Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care. Issue 9 (27th September 2017)

• Record Type: Journal Article
• Authors: Murray, Elizabeth; Sweeting, Michael; Dack, Charlotte; Pal, Kingshuk; Modrow, Kerstin; Hudda, Mohammed; Li, Jinshuo; Ross, Jamie; Alkhaldi, Ghadah; Barnard, Maria; Farmer, Andrew; Michie, Susan; Yardley, Lucy; May, Carl; Parrott, Steve; Stevenson, Fiona; Knox, Malcolm; Patterson, David
• Is Part Of: BMJ open. Volume 7:Issue 9(2017)
• Publication Date: 2017-09-27
• Subjects: internet -- self care -- diabetes mellitus, type 2 -- primary care; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-016009
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To determine the effectiveness of a web-based self-management programme for people with type 2 diabetes in improving glycaemic control and reducing diabetes-related distress. Methods and design: Individually randomised two-arm controlled trial. Setting: 21 general practices in England. Participants: Adults aged 18 or over with a diagnosis of type 2 diabetes registered with participating general practices. Intervention and comparator: Usual care plus either Healthy Living for People with Diabetes (HeLP-Diabetes), an interactive, theoretically informed, web-based self-management programme or a simple, text-based website containing basic information only. Outcomes and data collection: Joint primary outcomes were glycated haemoglobin (HbA1c) and diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) scale, collected at 3 and 12 months after randomisation, with 12 months the primary outcome point. Research nurses, blind to allocation collected clinical data; participants completed self-report questionnaires online. Analysis: The analysis compared groups as randomised (intention to treat) using a linear mixed effects model, adjusted for baseline data with multiple imputation of missing values. Results: Of the 374 participants randomised between September 2013 and December 2014, 185 were allocated to the intervention and 189 to the control. Final (12 month) follow-up data for HbA1c were available for 318 (85%) and for PAID 337 (90%) of participants. Of these, 291 (78%) and 321 (86%) responses were recorded within the predefined window of 10–14 months. Participants in the intervention group had lower HbA1c than those in the control (mean difference −0.24%; 95% CI −0.44 to −0.049; p=0.014). There was no significant overall difference between groups in the mean PAID score (p=0.21), but prespecified subgroup analysis of participants who had been more recently diagnosed with diabetes showed a beneficial impact of the intervention in this group (p = 0.004). There were no reported harms. Conclusions: Access to HeLP-Diabetes improved glycaemic control over 12 months. Trial registration number: ISRCTN02123133.