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Diabetes Educ. 2014 Jul;40(4):516-525. Epub 2014 Apr 17.

A Comparison of In-person, Telephone, and Secure Messaging for Type 2 Diabetes Self-Management Support.

Author information

Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss).
Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise).
Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier).
Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda).


Ongoing interaction between diabetes educators and patients is necessary for making and sustaining behavior changes essential for glycemic control and subsequently reducing the complications of diabetes.


The purpose of this study was to determine the feasibility of diabetes self-management support (DSMS) delivered via telephone or secure message and to compare clinical outcomes (A1C, LDL), behavioral goal achievement, and health maintenance task completion.


In sum, 150 persons with type 2 diabetes who completed diabetes self-management education self-selected DSMS methods: 1 in-person visit (n = 47), 3 brief visits by phone (n = 44), or 3 by secure message (n = 59) through electronic health record. DSMS included evaluation of goal achievement, barriers and facilitators, problem solving, and review of health maintenance exams. Self-reported data were collected at 9 months.


There were no significant differences among groups in main outcomes between baseline and 9-month follow-up. Behavioral goals were achieved by 59% of in-person participants, 73% phone, and 77% secure message. Sixty-two completed the intervention per protocol: fewer online than in-person or phone groups. Mean attempts to contact participants was significantly greater in the secure message group. Phone contact was significantly longer than secure message.


Telephone and secure message was feasible for providing DSMS. Three brief contacts by phone or secure message resulted in similar outcomes when compared to an in-person visit. Secure messaging required less staff time, but increased patient engagement is needed.

[Indexed for MEDLINE]

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