Interventions with a duration of 2 - 6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes .
While the meta-analyses demonstrated nonsignificant results for depression and distress scores , this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes .
BACKGROUND Poor diabetes self-care can have a negative impact on psychological well-being and quality of life .
Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs , Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions .
However , there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes .
OBJECTIVE This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes .
The burden of treatment failure in type 2 diabetes.
OBJECTIVE In type 2 diabetes , therapies to maintain blood glucose control usually fail after several years . We estimated the glycemic burden that accumulates from treatment failure and describe the time course and predictors of failure . RESEARCH DESIGN AND METHODS A prospect i ve , population -based study using retrospective observational data . We identified all 7208 complete courses of treatment with nondrug therapy , sulfonylurea monotherapy , metformin monotherapy , and combination oral antihyperglycemic therapy between 1994 and 2002 , inclusive , among members of the Kaiser Permanente Northwest Region . We calculated mean cumulative glycemic burden , defined as HbA(1c)-months > 8.0 or 7.0 % for each treatment . We then measured the likelihood that the next HbA(1c ) would exceed 8.0 and 7.0 % after HbA(1c ) exceeded each of ten hypothetical treatment thresholds . Finally , we estimated multivariate logistic regression models to predict when HbA(1c ) would continue to deteriorate . RESULTS In this well-controlled population , the average patient accumulated nearly 5 HbA(1c)-years of excess glycemic burden > 8.0 % from diagnosis until starting insulin and about 10 HbA(1c)-years of burden > 7.0 % . Whenever patients crossed the American Diabetes Association-recommended treatment threshold of 8.0 % , their next HbA(1c ) result was as likely to be < 8.0 as > 8.0 % . Multivariate prediction models had highly statistically significant coefficients , but predicted < 10 % of the variation in future HbA(1c ) results . CONCLUSIONS Clinicians should change glucose-lowering treatments in type 2 diabetes much sooner or use treatments that are less likely to fail . An action point at 7.0 % or lower is more likely to prevent additional deterioration than the traditional action point of 8.0 %
Interventions with a duration of 2 - 6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes .
While the meta-analyses demonstrated nonsignificant results for depression and distress scores , this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes .
BACKGROUND Poor diabetes self-care can have a negative impact on psychological well-being and quality of life .
Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs , Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions .
However , there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes .
OBJECTIVE This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes .