OBJECTIVE We hypothesized that people with type 2 diabetes in an online diabetes self-management program, compared with usual-care control subjects, would (1) demonstrate reduced A1C at 6 and 18 months, (2) have fewer symptoms, (3) demonstrate increased exercise, and (4) have improved self-efficacy and patient activation. In addition, participants randomized to listserve reinforcement would have better 18-month outcomes than participants receiving no reinforcement. RESEARCH DESIGN AND METHODS A total of 761 participants were randomized to (1) the program, (2) the program with e-mail reinforcement, or (3) were usual-care control subjects (no treatment). This sample included 110 American Indians/Alaska Natives (AI/ANs). Analyses of covariance models were used at the 6- and 18-month follow-up to compare groups. RESULTS At 6 months, A1C, patient activation, and self-efficacy were improved for program participants compared with usual care control subjects (p < 0.05). There were no changes in other health or behavioral indicators. The AI/AN program participants demonstrated improvements in health distress and activity limitation compared with usual-care control subjects. The subgroup with initial A1C > 7% demonstrated stronger improvement in A1C (p = 0.01). At 18 months, self-efficacy and patient activation were improved for program participants. A1C was not measured. Reinforcement showed no improvement. CONCLUSIONS An online diabetes self-management program is acceptable for people with type 2 diabetes. Although the results were mixed they suggest (1) that the program may have beneficial effects in reducing A1C, (2) AI/AN populations can be engaged in and benefit from online interventions, and (3) our follow-up reinforcement appeared to have no value.
Copyright American Diabetes Association. Reprinted with permission from The American Diabetes Association.

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