Diabetes Self-Management Education

Web-Based Education Initiatives and Blood Sugar Levels

The topic appears to be widely researched and presents interest for a variety of scientists and professionals around the world. Lynch, Williams, Ruggiero, Knapp and Egede (2016) report an increased interest of health care professionals towards electronic remote means to deliver diabetes education. Kurti, Logan, Manini, and Dallery (2015) also report the need for web-based interventions in rural communities, as the levels of knowledge remain insufficient for adequate self-monitoring. Evidence suggests that web-based education initiatives positively correlate with self-management outcomes in patients with type 2 diabetes.

Online Help Initiatives

In the course of a quasi-experimental study conducted by Sepah, Jiang and Peters (2015), 562 patients underwent a weight loss program lasting 16 weeks. The program included a combination of web-based interventions such as online coaching, result measuring and analysis, group support and training. In accordance with the research results, A1c levels along with body weight demonstrated significant decrease. Thus after the program was completed, normal range blood sugar levels were achieved. What is more, the results maintained in the long-term period of two years. However, what the authors called a significant decrease equaled 0.37 percent after one year and 0.43 percent after the second year.

In accordance with the conclusions reached by Pal et al. (2013), the overall effectiveness of the web-based educational interventions is present but insignificant. The researchers identified 16 studies that tested the effectiveness of various electronic means on diabetes-related parameters. In studies that used computer programs, the positive change in A1c was at the level of 0.2%. Those in which mobile applications were utilized the change amounted to 0.5% at best. Given that, Pal et al. (2013) argue for the limited effect that current electronic web-based means of DSME can provide.

However, a more recent study conducted by Welch et al. (2015) suggests that web-based initiatives achieved a significant decrease in HbA1c levels by 1%. The study was designed as a parallel-groups randomized trial, which was utilized to test diabetes dashboard on a sample consisting of 199 type 2 Latino patients with diabetes. In comparison to conventional in-house diabetes care, the Internet-based intervention achieved the HbA1c level of 53 mmol/mol as compared to 64 mmol/mol in usual care (Welch et al., 2015). In addition to that, researchers concluded that in comparison with conventional methods, web-based diabetes self-management education (DSME) yields visible results, which can be sustained for prolonged periods of time.

Telemedicine

Multiple researchers identify issues that patients located in remote rural areas face when it comes to conditions such as diabetes. Nuovo (2013) recognizes the low level of education about diabetes among the inhabitants of such areas. The results of his study suggest that telemedicine intervention in Rural California resulted in patients being less stressed and more knowledgeable about managing their condition.

The intervention included a single class on diabetes management that lasted for 2 hours. The sample included 239 participants (Nuovo, 2013). Another telemedicine intervention was implemented and studied longitudinally by Chen et al. (2013). The scientists devised a telehealthcare educational program with 7 activities in which 59 diabetic patients participated for 18 months. The control group was almost two times larger and consisted of 103 patients.

The evidence obtained by the researchers suggests that blood glucose changed positively and the change was statistically meaningful thanks to the introduction of the online diabetes self-management system (DSMS). Additionally, the researchers identified increased awareness and reduced risks of negative side-effect related to improper self-management. Chen et al. (2013) note that telehealth initiatives mostly affect patients through behavioral pathways, the nature of which requires a longer period of time to instigate change.

Peimani et al. (2016) suggest that the usage of SMS-based education services could decrease HbA1c levels as well as improve glycemic control and diabetes self-care overall. The study included a sample of 150 patients with type 2 diabetes divided into three randomized groups. The two intervention groups (tailored and non-tailored) for 12 months received short educational messages based on the adherence barriers identified by the patients themselves. Despite overall positive results achieved by the patients regarding their diabetes self-management, A1c levels decreased insignificantly as compared to other health-related improvements.

A Combination of Web-Based Education Initiatives

Further research of online help for patients with diabetes is provided by Aikens, Rosland, and Piette (2015). According to their study, blood glucose readings improved as a result of a combination of web-based measures including automated telemonitoring, online notification, and clinician support. In addition to the improved glucose levels, patients’ psychological condition also changed positively. Due to constant virtual assistance and provision of information over the internet, most of the 303 patients who participated adhered to their medications more frequently as compared to no intervention. The experiment lasted for 3 to 6 months (Aikens et al., 2015).

Another prominent web-based intervention that showed statistically significant results was researched by a group of scientists from the Netherlands. Van Vugt, de Wit, Cleijne, and Snoek (2013) identified 13 randomized controlled studies which tested unique educational initiatives. Among them were weekly sessions, self-administered quizzes, videos, counseling, and activity feedback and self-management coaching. HbA1c levels were found to have improved as a result were reported in five of them. Most of the success was attributed to the increased self-regulation that was enhanced through educational initiatives.

Summary Statement

As mentioned earlier, in the scientific community there is a significant interest in the possibilities of modern web-based technologies in regard to their application to DSME. Most of the studies identified in this literature review demonstrate the positive impact of web-based educational interventions on blood sugar levels. The spread of the numerical value of A1c is within 0.2-0.6% which is regarded by certain scientists as moderate change.

Due to the differences in methods and data analysis techniques utilized by the researchers, there is a difficulty in proper comparison of the results. It may be argued, however, that a combination of web-based techniques produces one of the most significant results in terms of influencing blood sugar levels. It is notable that few researchers attempt to compare web-based educational initiatives with conventional ones. Due to such insight, the relevance and significance of the present research question become noticeable.

Conventional Education Initiatives and Blood Sugar Levels

Device-Based Education

Non-internet DSME is still widely used among clinics in the U.S. and are also supported by scientific studies that report their usability and effectiveness. Ziegler, Eichholz, and Schulz (2015) in their study tested the use of a device that measured blood glucose and ß-Ketone on 350 patients with type 2 diabetes. The results indicate that the use of such a measuring technique yielded a decrease in 0.3% A1c after 6 months. The authors suggest the increased usage of reminders inbuilt in the device helped increase the awareness and served as an educational intervention.

Schnell, Klausmann, Gutschek, Garcia-Verdugo, and Hummel (2017) have found that after 6 months patients who used an improved mechanism of glucose monitoring had their HbA1c levels decreased by 0.2%. The study involved 193 type 1 and 2 diabetes patients with a mean age of 60 in a prospective observational study, which took place in nine sites across Germany. The self-reported data that contained self-management procedures performed by patients daily was obtained through manually delivered questionnaires. The authors of the study suggest that the new tool not only improves the health conditions of the patients but also positively influences their attitudes towards diabetes management.

Home Visit Education

Yuan et al. (2014) studied the effects of the short-term educational interventions in the face of conventional diabetes self-management advice provided by health care professional. Under the quantitative method using control and intervention groups consisting of 40 and 36 patients respectively, the researchers measured body weight, HbA1c, and other metabolic markers. The intervention was comprised of 2-hour educational sessions which lasted for 8 weeks. The results indicated 0.6% reduction in A1c levels and 0.5 kg of weight reduction (Yuan et al., 2014). Regardless of the relatively small sample, the findings are consistent with the scientific body of research identified above.

Another conventional intervention such as a home visit lecture-based 4-month learning program was examined by Ba-Essa, Mobarak, Alghamdi, and Al-Daghri (2015). The researchers identified positive changes in the glucose levels, HbA1c, and Fasting blood sugar yet the statistically significant results were visible only with HbA1c. It is paramount to note that the intervention was tested against no intervention.

A Combination of Conventional Education Methods

It is of note that most of the interventions either web-based or conventional resulted in A1C level reductions that on average were estimated at 0.57 (Chrvala, Sherr & Lipman, 2016). When it comes to conventional educational interventions patients with diabetes yielded the most benefit from a combination of individual and group learning sessions. In a similar fashion, the most benefit from DSME interventions was registered when several health providers facilitated it.

Any kind of DSME was positively associated with an improved glycemic control in patients who controlled it poorly prior to interventions. It is also noteworthy that no significant results were achieved with interventions that lasted less than ten hours total, which indicates that prolonged educational interventions of any kind could be more beneficial (Chrvala et al., 2016).

Summary Statement

The studies that chose the standard of care interventions as their research subject tend to demonstrate positive results. Regardless of the proposed methodology, length of study, diabetes type, or other significant parameters, the intervention was significantly more effective in juxtaposition to no intervention. However, little studies that compared web-based as opposed to standard practice DSME were identified, which appears to solidify the basis for the current research.

The changes induced by visit-based, device-based or mixed method education appear to change blood sugar level positively but within rigid numbers. Thus, the fluctuation of A1c changes was from 0.2 to 0.6%. In light of that, it is paramount to notice that the research methods were always unique as the researchers tended to employ different sample size, timeframes, and administration pathway. Such differences to a certain extent limit the comparison of the methods.

References

Aikens, J. E., Rosland, A.-M., & Piette, J. D. (2015). Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Primary Care Diabetes, 9(2), 127–134. Web.

Ba-Essa, E. M., Mobarak, E. I., Alghamdi, A., & Al-Daghri, N. M. (2015). Intensified glucose self-monitoring with education in Saudi DM patients. International Journal of Clinical and Experimental Medicine, 8(10), 19374–19380.

Chen, L., Chuang, L.M., Chang, C.H., Wang, C.S., Wang, I.C., Chung, Y., … Lai, F. (2013). Evaluating self-management behaviors of diabetic patients in a telehealthcare program: Longitudinal study over 18 months. Journal of Medical Internet Research, 15(12), e266. Web.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926–943. Web.

Kurti, A. N., Logan, H., Manini, T., & Dallery, J. (2015). Physical activity behavior, barriers to activity, and opinions about a smartphone-based physical activity intervention among rural residents. Telemedicine Journal and E-Health, 21(1), 16–23. Web.

Lynch, C. P., Williams, J. S., J. Ruggiero, K., G. Knapp, R., & Egede, L. E. (2016). Tablet-aided behavioral intervention effect on self-management skills (tablets) for diabetes. Trials, 17. Web.

Nuovo, J. (2013). The impact of a diabetes self-management education program provided through a telemedicine link to rural California health care clinics. Health Services Insights, 6, 1–7. Web.

Pal, K., Eastwood, S. V., Michie, S., Farmer, A. J., Barnard, M. L., Peacock, R., … Murray, E. (2013). Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. The Cochrane Database of Systematic Reviews, (3), CD008776. Web.

Peimani, M., Rambod, C., Omidvar, M., Larijani, B., Ghodssi-Ghassemabadi, R., Tootee, A., & Esfahani, E. N. (2016). Effectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study. Primary Care Diabetes, 10(4), 251–258. Web.

Schnell, O., Klausmann, G., Gutschek, B., Garcia-Verdugo, R. M., & Hummel, M. (2017). Impact on diabetes self-management and glycemic control of a new color-based SMBG Meter. Journal of Diabetes Science and Technology, 11(6), 1218–1225. Web.

Sepah, S. C., Jiang, L., & Peters, A. L. (2015). Long-term outcomes of a Web-based diabetes prevention program: 2-year results of a single-arm longitudinal study. Journal of Medical Internet Research, 17(4), e92. Web.

van Vugt, M., de Wit, M., Cleijne, W. H., & Snoek, F. J. (2013). Use of behavioral change techniques in web-based self-management programs for type 2 diabetes patients: Systematic Review. Journal of Medical Internet Research, 15(12). Web.

Welch, G., Zagarins, S. E., Santiago-Kelly, P., Rodriguez, Z., Bursell, S.-E., Rosal, M. C., & Gabbay, R. A. (2015). An internet-based diabetes management platform improves team care and outcomes in an urban Latino population. Diabetes Care, 38(4), 561–567. Web.

Yuan, C., Lai, C. W. K., Chan, L. W. C., Chow, M., Law, H. K. W., & Ying, M. (2014). The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus. Web.

Ziegler, R., Eichholz, R., & Schulz, B. (2015). Use of a combined blood-glucose- and ß-ketone-measuring device improves glycemic control in insulin-treated patients with diabetes: The gold plus study. Journal of Diabetes Science and Technology, 9(6), 1270–1274. Web.