Introduction

The World Health Organization defines e-health as the combined use of electronic information and communication technology (ICT) in the health sector. According to a systematic review of evaluations of e-health implementations by Blaya et al. (2010), the greatest potential for e-health may lie in systems that improve communication between health-care institutions, support medication ordering and management, and help monitor and improve patient compliance with care regimens. Evaluations of personal digital assistants and mobile devices may also indicate the level of effectiveness in improving data collection time and quality. Despite this potential, there is a severe need for more rigorous evaluation of the effectiveness and cost-effectiveness of these systems in less-developed countries (Blaya et al., 2010; Kahn et al., 2010).

In this study, we used a randomized controlled trial to evaluate the impact of an Internet and SMS-based information intervention on the health promotion and disease management of diabetic patients treated in health-care centers in Montevideo, Uruguay. The intervention granted access to information and materials related to type 2 diabetes through a private website called Diabetes 2.0. The intervention group had unlimited access to the site and could download all available materials at no charge. Materials included articles or brief presentations, videos and images, news, and links to other related websites. Patients in this group received periodic reminders about new topics through email and SMS. In addition, the intervention group had access to a social network through the site, aimed at facilitating the exchange of personal experiences, questions and knowledge between patients that shared the same condition.

Diabetes is one of the most expensive diseases for the health-care system. A recent study in the United States (Dall et al., 2010) shows that the average annual cost per case is $2,864 for undiagnosed diabetes, $9,975 for diagnosed diabetes ($9,677 for type 2 and $14,856 for type 1) and $443 for prediabetes (medical costs only). This amounts to approximately $700 annually for every American, regardless of diabetes status. The prevalence of diabetes in Uruguay is 8.2 percent, with 90 percent of these have type 2 diabetes (Ferrero and Garcia 2005). Patients with diabetes require constant follow-up from the head physician and significant support to achieve self-control.