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Mixed results on computer-based support for diabetes

By Genevra Pittman

NEW YORK (Reuters Health) - Computer and mobile phone programs that provide tailored advice and support to people with diabetes may not do much to improve their health and quality of life, a new report suggests.

The findings are based on a review of 16 past studies, each looking at a different type of interactive intervention. Some of the programs provided access to social networking and peer support groups from home; a few were available to patients only when they visited a clinic.

On average, people who used the programs saw a small improvement in their blood sugar levels compared to those without access. But other results - including effects on weight, cholesterol levels and quality of life - were more mixed.

"At the moment, these things have a lot of potential, but there's really not a lot of evidence to suggest that people should go out straightaway and start using them," said Kingshuk Pal, who led the new review at University College London.

Pal said research shows face-to-face diabetes education programs can help people improve their long-term health. But because that type of treatment can be expensive - and some patients have trouble accessing it at all - researchers, diabetes charities and companies have been looking to make diabetes management more mobile.

The 16 studies included a total of about 3,600 people with diabetes in the United States, UK, South Korea and China. Participants were randomly assigned to use a computer- or mobile phone-based program for between one and twelve months or to receive standard diabetes care or another type of intervention, such as printed materials.

Along with giving them tailored advice, some of the programs helped people set goals and responded to personal input with feedback.

Across the studies, people assigned to use one of those programs had a 0.2-percent improvement in their glycemic control over those in comparison groups.

None of the studies that looked at health-related quality of life measured a benefit attributed to the intervention. Five of six reports found improvements in participants' diet, but just two of five noted a borderline increase in exercise among computer-program users. A combined analysis showed no effect on weight.

Some studies hinted that the interventions increased people's knowledge and confidence - but they did not alleviate depression, Pal and his colleagues wrote in their Cochrane Library report.

The Cochrane Collaboration is an international organization that evaluates medical research.

BETTER HABITS

Charlene Quinn, whose own research was included in the analysis, said the hope is that certain types of technology can encourage better habits among people with diabetes.

"In our studies we learned people needed an individualized approach to manage their diabetes, feedback and communication with a trusted source (health provider, diabetes educator, trained lay person or peer), and for some persons, linking the ongoing feedback and results with their diabetes health provider," Quinn, from the University of Maryland School of Medicine in Baltimore, told Reuters Health in an email.

She said there's a need for more research on the type of computer-based programs that work best for specific people.

"For persons with chronic diseases, like diabetes, hypertension (and) high cholesterol, we need to design and scientifically evaluate technology interventions for the general population - taking into consideration cultural, race, income, literacy and age related differences," she added.

Pal told Reuters Health interventions involving mobile phones, such as text message reminders, seem to have the most potential. But he said the effects of even the more helpful programs may fade over time.

"What we need to do is create better interventions that provide long-term support," Pal said.

SOURCE: http://bit.ly/bVvvzJ Cochrane Library, online March 27, 2013.

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