This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. Diabetes is a complex chronic disease that affects 1 in 10 Americans. African Americans and other minorities bear a disproportionate burden of the disease and its adverse outcomes. It is expensive and leads to serious complications like kidney failure, myocardial Infarction, stroke, blindness and limb amputation. There is now unprecedented evidence regarding the benefits of aggressive glycemic control in reducing the risk for and delaying the progression of diabetes complications. However, aggressive glycemic control requires a lifelong adherence to complex lifestyle management involving routine blood glucose monitoring, self-adjustment of medications, nutrition management and a physically active lifestyle. Self-management is the foundation for achieving optimum glucose control necessary to avoid the complications of diabetes through increasing knowledge and awareness and learning effective behavioral techniques to manage diabetes. Data on the reach of self-management education programs reveals broad variation in attendance at DSME programs. Persistence of effects of DSME also varies. Given the general reluctance of patients with diabetes to attend diabetes classes and group sessions, Internet-based and other eHealth approaches to diabetes self-management education (DSME) have great potential to reach a large population at relatively low costs. The reach and effectiveness of DSME in the CPN and similar practices is unknown. We hypothesized that DSME reach would be lower than the recommended goal of 60% for healthy people 2010, so we undertook the ehealthystrides? project to test the efficacy of an online interactive program to improve self-management skills. The ehealthystrides? application integrates peer to peer social networking as well as feedback and counseling by a health coach located at the participants'primary care practice. We also hypothesized that ehealthystrides?, an integrated system which empowers and engages patients and their care team by providing diabetes knowledge, linked to patient-driven results of blood glucose, exercise and blood pressure monitoring would aid in improving self management skills attainment, persistence and reach among adult African American patients with diabetes.
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