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In This Issue of Diabetes Care

Rapid growth in technology—particularly mobile technology—has opened the door for development of novel strategies to improve diabetes self-management. Although face-to-face meetings have historically been the gold standard for improving self-management skills among people with diabetes, the practical challenges associated with attendance at these meetings (e.g., transportation, child care, lost wages) have resulted in a push to leverage the popularity of personal computers and mobile devices to access patients with diabetes for whom face-to-face meetings are inconvenient, impractical, or not desired. But how effective are these self-management technologies at improving key outcomes? A review and meta-analysis in this issue of Diabetes Care (p. 1759) concluded that at the current time, computer-based interventions for diabetes self-management have only a small benefi t on key outcomes such as glucose control and that they have no impact on depression, quality of life, or weight. The new study included data from 16 randomized trials focusing on computer applications that used information input by the patient to provide a tailored response that aimed to improve one or more elements of diabetes self-management. Together, these studies used data from nearly 3,600 people with type 2 diabetes to whom interventions were delivered in clinics, by the Internet, and through mobile phones. Although the computerized technologies reduced HbA1c by only –0.2% across the studies, the authors noted that the impact of the interventions on HbA1c was larger in the subgroup of patients whose interventions involved mobile phones. In addition to the modest benefi ts that are summarized in the new report, the authors pointed out a number of methodological concerns in the design and implementation of the trials. These included issues as varied as randomization, selection bias, and attrition. The authors suggest that strategies for forward movement in this area should focus on improved design as well as exploration of protocols that focus on computerized interventions targeting both providers and patients. — Helaine E. Resnick, PhD, MPH