The Diabetes Control and Complications Trial has conclusively shown that effective control of blood glucose levels delays the onset and slows the progression of diabetes complications [1
]. The day-to-day management of diabetes is carried out almost exclusively by the patient and can often be complex and emotionally challenging. To enable patients to be effective self-managers of their diabetes, they need to be provided with the information and support necessary to make informed decisions [2
]. Internet-based interventions to aid self-management have the potential to assist patients by offering access to these resources from their own homes, schools, or workplaces and at times when they are most in need of them.
A number of recent Internet-based interventions have been reported on for use with patients with diabetes [3
], and a pilot study has shown the feasibility of patients with type 2 diabetes co-managing their condition from home [11
]. Most of the studies have assessed the usage or usability of their telemedicine systems [3
]; some have assessed biological measures, namely HbA1c [3
]; and one has reported on psychological measurements [5
]. Results often indicate improvements in HbA1c values but limited improvements in psychological measurements. Many of the systems have shown feasibility and potential benefits for improvement of diabetes care.
The systems developed for these interventions were often based on the uploading of biological measurements, whilst others provided patients with access to online self-management “coaches”. As a result, these interventions have commonly used complex and bespoke systems; few have used freely available communities. In order for an Internet-based system to be effective, it needs to employ a simple user interface to collect a minimum amount of data [12
]. In the current study, a pre-existing virtual clinic prototype was developed as an intervention to aid diabetes self-management, one aimed at patients who used insulin pumps to manage their diabetes.
Continuous subcutaneous insulin infusion (CSII), or pump therapy, is a method of administering insulin over twenty-four hours via a small needle or cannula inserted under the skin. The pump delivers insulin continuously with an additional boost programmed and administered by the patient to match food or reduce raised blood glucose levels [13
]. There are a number of reasons why patients may be recommended for CSII. These include inadequate glycemic control with other treatment options, marked variability in glucose on a day-to-day basis, a history of hyperglycemia unawareness, a need for flexibility in lifestyle, pregnancy, insulin sensitivity and low insulin requirements [14
]. This particular group has not been studied in any of the previous interventions referenced, despite insulin pump patients showing a great deal of interest in their condition and motivation towards self-management [15
Community support is believed to be a fundamental aspect of disease self-management, and when peer-support elements are incorporated into Internet-based interventions for diabetes, they are often the most used components [5
]. The benefits of peer support in relation to health include: decreased feelings of isolation, promotion of positive psychological states and increased motivation, deterring maladaptive behaviors, and providing information on the benefits of behaviors that positively influence health [16
]. Studies have shown that discussion forums and chat rooms can have a positive effect on participants by helping them to cope better with diabetes [17
Self-efficacy can also increase the successful self-management of diabetes. The theory of self-efficacy proposes that an individual’s confidence in their ability to perform a certain behavior influences which behavior they will engage in, how much effort will be expended, and how long they will persist in it [18
]. Interventions based on self-efficacy theory have been shown to be significantly more effective than those that are not [19
In addition to ensuring that the content of an intervention increases self-efficacy, it is important that a system meets patient needs and is designed in conjunction with potential users. Hence, extensive stakeholder consultation [20
] and preliminary testing [21
] were undertaken to ensure public and patient involvement at all stages of the system’s development. Following this patient-centered approach, we report here on pilot testing of the Internet-based virtual clinic for patients using insulin pumps to manage their diabetes. We aimed to explore the feasibility, acceptability, and effectiveness of the system.