Promoting control of type 2 diabetes : computer-aided versus conventional care

Abstract

The aim of this dissertation was to see if computer-aided care is more effective than conventional care in lowering HbAlc level in adults with Type 2 diabetes. Computer aided care is a form of follow-up care system that occurs through the computer. This encompasses educational modules, a messaging system for communication between patient and health providers and allows uploads from monitoring devices. As we are living in a technological era, follow-up care delivered through the computer can be of a particular interest. The research question derived from the PICO format was; 'Is computer-aided care better than conventional care in promoting diabetes self management and blood glucose control?'. The population studied consisted of adults with Type 2 diabetes. The intervention examined was computer-aided care in comparison with conventional care. The outcome consisted of HbA1c level, aimed to reflect diabetes self-management and blood glucose control. To select the key articles, criteria had to be formulated. Inclusion criteria included systematic reviews and randomised controlled trials (RCTs) that were published in the English language and between January 2005 and December 2011; studies that included men or women with Type 2 diabetes; studies that used computer-aided care as the intervention and conventional care as the control and measured the HbA1c level as one of the outcomes. Studies were excluded if they used computer-aided care for prevention measures; measured the cost-effectiveness of computer-aided care and used computer-aided care to manage diabetes and any other chronic diseases. Fourteen articles were found that complied with these criteria and were used as key studies. These were critiqued using the CASP tools. Most studies showed that with computer-aided care the HbA1c level had decreased and eight RCTs showed a statistically significant difference. However, as few articles had good methodological characteristics one cannot conclude that computer-aided care is more beneficial than conventional care, thus future research still needs to verify this. Based on this conclusion, it is suggested that for the time being effort is directed towards improving conventional care which is presently being delivered, such as by increasing the number of health professionals who carry out follow-up care. This, together with other changes will make the transition to computer aided care more feasible, if it is to be implemented in the future.