Diabetes Self-Management

Adolescents with type 1 diabetes have a new, effective tool to improve self-management – an Internet-based program called YourWay.

Shelagh Mulvaney, Ph.D., assistant professor at Vanderbilt University School of Nursing, led the first-ever study of a Web-based intervention to improve glycemic control among adolescents with Type 1 diabetes. The study was recently published in the journal Diabetes Care, and the results were presented at the annual meeting of the International Society for Research on Internet Interventions in Amsterdam.

“It is very challenging to cope with diabetes as a teenager,” said Mulvaney.  “We wanted to take an approach that used real-world experiences and capitalized on the interest many teens have for the Internet and new technologies.”

Mulvaney enlisted help from colleagues at the Vanderbilt Eskind Pediatric Diabetes Clinic, securing 72 study participants, 13 to 17 years old, with type 1 diabetes. One group received conventional care and the other received conventional care plus access to YourWay.

A multidisciplinary team of diabetes professionals, researchers, young patients, and volunteers wrote and edited Web site content that included six multimedia scenarios that these adolescents often face. The stories focused on key psychosocial barriers to self-management, such as time pressures, competing demands such as school and social goals, embarrassment, and modeled approaches to coping and problem solving.

The YourWay site also included a personalized home page, guided applied problem-solving, a peer forum, social comparison of responses with other adolescents, help from a problem-solving expert, and weekly e-mails to encourage participation.

“Dealing with a chronic disease is difficult for anyone,” said Mulvaney. “It is particularly daunting for teens diagnosed with type 1 diabetes, and transition to successful self-management is critical for the rest of their lives.”

The results are promising as glycemic control, problem-solving, and self-management adherence improved. Most of the adolescents viewed all stories at least once and completed the problem-solving activities, perhaps because the stories were rated as highly relevant and realistic.

Mulvaney and collaborator Russell Rothman, M.D., have also created a parallel problem-solving Web site for parents of teenagers with diabetes, and adapted the YourWay Web site for adolescents with type 2 diabetes. Mulvaney and Kevin Johnson, M.D., have designed a text messaging intervention that will be tested this spring.