Adolescents with type 1 diabetes were randomly assigned to receive usual care or usual care plus Internet-based problem-solving self-management support. Eligible participants within the Vanderbilt Eskind Pediatric Diabetes Clinic were 13–17 years, had Internet access, were diagnosed with type 1 diabetes for at least 6 months, spoke English, and had no disabilities that precluded understanding website content.

Between July and November 2008, participants were block randomized at 2:1 to the intervention group in sets of six. Condition was revealed by the research assistant opening a sealed envelope, generated by the principal investigator. The study was approved by the Vanderbilt Institutional Review Board, and parental consent and adolescent assent were obtained at study initiation.

No statistically significant differences between the groups existed at baseline (Table 1A, available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc09-1881/DC1) with the exception of A1C, which was higher for the intervention group (P = 0.02). No statistically significant group differences in change over time were found using intention-to-treat analyses.

When data were analyzed using an as-treated approach, the same patterns were seen for average group characteristics at baseline; however, problem solving improved by 0.30 SDs for the intervention group (d = 0.30, P = 0.23, 95% CI 0.14–0.49). Self-management adherence improved compared with the control group (d = 0.64, P = 0.02, 0.53–0.79). The intervention group A1C remained constant but showed improvement relative to the control condition, which showed worsening values (d = −0.28, P = 0.27, 0.25–0.67) (Table 1). Although lower than the intervention group at post-study, the change between the first and second A1C measurements for the control group was +0.33% and for the intervention group was −0.01%.

Previous research has indicated a general trend of increasing A1C during adolescence. A brief Internet-based self-management intervention was rated highly by participants and was effective at improving problem solving and self-management and appeared to offset the typical adolescent increase in A1C. To our knowledge, this is the first trial of an Internet program to improve problem solving in type 1 diabetes adolescents and the first intervention in this area that does not require additional clinician effort. The study is limited by a brief intervention period, small sample, and a lack of randomization on A1C values. The range of effect sizes observed within this short-term study (0.28–0.64) is consistent with other typically longer-duration, problem-solving, and coping intervention studies using a face-to-face modality (^{12, B13, B14}–¹⁵) and suggests that an Internet-based intervention is a feasible and accessible means of improving diabetes care. Further research is necessary to establish efficacy with a larger randomized trial, integrate parents and clinicians, fully validate the problem-solving measure, and identify issues in sustainability.

Clinical trial registry no. NCT00848705, clinicaltrials.gov.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

This study was supported by grant DK070026 from the National Institutes of Health to S.A.M. (trial registration: clinicaltrials.gov identifier NCT00848705).

No potential conflicts of interest relevant to this article were reported.

We are indebted to Hashrocket, LLC, and Anderson Design, LLC, for programming and design expertise and Cara Baughman, Eric Pittel, Courtney Fahnhorst, and Alison Hartog who helped conduct the study and create the multimedia stories.