Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

People with diabetes need to adjust their diet in order to control their blood sugar levels and avoid complications. Healthcare professionals often take dietary histories from patients to help them monitor their dietary intake and provide them with advice. Patient histories may be recorded manually by using oral-and-written methods or via a computer-assisted history taking system. Computer-assisted history taking systems can be used by healthcare professionals, or directly by patients, as in the case of, for example, pre-consultation interviews.They can be used remotely, for example via the Internet, telephone  or on-site. They draw on a range of technologies such as personal computers, personal digital assistants, mobile phones and electronic kiosks; data input can be mediated via, amongst others, keyboards, touch screens and voice-recognition software. Although computer-assisted history taking methods were first used in the 1960s we are still not certain about their effects on dietary history taking in people with diabetes. Therefore, we reviewed the literature to find studies that compare the effects of oral-and-written to those of computer-assisted dietary history taking on the quality of collected data as well as on the quality of patients' lives. We found only one publication with 38 study participants that compared the two methods of history taking over a total of eight weeks. This study found that computer-assisted diet history taking would be as accurate as the oral-and-written method and may potentially allow doctors to spend more time with their patients to discuss as opposed to taking measurements. However, it is not possible to draw reliable conclusions of which of the two methods is more effective from a single small study. We therefore suggest that more primary research is required in this area to allow an informed decision to be made by physicians, patients and policymakers.

Authors' conclusions: 

Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.

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Background: 

Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. 

Objectives: 

To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus.

Search strategy: 

We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status.

Selection criteria: 

Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus.

Data collection and analysis: 

Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently.

Main results: 

Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study.

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