This project will employ a technologically sophisticated, accessible telecommunications approach to provide diabetes self-management counseling and support for adult patients with non-insulin dependent diabetes (NIDDM). A home-based computer network via the Internet will provide information, feedback and emotional support to participants to help improve self-management and glycemic control and reduce cardiovascular risk. Such a system is technically feasible and has been shown to be attractive and used by patients with other chronic diseases, and is currently being piloted. Following a year of formative and qualitative evaluation to ensure that the system is user friendly and stable, 300 heterogeneous participants will receive basic information on diabetes and will complete assessment instruments via computer. Two important factors will be investigated within a 2 (peer social support group) X 2 (personalized self-management skills training with feedback) randomized clinical trial. The impact of these interventions on network use, self-management behaviors, physiological outcomes, quality of life, medical utilization, and patient satisfaction will be assessed. Process measures will include changes in perceived social support, diabetes problem-solving skills, and several program implementation variables, the latter of which will be automatically tracked by the computer network system. This study builds upon prior work that has developed and partly validated a model of diabetes self-management. Results from this project should have implications not only for diabetes management, but also for similar self-management issues for other chronic diseases.
