Web-based self-management of insulin titration in patients with type 2 diabetes: The Di@log Study


Patients with type 2 diabetes, aged 35-75 years, who are suboptimal controlled with oral antidiabetic agents (i.e. HbA1c > 7.0%), are eligible for treatment with insulin glargine and can use the internet, will be included from general practitioners in the regions of Amsterdam and Twente.

General practices will be randomly assigned and their patients will be allocated to the intervention group or the control group. The intervention group will get education and use an internet programme to self-manage insulin titration. The control group will receive care as usual, i.e. the insulin titration will be arranged by their own general practitioner or practice nurse and the GP or practice nurse is free to do like they are used to with regard to education.


Outcome measures


Primary outcome measure

Difference between intervention and control groups in change in glycaemic control measured by glycosylated haemoglobin concentration (HbA1c).

Secondary outcome measures

Treatment satisfaction, Quality of life, Self-efficacy beliefs, Illness perceptions, Number of hypoglycaemias.



The internet programme functions as a facilitating and supporting tool, where patients can monitor their glucose levels and where feedback and advice will be given, guided by the principles of the theory of self-regulation of Leventhal. This will result in better performance of self-management skills and consequently in better glycaemic control. In addition, we also expect that benefits will be achieved in terms of increases in treatment satisfaction, quality of life and self-efficacy.



The study will start in October 2008 and is expected to report in 2011 and will provide evidence to support or discourage web-based self-management of insulin titration in patients with type 2 diabetes mellitus.