Skip to main content
SpringerLink
Log in

Internet use among primary care patients with type 2 diabetes

The generation and education gap

  • Mini-Symposium On Diabetes Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: The Internet represents a promising tool to improve diabetes care.

OBJECTIVE: To assess differences in demographics, self-care behaviors, and diabetes-related risk factor control by frequency of Internet use.

DESIGN AND PARTICIPANTS: We surveyed 909 patients with type 2 diabetes attending primary care clinics.

MEASUREMENTS: Frequency of Internet use, socioeconomic status, and responses to the Problem Areas in Diabetes (PAID), Summary of Diabetes Self-care Activities (SDSCA), and Health Utilities Index (HUI) scales. Survey responses were linked to last measured hemoglobin Alc, cholesterol, and blood pressure results. Comorbidities and current medications were obtained from the medical record.

RESULTS: Internet “never-users” (n=588, 66%) were significantly older (70.0±11.2 vs 59.0±11.3 years; P<.001) and less educated (26% vs 71% with > high school; P<.001) than Internet users (n=308, 34%). There were few significant differences in PAID or SDSCA scores or in diabetes metabolic control despite longer diabetes duration (10.3±8.2 vs 8.3±6.7 years; P<.001) and greater prevalence of coronary disease (40% vs 24%; P<.001) in nonusers. Less than 10% of current nonusers would use the Internet for secure health-related communication.

CONCLUSIONS: Older and less educated diabetes patients are less likely to use the Internet. Despite greater comorbidity, nonusers engaged in primary care had equal or better risk factor control compared to users.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA. 2003;290:259–64.

    Article  PubMed  Google Scholar 

  2. Smith SP. Internet visits: a new approach to chronic disease management. J Med Pract Manage. 2002;17:330–2.

    PubMed  Google Scholar 

  3. Ball MJ, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inform. 2001;61:1–10.

    Article  PubMed  CAS  Google Scholar 

  4. Kassirer JP. Patients, physicians, and the Internet. Health Aff (Millwood). 2000;19:115–23.

    Article  CAS  Google Scholar 

  5. McKay HG, Feil EG, Glasgow RE, Brown JE. Feasibility and use of an Internet support service for diabetes self-management. Diabetes Educ. 1998;24:174–9.

    Article  PubMed  CAS  Google Scholar 

  6. Zrebiec JF, Jacobson AM. What attracts patients with diabetes to an internet support group? A 21-month longitudinal website study. Diabet Med. 2001;18:154–8.

    Article  PubMed  CAS  Google Scholar 

  7. Cimino JJ, Patel VL, Kushniruk AW. The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records. Int J Med Inform. 2002;68:113–27.

    Article  PubMed  Google Scholar 

  8. De Clercq PA, Hasman A, Wolffenbuttel BH. A consumer health record for supporting the patient-centered management of chronic diseases. Med Inform Internet Med. 2003;28:117–27.

    Article  PubMed  Google Scholar 

  9. Masys D, Baker D, Butros A, Cowles KE. Giving patients access to their medical records via the internet: the PCASSO experience. J Am Med Inform Assoc. 2002;9:181–91.

    Article  PubMed  Google Scholar 

  10. Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera MJ. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Prev Med. 2003;36:410–9.

    Article  PubMed  Google Scholar 

  11. Montani S, Bellazzi R, Quaglini S, d’Annunzio G. Meta-analysis of the effect of the use of computer-based systems on the metabolic control of patients with diabetes mellitus. Diabetes Technol Ther. 2001;3:347–56.

    Article  PubMed  CAS  Google Scholar 

  12. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care. 1998;21:518–24.

    Article  PubMed  CAS  Google Scholar 

  13. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. Am J Public Health. 2001;91:76–83.

    PubMed  CAS  Google Scholar 

  14. Whaley KC. America’s digital divide: 2000–2003 trends. J Med Syst. 2004;28:183–95.

    Article  PubMed  Google Scholar 

  15. Cashen MS, Dykes P, Gerber B. eHealth technology and Internet resources: barriers for vulnerable populations. J Cardiovasc Nurs. 2004;19:209–14.

    PubMed  Google Scholar 

  16. Grant RW, Meigs JB. The use of computers in population-based diabetes management. J Clin Outcomes Manage. 2002;9:390–6.

    Google Scholar 

  17. Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care. 1997;20:760–6.

    Article  PubMed  CAS  Google Scholar 

  18. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes selfcare activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50.

    Article  PubMed  CAS  Google Scholar 

  19. Torrance GW, Feeny DH, Furlong WJ, Barr RD, Zhang Y, Wang Q. Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Med Care. 1996;34:702–22.

    Article  PubMed  CAS  Google Scholar 

  20. Grant RW, Cagliero E, Sullivan CM, et al. A controlled trial of population management: diabetes mellitus—putting evidence into practice (DM-PEP). Diabetes Care. 2004;27:2299–305.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Medicine Division, Massachusetts General Hospital, Boston, MA, USA

    Richard W. Grant MD, MPH & James B. Meigs MD, MPH

  2. Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA

    Enrico Cagliero MD

  3. Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA

    Henry C. Chueh MD

  4. Harvard Medical School, Boston, MA, USA

    Richard W. Grant MD, MPH, Enrico Cagliero MD, Henry C. Chueh MD & James B. Meigs MD, MPH

Authors
  1. Richard W. Grant MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrico Cagliero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry C. Chueh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James B. Meigs MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard W. Grant MD, MPH.

Additional information

Authors report no conflicts of interest

See Editorial by Vinicor, p. 483.

Supported by the MGH Primary Care Operations Improvement program and an unrestricted research grant from Pfizer, Inc. Dr. Meigs is supported by an American Diabetes Association Career Development Award.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grant, R.W., Cagliero, E., Chueh, H.C. et al. Internet use among primary care patients with type 2 diabetes. J GEN INTERN MED 20, 470–473 (2005). https://doi.org/10.1111/j.1525-1497.2005.04239.x

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.04239.x

Key words

Search

Navigation