Effect of computer-generated tailored feedback on glycemic control in people with diabetes in the community: a randomized controlled trial

OBJECTIVE

It is unknown whether computer-generated, patient-tailored feedback leads to improvements in glycemic control in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We recruited people with type 2 diabetes aged ≥40 years with a glycated hemoglobin (A1C) ≥7%, living in Hamilton, Canada, who were enrolled in a community-based program (Diabetes Hamilton) that provided regular evidence-based information and listings of community resources designed to facilitate diabetes self-management. After completing a questionnaire, participants were randomly allocated to either receive or not receive periodic computer-generated, evidence-based feedback on the basis of their questionnaire responses and designed to facilitate improved glycemic control and diabetes self-management. The primary outcome was a change in A1C after 1 year.

RESULTS

A total of 465 participants (50% women, mean age 62 years, and mean A1C 7.83%) were randomly assigned, and 12-month A1C values were available in 96% of all participants, at which time the A1C level had decreased by an absolute amount of 0.24 and 0.15% in the intervention and control groups, respectively. The difference in A1C reduction for the intervention versus control group was 0.09% (95% CI −0.08 to 0.26; P = 0.3). No between-group differences in measures of quality of life, diabetes self-management behaviors, or clinical outcomes were observed.

CONCLUSIONS

Providing computer-generated tailored feedback to registrants of a generic, community-based program that supports diabetes self-management does not lead to lower A1C levels or a better quality of life than participation in the community-based program (augmented by periodic A1C testing) alone.Diabetes is a common chronic disease characterized by hyperglycemia that currently is estimated to affect >285 million people worldwide (1). People with diabetes are at high risk for serious chronic consequences, including retinopathy, nephropathy, blindness, cataracts, renal failure, limb amputation, cardiovascular events, and premature death. Indeed, the high prevalence and associated comorbidities cost $174 billion in the U.S. in 2007 alone (2,3). More than 90% of affected people have type 2 diabetes, and several large trials have shown that glucose-lowering strategies targeting an A1C <7% can reduce some of these health consequences (4,5). As such, most clinical practice guidelines recommend A1C measurement every 3 months with target values <7% (6,7).Evidence that self-management education can reduce the impact of diabetes (8–11) has led to recommendations that it be implemented for all individuals with diabetes (6,7). Information and resources designed to facilitate diabetes self-management have been freely available to people with diabetes residing in the region of Hamilton, Canada, since 1999 through a free community-based program (Diabetes Hamilton). After completing a brief questionnaire focused on diabetes-related health status and behaviors, registrants (and their primary care physicians) received access to an inventory of community resources, tools to facilitate self-care, and quarterly newsletters describing evidence-based information pertaining to diabetes. As of April 2010, >4,300 individuals (~10% of the city’s population with diabetes) have registered in the program and are being followed annually.A growing body of evidence pertaining to smoking cessation, blood pressure control, and lifestyle changes suggests that the provision of tailored information that is specific to a particular individual may achieve better health outcomes than generic information alone (12–17). Whether adding such feedback improves glycemic control and quality of life in people with diabetes in the community setting is unknown and was assessed in a randomized controlled trial.