Social Support Strategies in Adult Patients With Diabetes

A Review of Strategies in the USA and Europe

Julienne K Kirk; Christine N Ebert; Ginger P Gamble; C Edward Ebert


Expert Rev Endocrinol Metab. 2013;8(4):379-389. 

In This Article

Five-year View

Social Support Involving Technology

Maintaining regular contact with patients via electronic media is gaining widespread popularity. Synthesis of social support networks, healthcare professionals and modern technology can be a potent force in increasing a patients' ability to monitor and moderate their diabetes symptoms with real-time information. A systematic review of information technology from 1990 to 2004 was investigated by Jackson et al.[29] They evaluated randomized, controlled trials and observational studies (n = 26) among adult patients with diabetes. Interventions considered included internet-assisted education, telephone-automated calls, telemedicine, computer-assisted integration of clinical information, electronic disease management, personal database manager and computer-assisted flow sheet. Overall, there were studies representative of both patient and providers, and significant declines in A1C levels compared with controls were reported. Investigators also looked at healthcare utilization, behaviors, attitudes, knowledge and skills. The cost–effectiveness of using informational technology, evaluation of long-term clinical outcomes and reimbursement for provider time remain important issues for future research.

With the advent of social media and increasing widespread availability of wireless devices, new strategies for contacting, coaching and engaging patients have arisen. Several studies have tentatively investigated the aspects of connection that may be useful in improving patient behaviors and health outcomes. Roblin conducted a pilot study wherein patients who were recruited into the study also nominated peer support personnel to receive text messages whenever blood glucose levels were transmitted.[30] Patients generally found the system easy to use, and several commented positively about how their peer supporter(s) reinforced adherence. Conversely, another study compared peer versus diabetes specialist nurse support and found that the nurse was more valued.[31] However, the peers were strangers to the patients; while trained in support techniques, they had no prior personal connection. Patients who remained in the study did report generally positive impressions, particularly about having someone with whom to 'share their experience' as a person with diabetes. The authors note that perhaps better matching between recruited peers and patients might have improved outcomes. Still, in both studies, patients found the technology to be usable. A Cochrane analysis of mobile phone messaging for facilitating self-management of long-term disease such as diabetes was also performed, reviewing the literature of randomized, controlled trials from 1993 to 2009.[32] There were two studies regarding diabetes in this review that yielded moderate-quality evidence showing no statistical difference from text messaging interventions compared with usual care or email reminders for glycemic control.

The earlier studies showed that adult patients generally were capable of utilizing various electronic reporting methods; one might suspect that younger patients would find the use of technology even more palatable. A study of adolescents and young adults compared text message versus email reminders, and found that all were capable of wireless contact and initially approximately 60% regularly responded to the reminders.[33] However, after 3 months, response rates were very low, suggesting that the youths were not as engaged or interested in the system once the novelty wore off.

In the context of exploring how remote delivery of information is packaged, a study was conducted to evaluate the response to different forms of delivery.[34] Although the study enrolled only nine participants, it found that the more specific and personalized that the information was, the more likely that patients were to act on it. Finding ways to increase the patient's connection to the peer support seems to be more important than having a face-to-face meeting.

The importance of connection and online community building was further reinforced in two connected manuscripts. The first described a study similar to others presented here, but examined the role of online community features in addition to an internet-mediated walking program. Although there was no significant difference in behavioral results, those who were not part of the online community increased their exercise at the same rate as did those who did participate, there was significantly less attrition in those patients who took part in the online community.[35] The second study of the same group examined particular methods of recruiting patients to an online community and how to build a 'critical mass' where the patients take the lead in supporting each other.[36] Promotions, seeding by staff, website design and response to initial comments were found to be key factors in engaging patients to become active on the site themselves. These studies, in particular, exhibit how a personalized experience can engage patients even at a distance and encourage greater adherence and better health outcomes. Careful design and subtle prodding are needed for many patients to participate, but once they are in, they tend to stay in and support others experiencing the same difficulties. As wireless experiences and capabilities continue to expand, more opportunities will be available to explore how to reach and encourage greater numbers of patients with chronic conditions. There is a growing need to evaluate new methods and plan appropriate distance engagement.