rapid development of the technology has led to the progression from generation of printed modules from computer and CD-ROMs to ‘live’ interaction of patients with the system and/or researchers via the Internet. Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage T2DM. Generally, the self-monitoring

Funding

This systematic review was developed for Dietary Intervention Programme for Patients with Type 2 Diabetes Mellitus: An e-Approach (NCT01246687) that was funded by Monash University Sunway Campus's Seed Grant (MED2009-CM (SG)-004-QKF).

Author contributions

Amutha Ramadas contributed to the literature search, concept and review design, and review write-up; Quek Kia Fatt and Carina KY Chan provided feedback on the review drafts and revised the review; Brian Oldenburg provided feedback on the review drafts and methodological quality, and revised the review.

Competing interest

None of the authors has any conflict of interest in the manuscript.

Summary points

What was already known?

  • Behavioural and self-monitoring interventions could assist type 2 diabetes mellitus prevention and management effort.

  • Websites are feasible medium for the delivery of behaviour interventions.

What this study adds?

  • Constant tracking progress of participants, setting personalised goals, strong theoretical background, self-monitoring, providing social and peer support are important to determine the

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