Lifestyle Education Based on Electronic Media for Diabetes

Management

A Systematic Review

Komang Agus Jerry Widyanata

, Kusnanto

and Suprajitno

Magister of Nursing Student, Universitas Airlangga, Surabaya, Indonesia

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Nursing Department, Poltekkes Malang, Indonesia

Keywords : Electronic, Lifestyle Education, Self-Management, Type 2 Diabetes.

Abstract : The number of deaths due to diabetes mellitus is still high and tends to increase, this is due to the lack of self-

management of patients with diabetes mellitus. The purpose of this research is to identify education with

electronic media to improve self-management of diabetes mellitus type 2. This study was used systematic

review with a literature search using online reference databases: ProQuest, EBSCOhost, PubMed, Scopus,

and Science Direct. The determination of the keyword is based on PICOT framework (P: diabetes mellitus

type 2, I: internet, computer, telephone, electronics, telehealth, C: -, O: behavior, lifestyle, blood sugar

control, self-management, T: 2009-2018). Studies were included if they described interventions with

electronic media targeted at patients with type 2 diabetes, focused on behavioral, biomedical, and

psychological changes. The review of 15 papers that met the criteria showed significant results in the use of

electronic media to the level of knowledge, confidence, nutrition intake, physical activity, self-efficacy and

empowerment. Electronic media also significantly affects biomechanics especially for HbA1c results.

Electronic media can be one of the right choices in providing self-management education of type 2 diabetes

mellitus.

1 BACKGROUND

Currently Indonesia is ranked fifth world as a

country that has the largest number of diabetes

mellitus cases (PERKENI, 2015). The International

Diabetes Federation notes that by 2013 there are 382

million people in the world who suffer from diabetes

mellitus, of which there are 175 million undiagnosed

and threatened progressively unconscious

complications resulting from without precautions.

Data for the year is expected to increase to 592

million people who will suffer diabetes mellitus in

2035 (IDF, 2013)

In addition to the increasing number of cases,

diabetes mellituS is also known to cause many

complications that are divided into two, they are

acute complications and chronic complications.

Acute complications include hypoglycemia, diabetic

ketoacidosis, and non-ketotic hyperosmolar, and

chronic complications are macroangiopathy,

microangiopathy and neuropathy (PERKENI, 2015).

The number of cases and complication problems put

the case of diabetes mellitus in the third rank cause

of the highest non-infectious disease mortality in

Indonesia in 2016 (Departemen Kesehatan RI,

2014).

The main goal in the management of diabetes

mellitus is the achievement of near-normal

glycemic. by self management diabetes mellitus

such as diet, exercise, blood sugar control and

Diabetes mellitus treatment (Gb & Premkumar,

2016). Individuals with chronic diseases such as

diabetes, require innovative methods of health

education, individuals claim that they want

information in as many formats as possible and as

early as possible after diagnosis. (Booth et al.,

2016). Making their own decisions for improving

blood sugar levels and performing related self

chosen actions and maintaining its long term

performance is the key element in diabetes self care

management (Gb & Premkumar, 2016)

International Diabetic Federation (2013) states

that at the individual level of diabetes self-

220

Widyanata, K., Kusnanto, . and Suprajitno, .

Lifestyle Education Based on Electronic Media for Diabetes Management.

DOI: 10.5220/0008323002200228

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 220-228

ISBN: 978-989-758-336-0

management education that integrates clinical,

behavioral and psychosocial aspects of diabetes self-

management should be available and sustainable.

Effective self-management can improve the health

of diabetes and prevent or delay the onset of

complications, yet difficult and complex to achieve.

This can be realized by allowing patients to

understand their condition, combined with a barrier

resolution for compliance(Dale, Caramlau, Sturt,

Friede, & Walker, 2009).

The use of technology in the treatment of

diabetes can facilitate improved communication

between nurses and patients, reliable data collection,

and the provision of a comfortable life for patients.

An important goal of treatment with electronic

media is to give patients the opportunity to maintain

their education effectively without interruption

(Tavşanli, 2013). Telenursing methods are beginning

to demand as health services to support patients in

home care (Higano, 2015). Telenursing refers to the

use of telecommunications and information

technology in the provision of remote nursing care,

which can help solve patient problems, reduce

distance and travel time, and maintain the health

status of patients at home (Higano, 2015).

According Tavşanli (2013) in his research on the

application of telenursing in patients with type 2 DM

recommends that more research to study the impact

of technical innovation on improving disease

management and medical results and prevention of

diabetes complications with good glycemic control

Computer-based tools represent one such approach

that helps support diabetes education provided by

healthcare professionals. Telephone interventions

are very important. Interesting because they are

relatively cheap, easily accommodated around

individual schedules, and possibly improved health

literacy skills than print interventions (Chamany et

al., 2015).

There is some evidence that the use of

Computer-based education can increase knowledge,

motivation, and self-care behavior in diabetics.

Booth et al., (2016) In addition, several studies have

demonstrated the efficiency of indirect forms of

preventive interventions such as telephone, letters,

and consultations via the Internet, may be better

suited to provide preventive interventions, for high-

risk populations at low cost, and allow treatment to

involve more people compared with face-to-face

method (Tokunaga et al., 2014).

The main purpose of this review is to identify the

study used Intervention-based electronic media

education to promote diabetes education and

lifestyle modification of adults with type 2 diabetes.

2 METHODS

2.1 Design

The design of this study is a systematic review,

synthesis of findings from a study comparing the use

of electronic media as a medium of education with

usual care in patients with diabetes mellitus.

2.2 Search Strategy

The method used in this systematic review begins

with topic selection, then the keyword is determined

to search the journal through several databases such

as ProQuest, Ebsco, PubMed, and Science Direct.

The determination of the keyword is based on

PICOT framework (P: diabetes mellitus type 2, I:

internet, computer, telephone, electronics, telehealth,

C: -, O: behavior, lifestyle, blood sugar control, self-

management, T: 2009-2018). A full of literature

search and study selection process in accordance

with the PRISMA guidelines. Studies are included

when describing interventions with electronic media

targeted at patients with type 2 diabetes, focusing on

behavior, biomedical, and psychological.

2.3 Sample

Based on the search results obtained 1072 articles

and 15 articles that meet the inclusion criteria. Each

study creates educational interventions using

electronic media designed to promote diabetes

education and some changes in health behavior.

From 15 journals reviewed 13 articles with

randomized control trial design (RCT) while 2

papers used quasi-experimental design. Each study

uses electronic media designed for the promotion of

diabetes education. There are 5 out of 15 reviewed

papers focusing on behavior change, 11 out of 15

papers focusing on biomedical changes, and 7 out of

10 papers focusing on the psychological aspects.

2.4 Eligibility Criteria

Articles selected for review based on studies that

match inclusion criteria. The inclusion criteria are

electronic use and are not limited by the type of

electronics used as educational media that target

adults with type 2 diabetes mellitus, focusing on

behavioral, biomedical, and psychological changes.

Studies that focus exclusively on glucose monitoring

or electronic health records/web portals to upload

data are not included.

Lifestyle Education Based on Electronic Media for Diabetes Management

221

Figure. 1: flow diagram of search results for lifestyle education based on electronic media for diabetes management

according with the PRISMA guidelines.

3 RESULTS

3.1 Overview of Studies

Based on the search results obtained 1072 articles

and 15 articles that meet the inclusion criteria, 13

articles with randomized control trial design (RCT)

while 2 papers used quasi-experimental design.

Electronic media used from all articles are 8 articles

using telephone, 1 article using DVD, 1 article using

a computer, 1 article using television, 1 article using

videoconveren, and 3 articles using web based.

3.2 Outcome

There are three main results obtained in this review

that is the effect of electronic media as a medium of

education on behavioral, on biomedical, and on the

psychological aspects of patients with type 2

diabetes mellitus.

3.2.1 Behavioral Outcomes

Half of the studies reviewed looked for outcomes for

changes in activity (5/10). Changes in activities

assessed are diet and physical activity. Tokunaga et

al., (2014) reported that computer-based lifestyle

interventions decreased significantly greater energy

intake six months after baseline (p = 0.0099), Karim

et al., (2011) reported had no significant effect on

diabetic self-care behavior after obtaining a

multimedia-based (video) education intervention.

Educational interventions using telephone media can

increase physical activity and decrease nutrient

intake (p = 0.02) (Chamany et al., 2015; Swoboda,

et al., 2017). (Greef et al., 2011) reported that

behavioral modification interventions with the phone

increased their / day move in 2744, their total PA by

23 minutes / day (p <0.001) and decreased their

sedentary behavior by 23 minutes/day (p <0.05).

Additional records identified

through other sources

(n = 156)

Records excluded

(n=810)

Full text articles excluded

(n=18)

Records identified through

database searching

(n = 916)

Records screened

after duplicates

removed

(

n = 843

)

Full text articles

assessed for

eligibility

(n = 33)

Studies included in

integrative review

(n = 15)

ent

ifi

cat

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

222

3.2.2 Biomedical Outcomes

The most widely measured biomedical outcome was

the HbA1c value. All of the biomedical assessments

all measured HbA1c (11/15). Eight research reported

a greater decrease in HbA1c values in the

intervention group than in the control group (Aguiar

et al., 2016; Chamany et al., 2015; Goodarzi et al,

2012; Karim et al, 2011; Moattari et al, 2012; Davis

et al, 2010; Tavşanli, 2013; Yoo An et al, 2010)

Education with telephone effective to decreases the

HbA1c value at six month compared with the

control group (p = 0.013) (Tavşanli, 2013).

Meanwhile, according to Tokunaga Metal., (2014)

no difference HbA1c in the intervention group with

the control group in the use of the computer as

educational media. Dale et al., (2009); Pacaud et al,

(2012) also reported no difference HbA1c in the

intervention group with the control group in the use

of telephone as educational media. Another

biomedical that is also measured is the body mask

index. The use of DVD-based educational media can

significantly reduce BMI (p <0.0001) (Aguiar et al.,

2016). However, telephone-based education

interventions have no effect on BMI (Karim et al.,

2011; Tokunaga et al., 2014).

3.2.3 Psychology Outcomes

There are seven studies reviewed with outcome

psychology. Psychology outcome that many in

measure is self efficacy (6/10). According to (Lari

et al, 2018) the use of teching cd base can improve

self efficacy of type 2 DM patients compared with

control group (P <0.001). Similarly, (Goodarzi et al.,

2012; Swoboda et al., 2017) support telephone

coaching intervention can improve self efficacy

significantly compared to the control group (0.002)

and also effectively reduce stress (0.004), Pacaud et

al., (2012) reports that there is an increase in self-

efficacy after education with web-based. Whereas

other research reported no effect of multimedia-

based education and telephone on self efficacy (Dale

et al., 2009; Karim et al., 2011). Other psychological

data reported by research that electronic-based

education can improve the empowerment of people

with diabetes mellitus type 2 (Zamanzadeh et al,

2016; Swoboda et al 2017)

Table 1: Measured outcomes and results of electronic based type 2 diabetes studies meeting inclusion criteria

Author, year Study

Design

Sampel Outcome results

ehavio

iomedical

sycological

(Tokunaga-

nakawatase,

Nishigaki and

Taru, 2014)

RCT patients with diabetes

mellitus aged 30-60

years n=141

energy

intake

physical

activity

levels

BMI

HbA1c

Colesterol

a significantly greater

decrease in energy

within six months from

the beginning of the

intervention, compared

with control (p =

0.0099) and No

differences were found

in physical energy

expenditure.

(Zamanzadeh,

Zirak and

Hemmati,

2016)

RCT patients with type 2

diabetes n = 66

The

empowerment

There was a

significantly increased

empowerment in the

intervention group

compared with the

control group after

three months of

distance education (p

<0.00, EF = 1.16).

Lifestyle Education Based on Electronic Media for Diabetes Management

223

(Lari,

Tahmasebi

and

Noroozi,

2018)

quasi-

experimental

Patient with

type II

diabetes in the

city of

Bushehr, a

southwestern

province in

Iran.

n = 80

Psycal

activity

Self efficacy

Friend

support

There were significant

differences between the

intervention group and the

control group, health status (p =

0.032), self-efficacy (p <0.001),

peers support in physical activity

(p <0.001), physical activity (P

<0.001), (p <0.001) and

equivalent metabolic task (MET)

(p <0.001).

(Karim

and

Gerber,

2011)

RCT Ethnic

minorities

with type 2

diabetes

received care

from a local

clinic in

Chicago,

Illinois.

n = 129

Physical

activity

HbA1c Self efficacy The results obtained were an

increase in the number of oral

diabetes drugs (p = 0.017).

HbA1c (p = 0.06). There was no

difference between the

intervention and control groups

in self-efficacy, blood pressure,

and diabetes-related behaviors.

The exercise increased in the

control group compared with the

multimedia group (p = 0.016)

(Chamany

et al.,

2015)

RCT Adults with

diabetes

mellitus

n = 941

HbA1c

BMI

Pysical

activity

The results obtained decreased

HbA1c in the intervention group

0.9 and in the control group 0.5

(p = 0.01). Both groups

experienced similar

improvements in self-care

activities, medication adherence,

and intensification.

(Dale et

al., 2009)

RCT Pasient with

diabetes

melitus.

n=231

HbA1c

BMI

Self efficacy The results obtained are no

statistically significant difference

self-efficacy score (p = 0.68),

HbA1c (p = 0.87) or other

secondary outcome measures

between the intervention group

and the control group

(Swoboda,

Miller and

Wills,

2017)

RCT Patient with

diabetes

melitus from

metropolitan

area in the

Midwestern

United States

n=54

Healty

eating

indext

Self efficacy

Diabetes

empowerment

Diabetes

distress

The results obtained were

increased empowerment of

diabetes (p = 0.045), diet quality,

self-efficacy, diabetes

empowerment, and depressive

symptoms (all p <0.05) occurred

in the intervention group.

(Greef et

al., 2011)

quasi-

experimental

Patient with

diabetes

melitus in

endocrinology

department of

the Ghent

University

Hospital,

Belgium

n=92

Pysical

activity

The results obtained were

increased physical activity in the

intervention group compared

with the control group (p

<0.001). After 1 year the

intervention group still had total

physical activity (p <0.001).

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

224

(Aguiar et

al., 2016)

RCT Men with

Type 2

diabetes,

New South

Wales,

Australia

n=101

HbA1c

BMI

weight

The results obtained were the

differences in weight loss between

the intervention group and the

control group (p <0.001), BMI (p

<0.05), and glycated hemoglobin

(P<0.002)

(Tavşanli,

2013)

RCT Patient with

diabetes

melitus

n=48

HbA1c

Blood glucose

The results obtained at the end of

six months monitoring that the

individual A1c levels in EG were

preprandial blood glucose levels of

diabetic patients in EG were lower

than that of prepregulated diabetic

blood glucose in CG significantly.

(Goodarzi

et al.,

2012)

RCT Patient with

diabetes

melitus

n=81

HbA1c,

cholesterol

triglycerides

HDL

LDL

Self

efficacy

The results obtained were

significant differences between

experimental groups compared with

HbA1c control (p = 0.0024), LDL

(p = 0,019), cholesterol (p = 0.002),

and self efficacy (p <0.001).

(Pacaud et

al., 2012)

RCT Patient with

diabetes

melitus

n=79

HbA1c Self

efficacy

The results of the comparison

between the intervention group and

the control group were increased

diabetes knowledge (p = 0.005),

self efficacy (p = 0.019), and self-

care (p = 0.006). Not significant

between group differences in

HbA1C

(Moattari

et al.,

2012)

RCT Patient with

diabetes

melitus

n=48

HbA1c

total

cholesteroHDL

LDLl

The results of the differences

between the intervention and

control groups were HbA1c (p

<0.001) and LDL (P <0.02)

(Yoo et

al., 2010)

RCT Patient with

diabetes

melitus

n=40

HbA1c

blood pressure,

body

mass index,

triglycerides,

HDL

LDL

The result was a significant

decrease in HbA1c value in the

intervention group compared with

the control group (p = 0.031), but

no other value difference between

the groups

(Davis et

al 2010)

RCT Patient with

diabetes

melitus

n=165

HbA1c

LDL

The results obtained were

significant decreases in the first 6

months of HbA1c values in the

intervention group compared with

the control group (p = 0.003),

baseline to 12 months (p = 0.004),

and LDL cholesterol from baseline

to 12 months (p = 0.02

Lifestyle Education Based on Electronic Media for Diabetes Management

225

4 DISCUSSION

People with a family history of type 2 diabetes often

lack sufficient knowledge of lifestyle behaviors in

preventing diabetes and it is difficult for medical

professionals to motivate them to change their

lifestyle habits (Tokunaga et al., 2014). An effective

and efficient medium is needed to assist in the

delivery of information to patients.

This study synthesizes evidence of the use of

electronic media in the provision of lifestyle

education in people with type 2 diabetes mellitus.

The most widely used electronic media is the

telephone. There are 7 papers that use the phone as

an educational media and the each other use

computers, CDs, DVD, multimedia (television) and

web-based.

Two studies have shown improvement in diit

after obtaining educated electronic education

(Swoboda et al., 2017; Tokunaga-nakawatase et al.,

2014). These two studies use different electronic

media, one using a computer (Tokunaga-nakawatase

et al., 2014) and one using a telephone (Swoboda et

al., 2017). This shows that the use of the phone is

not necessarily better than the computer and vice

versa. Two studies have also shown improvement in

physical activity after receiving telephone-based

education interventions (Chamany et al., 2015;

Greef et al., 2011).

In biomedical results, four studies showed

improvement of glycemic profile (HbA1c) compared

with control group (Aguiar et al., 2016; Chamany et

al., 2015; Karim et al, 2011; Tavşanli, 2013).

Interventions applied were education with phone

media (Chamany et al., 2015; Tavşanli, 2013) with

DVD-multimedia (Aguiar et al., 2016) and

television multimedia in patient waiting room

(Karim & Gerber, 2011). While the other 3 studies

show the opposite result where educational

intervention with computer electronic media

(Tokunaga-nakawatase et al., 2014) and telephone

(Dale et al., 2009) did not show significant result in

lowering HbA1c.

Further research is needed to examine effective

methods of using electronic as an educational

medium and an optimal utilization pattern is

required and how the pattern varies according to the

target behavior / outcomes by individual users with

the assumption of some optimal "dose" interaction

with the required electronic-based program (Cotter,

Durant, Agne, & Cherrington, 2014). Another point

that is also often measured in the biomedical aspect

is BMI, from three studies that measured BMI

showed no effect of electronic-based educational

intervention on BMI (Karim & Gerber, 2011;

Tokunaga-nakawatase et al., 2014). This is because

it requires a continuous program in a long time to

generate changes in the value of BMI.

Psychology results in some studies focus more

on self efficacy. Self efficacy is a belief in one's

ability to perform a task that will produce the desired

result. Utilizing self-efficacy counseling skills is an

effective way to improve patient compliance with

self-care activities (Gb and Premkumar, 2016).

There are four studies showing that electronic-based

education intervention can increase self efficacy

significantly (Goodarzi et al., 2012; Lari et al., 2018;

Pacaud et al., 2012; Swoboda et al., 2017) and two

studies show no influence (Dale et al., 2009; Karim

and Gerber, 2011). This is because many factors

influence the self-efficacy so that it is required to

tightly control the other variables that may affect.

Factors that may affect self efficacy are the

previous positive and negative experiences

experienced by others, other people's experiences,

support or ambition from others, psychological and

emotional conditions (Bandura, 1994). In addition to

self-efficacy other factors assessed are stress and

empowerment. Electronic-based education can

reduce stress and increase the empowerment of

people with diabetes mellitus type 2 (Zamanzadeh,

Zirak and Hemmati, 2016; Swoboda, Miller and

Wills, 2017). The greatest challenge of any kind of

educational intervention including by involving

electronic media is to achieve patient adherence to

healthy behaviors over time.

5 CONCLUSIONS

The rapid development of informatics technology

can be utilized in the provision of optimal health

services in patients, especially patients with diabetes

mellitus type 2. Use of electronic media is the most

widely used is the telephone due to its practicality.

The use of electronic media can be an option in

providing educational intervention in patients with

diabetes type 2 can be more effective and efficient.

The study discussed in this paper demonstrates the

ability of electronic-based education interventions to

successfully reach patients and promote appropriate

lifestyle modifications. The results shown can be

concluded that the use of electronic media as an

educational medium in diabetes patients is effective

in changing the behavior, blood sugar control and

patient psychological aspects. This intervention

provides an appropriate choice to facilitate

independent management processes outside of

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

226

clinical settings. However, further research on

utilization patterns that conforms to the assumption

of some optimal "dose" interaction with the

necessary electronic-based programs is required.

REFERENCES

Aguiar, E. J., Morgan, P. J., Collins, C. E., Plotnikoff, R.

C., Young, M. D., & Callister, R. (2016). Efficacy of

the Type 2 Diabetes Prevention Using LifeStyle

Education Program RCT. American Journal of

Preventive Medicine, 50(3), 353–364.

https://doi.org/10.1016/j.amepre.2015.08.020

Bandura. (1994). Self-efficacy. In V. S. Ramachaudran

(Ed.) Encyclopedia of human behavior (Vol. 4, pp. 71-

81). New York: Academic Press.

Booth, A. O., Lowis, C., Hunter, S. J., Dean, M.,

Cardwell, C. R., & Mckinley, M. C. (2016).

Development and Evaluation of a Computer - Based ,

Self - Management Tool for People Recently

Diagnosed with Type 2 Diabetes, 2016.

https://doi.org/10.1155/2016/3192673

Chamany, S., Walker, E. A., Schechter, C. B., Gonzalez, J.

S., Davis, N. J., Ortega, F. M., … Silver, L. D. (2015).

Telephone Intervention to Improve Diabetes Control.

American Journal of Preventive Medicine, 1–10.

https://doi.org/10.1016/j.amepre.2015.04.016

Cotter, A. P., Durant, N., Agne, A. A., & Cherrington, A.

L. (2014). Journal of Diabetes and Its Complications

Internet interventions to support lifestyle modi fi

cation for diabetes management : A systematic review

of the evidence ☆ , ☆☆. Journal of Diabetes and Its

Complications, 28(2), 243–251.

https://doi.org/10.1016/j.jdiacomp.2013.07.003

Dale, J., Caramlau, I., Sturt, J., Friede, T., & Walker, R.

(2009). Patient Education and Counseling Telephone

peer-delivered intervention for diabetes motivation

and support : The telecare exploratory RCT, 75, 91–

98. https://doi.org/10.1016/j.pec.2008.09.014

Departemen Kesehatan RI. (2014). Pusat Data dan

Informasi Kementerian Kesehatan RI: Situasi dan

Analisis Diabetes. Jakarta.

Gb, M., & Premkumar, J. (2016). Eff ects of a Behavioral

Intervention on Self-Effi cacy , Self- Care Behavior

and HbA1c Values among Patients with Type 2

Diabetes Mellitus, 1–6.

Goodarzi, M., Ebrahimzadeh, I., Rabi, A., Saedipoor, B.,

& Jafarabadi, M. A. (2012). Impact of distance

education via mobile phone text messaging on

knowledge , attitude , practice and self efficacy of

patients with type 2 diabetes mellitus in Iran, 1–8.

Greef, K. P. De, Deforche, B. I., Ruige, J. B., Bouckaert,

J. J., Tudor-locke, C. E., Kaufman, J., &

Bourdeaudhuij, I. M. De. (2011). Patient Education

and Counseling The effects of a pedometer-based

behavioral modification program with telephone

support on physical activity and sedentary behavior in

type 2 diabetes patients. Patient Education and

Counseling, 84(2), 275–279.

https://doi.org/10.1016/j.pec.2010.07.010

Higano, K. (2015). The Effects of Telenursing with Goal

Attainment Scaling in Diabetic Patients

: A Case

Report International Journal of Nursing & Clinical

Practices, 2, 6–8.

International Diabetes Federation (IDF) . (2013). IDF

Diabetes Atlas Sixth Edition, International Diabetes

Federation (IDF).

Karim, M. A. K. S. S. A. G. N. O. P. B. S., & Gerber, J. J.

Y. K. B. S. (2011). A Diabetes Education Multimedia

Program in the Waiting Room Setting, 2, 178–188.

https://doi.org/10.1007/s13300-011-0007-y

Lari, H., Tahmasebi, R., & Noroozi, A. (2018). Diabetes

& Metabolic Syndrome : Clinical Research & Reviews

Effect of electronic education based on health

promotion model on physical activity in diabetic

patients. Diabetes & Metabolic Syndrome: Clinical

Research & Reviews, 12(1), 45–50.

https://doi.org/10.1016/j.dsx.2017.08.013

Moattari, M., Hashemi, M., & Dabbaghmanesh, M. H.

(2012). The impact of electronic education on

metabolic control indicators in patients with diabetes

who need insulin : a randomised clinical control trial,

1–7. https://doi.org/10.1111/j.1365-

2702.2012.04200.x

Pacaud, D., Kelley, H., Downey, A. M., & Chiasson, M.

(2012). Successful Delivery of Diabetes Self-Care

Education and Follow-Up through eHealth Media.

Canadian Journal of Diabetes, 36(5), 257–262.

https://doi.org/10.1016/j.jcjd.2012.08.006

PERKENI. (2015). Pengelolaan dan pencegahan diabetes

melitus tipe 2 di indonesia 2015.

Richard M. Davis, Angela D. H itch, Muhammad M.

Salaam, W illiam H. Herman, Ingrid E. Zimmer-

Galler, E. J. . M.-D. (2010). T e le H e a lth Im p ro

ves D ia b e te s S e lf-M a n a g e m e n t in an U n d e

rs e rv e d C om m unity, 33(8).

https://doi.org/10.2337/dc09-1919.

Swoboda, C. M., Miller, C. K., & Wills, C. E. (2017).

Patient Education and Counseling Impact of a goal

setting and decision support telephone coaching

intervention on diet , psychosocial , and decision

outcomes among people with type 2 diabetes. Patient

Education and Counseling, (2016).

https://doi.org/10.1016/j.pec.2017.02.007

Tavşanli, N. G. (2013). The use of videophone technology

( telenursing ) in the glycaemic control of diabetic

patients : a randomized controlled trial.

https://doi.org/10.7243/2050-0866-2-1

Tokunaga-nakawatase, Y., Nishigaki, M., & Taru, C.

(2014). lifestyle-modification support program using

Lifestyle Intervention Support Software for Diabetes

Prevention ( LISS-DP ) for people with a family

history of type 2 diabetes in a medical checkup

setting : A randomized controlled trial. Primary Care

Diabetes, 8(3), 207–214.

https://doi.org/10.1016/j.pcd.2014.01.007

Yoo, H., An, K., & Ph, D. (2010). Web-Based

Comprehensive Information System for Self-

Lifestyle Education Based on Electronic Media for Diabetes Management

227

Management of Diabetes Mellitus, 12(5).

Zamanzadeh, V., Zirak, M., & Hemmati, M. (2016).

Diabetes & Metabolic Syndrome : Clinical Research &

Reviews Distance education and diabetes

empowerment : A single-blind randomized control

trial. Diabetes & Metabolic Syndrome: Clinical

Research & Reviews.

https://doi.org/10.1016/j.dsx.2016.12.039

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