Project objectives

The overall aim was to determine the effectiveness (and components associated with effectiveness) of computer-based self-management programmes (SMP) for adults with type 2 diabetes (T2DM). Specific objectives were to determine:

1. The effectiveness of computer-based SMP for adults with T2DM;
2. The active components of effective computer-based SMP for adults with T2DM;
3. The cost-effectiveness of computer-based SMP for adults with T2DM.

Brief summary

Methods

Data Sources

We retrieved 8715 abstracts from a systematic search of six electronic bibliographic databases. Three other databases were searched for conference proceedings and theses. The searches were run from inception to November 2011. Reference lists from relevant published studies were also screened and authors contacted for further information when required.

Study selection

Studies eligible for inclusion were randomized controlled clinical trials recruiting patients aged 18 and over with type 2 diabetes mellitus. Interventions eligible for inclusion were those that interacted with users to generate tailored content that aimed to improve one or more diabetes self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders. There were no language restrictions.

Data Extraction

Two authors independently extracted relevant data using standard data extraction templates.

Key findings

Results

Sixteen randomised controlled trials with 3578 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 glycaemic control: the pooled effect on HbA1c was -0.2% (-2.3 mmol/mol); 95% CI - 0.4% to -0.1%; I² = 58%, (suggesting substantial heterogeneity).

A sub-group analysis on mobile phone-based interventions showed a larger effect: the pooled effect on HbA1c from 3 studies was -0.50% (-5.46 mmol/mol); 95% CI -0.7% to -0.3%; I² = 0%, (suggesting low heterogeneity).

Current interventions do not appear to be effective in improving depression, quality of life, blood pressure, serum lipids or weight. There was no evidence of significant adverse effects. In the interventions included in the review, prompting self-monitoring of behavioural outcome and providing feedback on performance were 2 techniques commonly used in the more effective interventions.

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 sub-group. There was no evidence of benefit for other biological, cognitive, behavioural or emotional outcomes.

Plain English summary

There were 2 lay participants on the steering group for the systematic review. They had a key input in ensuring that the outcomes looked at were important and relevant to people living with type 2 diabetes. JI and BW also provided input into drafting the final Cochrane review which included a lay summary.

JI and BW have continued to work with the group and have collaborated with the team on a 5 year NIHR Programme Grant for Applied Research to develop, evaluate and implement an online self-management tool for adults with type 2 diabetes.

PPI input has been invaluable for the project. It has helped with focusing the research objectives on matters of relevance to patients as well as clinicians. It has also helped develop communication and dissemination by ensuring that written reports are accessible and interesting to a wide spectrum of readers. The relationships built during this work have also helped us with further PPI involvement in subsequent research projects, including the 5 year NIHR grant mentioned above.

Dissemination

1. Pal K, Eastwood SV,Michie S, Farmer AJ, BarnardML, Peacock R,Wood B, Inniss JD,Murray E. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD008776. DOI:10.1002/14651858.CD008776.pub2
   http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008776.pub2/full
2. Computer-Based Interventions to Improve Self-management in Adults With Type 2 Diabetes: A Systematic Review and Meta-analysis. Kingshuk Pal, Sophie V Eastwood, Susan Michie, Andrew Farmer, Maria L Barnard, Richard Peacock, Bindie Wood, Phil Edwards, Elizabeth Murray, Diabetes care. 06/2014; 37(6):1759-1766.
   http://care.diabetesjournals.org/content/37/6/1759.full

Public involvement

There were 2 lay participants on the steering group for the systematic review. They had a key input in ensuring that the outcomes looked at were important and relevant to people living with type 2 diabetes. JI and BW also provided input into drafting the final Cochrane review which included a lay summary.

JI and BW have continued to work with the group and have collaborated with the team on a 5 year NIHR Programme Grant for Applied Research to develop, evaluate and implement an online self-management tool for adults with type 2 diabetes.

PPI input has been invaluable for the project. It has helped with focusing the research objectives on matters of relevance to patients as well as clinicians. It has also helped develop communication and dissemination by ensuring that written reports are accessible and interesting to a wide spectrum of readers. The relationships built during this work have also helped us with further PPI involvement in subsequent research projects, including the 5 year NIHR grant mentioned above.

Impact

Previous systematic reviews in this area have been inconclusive and often provided a narrative synthesis of study findings. This review provided a quantitative and structured review of the evidence in this expanding and promising area of research.

This work also fed into the development of an online self-management tool for adults with type 2 diabetes developed as part of a 5 year NIHR Programme Grant for Applied Research.

This project was funded by the National Institute for Health Research School for Primary Care Research (project number 82)

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Primary Care Research, NIHR, NHS or the Department of Health.