Women in Control: A Virtual World Study of Diabetes Self-Management

The prevalence of diabetes mellitus (DM) in the US is disproportionately high among minority women. In order to participate as partners in healthcare, DM patients need self-management education and support. Diabetes self-management (DSM) support is effective in helping DM patients make good choices and achieve clinical goals but is difficult to deliver in medical practice settings. Virtual reality technology can assist DM patients and their clinical teams with DSM support by providing effective educational tools in an engaging, learner-centered context that fosters self-efficacy and skill proficiency. Our prior work demonstrated that virtual worlds, like Second Life (SL), are suitable for supporting DSM education for patients. SL, an Internet-based virtual world, is an example of an immersive, three-dimensional environment which supports social networking and interaction with information.

The investigators now aim to enhance the existing diabetes curriculum using a medical group visit design to study whether the Women in Control virtual world group medical visit leads to similarly effective health and educational outcomes compared to face-to-face group medical visits. The investigators aims are to conduct a randomized, controlled trial of the comparative effectiveness of a virtual world DSM group medical visit format vs. a face-to-face DSM group visit format to increase physical activity and improve glucose control among Black/African American and Hispanic women with uncontrolled DM at six month follow up, and to conduct a qualitative, ethnographic study of participant engagement with the virtual world platform during the virtual world group sessions, between group sessions, and following completion of the eight-week curriculum to characterize learners' self-directed interactions with the technology platform and assess the correlation of these interactions with DSM behaviors and diabetes control.

Inclusion criteria

• Diagnosed with type 2 diabetes mellitus (documented in the medical chart)
• Last recorded HbA1c >8.0
• Currently treated with diet, oral hypoglycemic agents or insulin
• Black/African American or Hispanic/Latina origin
• Has telephone access
• Able to understand and participate in study protocol
• Functionally capable of meeting the activity goals
• Understand and give informed consent
• Physician approval to participate in study
• Can communicate in English or Spanish

Exclusion criteria

• History of diabetic ketoacidosis
• Currently or planning pregnancy
• Unable or unwilling to provide informed consent
• Plans to leave area within 6 month study period that would interfere with ability to attend 8 weekly sessions and/or 6 month follow up
• Required intermittent glucocorticoid therapy within past 3 months.
• Experienced acute coronary event (myocardial infarction or unsable angina) within previous 6 months
• Medical condition that precludes adherence to study dietary recommendations (i.e. Crohn's, ulcerative colitis, etc)
• Medical or serious psychiatric illness (dementia, suicidal within last 5 months, psychiatric hospitalization). Those with diagnosis of depression or who take antidepressents are eligible.