Background: Adherence to core type 2 diabetes mellitus (T2DM) treatment behaviors is suboptimal, and nonadherence is generally not limited to one treatment behavior. The internet holds promise for programs that aim to improve adherence. We developed a computer-tailored eHealth program for patients with T2DM to improve their treatment adherence, that is, adherence to both a healthy lifestyle and medical behaviors. Objective: The objective of this study is to examine the effectiveness of the eHealth program in a randomized controlled trial. Methods: Patients with T2DM were recruited by their health professionals and randomized into either the intervention group, that is, access to the eHealth program for 6 months, or a waiting-list control group. In total, 478 participants completed the baseline questionnaire, of which 234 gained access to the eHealth program. Of the 478 participants, 323 were male and 155 were female, the mean age was 60 years, and the participants had unfavorable BMI and HbA1c levels on average. Outcome data were collected through web-based assessments on physical activity (PA) levels, caloric intake from unhealthy snacks, and adherence to oral hypoglycemic agents (OHAs) and insulin therapy. Changes to separate behaviors were standardized and summed into a composite change score representing changes in the overall treatment adherence. Further standardization of this composite change score yielded the primary outcome, which can be interpreted as Cohen d (effect size). Standardized change scores observed in separate behaviors acted as secondary outcomes. Mixed linear regression analyses were conducted to examine the effectiveness of the intervention on overall and separate treatment behavior adherence, accommodating relevant covariates and patient nesting. Results: After the 6-month follow-up assessment, 47.4% (111/234) of participants in the intervention group and 72.5% (177/244) of participants in the control group were retained. The overall treatment adherence improved significantly in the intervention group compared with the control group, reflected by a small effect size (d=0.27; 95% CI 0.032 to 0.509; P=.03). When considering changes in separate treatment behaviors, a significant decrease was observed only in caloric intake from unhealthy snacks in comparison with the control group (d=0.36; 95% CI 0.136 to 0.584; P=.002). For adherence to PA (d=−0.14; 95% CI −0.388 to 0.109; P=.27), OHAs (d=0.27; 95% CI −0.027 to 0.457; P=.08), and insulin therapy (d=0.35; 95% CI −0.066 to 0.773; P=.10), no significant changes were observed. These results from the unadjusted analyses were comparable with the results of the adjusted analyses, the per-protocol analyses, and the sensitivity analyses. Conclusions: Our multibehavior program significantly improved the overall treatment adherence compared with the control group. To further enhance the impact of the intervention in the personal, societal, and economic areas, a wide-scale implementation of our eHealth intervention is suggested. Trial Registration: Netherlands Trial Register NL664; https://www.trialregister.nl/trial/6664

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中文翻译：

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基于网络的计算机定制程序，可改善2型糖尿病患者的治疗依从性：随机对照试验

背景：对核心2型糖尿病（T2DM）治疗行为的依从性欠佳，并且不依从性通常不限于一种治疗行为。互联网对旨在提高依从性的计划抱有希望。我们为T2DM患者开发了计算机量身定制的eHealth程序，以改善他们的治疗依从性，即坚持健康的生活方式和医疗行为。目的：本研究的目的是在一项随机对照试验中检查eHealth计划的有效性。方法：T2DM患者由其卫生专业人员招募，并随机分为干预组（即使用eHealth计划达6个月）或等待名单对照组。共有478名参与者完成了基线调查问卷，其中234位用户可以使用eHealth计划。在478名参与者中，男性323名，女性155名，平均年龄为60岁，参与者的BMI和HbA1c水平平均偏低。通过基于网络的身体活动（PA）水平，不健康零食的热量摄入以及对口服降糖药（OHA）和胰岛素治疗的依从性评估来收集结果数据。对单独行为的变更进行了标准化，并汇总为代表总体治疗依从性变更的综合变更评分。该综合变化评分的进一步标准化产生了主要结果，可以将其解释为Cohen d（效应量）。在单独的行为中观察到的标准化变化评分是次要结果。进行了混合线性回归分析，以检验干预对整体和独立治疗行为依从性，纳入相关协变量和患者嵌套的有效性。结果：经过6个月的随访评估，干预组的参与者为47.4％（111/234），对照组为72.5％（177/244）。与对照组相比，干预组的总体治疗依从性显着改善，这反映在较小的效应量上（d = 0.27； 95％CI 0.032至0.509； P = .03）。当考虑不同治疗行为的变化时，与对照组相比，仅从不健康的零食中摄入的热量显着减少（d = 0.36； 95％CI 0.136至0.584； P = .002）。为了遵守PA（d = -0.14; 95％CI -0.388至0.109; P = .27），OHA（d = 0.27； 95％CI -0.027至0.457； P = .08）和胰岛素治疗（d = 0.35； 95％CI -0.066至0.773； P = .10），未观察到显着变化。未经调整的分析得出的这些结果与调整后的分析，按方案进行的分析和灵敏度分析的结果相当。结论：与对照组相比，我们的多行为方案显着改善了总体治疗依从性。为了进一步增强干预措施在个人，社会和经济领域的影响，建议广泛实施我们的eHealth干预措施。试用注册：荷兰试用注册NL664；https://www.trialregister.nl/trial/6664 未经调整的分析得出的这些结果与调整后的分析，按方案进行的分析和灵敏度分析的结果相当。结论：与对照组相比，我们的多行为方案显着改善了总体治疗依从性。为了进一步增强干预措施在个人，社会和经济领域的影响，建议广泛实施我们的eHealth干预措施。试用注册：荷兰试用注册NL664；https://www.trialregister.nl/trial/6664 未经调整的分析得出的这些结果与调整后的分析，按方案进行的分析和灵敏度分析的结果相当。结论：与对照组相比，我们的多行为方案显着改善了总体治疗依从性。为了进一步增强干预措施在个人，社会和经济领域的影响，建议广泛实施我们的eHealth干预措施。试用注册：荷兰试用注册NL664；https://www.trialregister.nl/trial/6664 为了进一步增强干预措施在个人，社会和经济领域的影响，建议广泛实施我们的eHealth干预措施。试用注册：荷兰试用注册NL664；https://www.trialregister.nl/trial/6664 为了进一步增强干预措施在个人，社会和经济领域的影响，建议广泛实施我们的eHealth干预措施。试用注册：荷兰试用注册NL664；https://www.trialregister.nl/trial/6664

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