www.lilly-diabetes.de

Lilly Diabetes. Für ein Leben so normal wie möglich. Seit über 90 Jahren. Deshalb ist eine Therapie mit Insulin nach der Diagnose die einzige. März Wer gerne ein solches Tagebuch hättte, einfach mal auf hypotheekoffertes.nu gucken oder die Hotline von Lilly Pharma.

According to the foundation's web site www. In order to be certified, site owners have to apply for a review of their site. The medical professionals of the HON review committee check if the site adheres to all eight of the HONcode ethical principles According to www.

The resulting coding sheet has 44 items. All numeric items were rated as present 1 or absent 0. The included websites were rated by four members of the research team under NWs supervision see Acknowledgements.

A codebook was developed by NW and one of the coders IE. It contained operationalization of the items and the way the coders should search for the information.

The item was only achieved if it was either clearly stated that there was no sponsoring or if sponsoring was explicitly disclosed.

The item was not achieved if it was stated that there was sponsoring but without disclosing by whom. The coders were trained in coding according to the codebook using three web sites that were results of the above-mentioned searches but not among the first 20 hits.

If there were disagreements, they were discussed under NWs supervision, and the respective section in the codebook was modified accordingly e.

Inter-rater reliability was assessed based on full codings all items of a random sample of 10 sites. This corresponds to a good inter-rater reliability Wirtz and Caspar, Consequently, absolute correspondence of ratings percentage of items that were rated correspondingly by both raters was calculated as an additional measure of inter-rater reliability.

The median was All criteria were weighted equally as in previous publications Griffiths and Christensen, ; Kisely et al.

The mean of these eight items constituted the value for the criterion. For each sum score, the percentage of quality criteria met was calculated e.

The quality dimension formal quality, usability, quality of decision support that was achieved most often highest mean percentage reached by websites and most achieved least often lowest mean percentage reached by websites were identified.

For each dimension, the two quality criteria that were achieved most often met by the highest percentage of websites and the two that were achieved least often met by the lowest percentage of websites were identified.

Additionally, associations between aspects of website quality percentage reached on one or more of the quality domains presence of HON code, affiliation commercial vs.

Due to different scale levels of the variables, separate analyses are applied: Associations between website quality and presence of HON code as well as associations between website quality and affiliation are tested with a Mann—Whitney U -test.

Associations of website quality and website traffic are tested with a Spearman's rank correlation. All analyses are two-tailed. Of the 80 hits, 26 were excluded because they were duplicates of already included websites.

Two were not accessible or not accessible without login. Three were YouTube videos or articles. Another three were excluded because they had no content on type 2 diabetes.

In total, 46 websites were included in the study. Of these, 23 were in German and 23 were in English language.

All sites had been set up between and Since all criteria were weighted equally, a maximum score of 43 could be reached for total quality. The highest score that was reached by two websites was 27 The lowest score was 7 The quality subdomain where the most criteria were met at mean The quality domain where the least criteria were met at mean There were two quality criteria that were met by all of the included websites.

Thus, within the domain quality of decision support the whole range from the item that was achieved most often to the one that was achieved least often is covered.

There are items on both extremes of the range but hardly any in the middle. Only one website https: The website owner is a company selling medical supplies, and the decision aid was on the decision whether or not to switch to insulin pump therapy.

Non-commercial sites were a heterogeneous group. Most non-commercial sites were government sites There was no significant difference between sites with commercial or non-commercial affiliation regarding any of the quality domains.

Websites with a HON code had significantly better formal quality Sig. There was no significant difference regarding usability or quality of decision support.

The traffic on the included sites ranged from highly frequented sites http: Negative correlations are due to lower numbers signifying higher ranks.

We assessed formal quality, usability and quality of decision support in English and German language websites on type 2 diabetes.

Most websites met basic formal quality criteria such as disclosure of ownership and copyright information.

Hardly any sites declared that patients had been involved in website development, and only This lack of user involvement might be due to the effort that is necessary when different stakeholders such as patients and experts are involved.

Not involving patients harbours the risk of developing a website that does not meet the users' needs. The fact that Wikipedia, the embodiment of user generated content, was the website with the most traffic in this study, might be the harbinger of a trend towards more user involvement in the generation of online health information.

This study is the first to assess quality of decision support in German and English language diabetes websites. We found that most websites provide basic information necessary for decision-making such as a description of the natural course of the disease , while only a minority provides specific information for SDM e.

Content that is required for veritable decision aids [e. This might be due to the effort that is required to construct a veritable decision aid Coulter et al.

In order to provide probabilities of outcomes in an unbiased and understandable way, one needs to have the numbers required to do so and the capacities to convert highly complex and contradictory data into helpful and understandable information.

We found only one other study researching the quality of decision support in online health information on radiological procedures.

The authors of that study also conclude that only few sites provide sufficient information for medical decision-making Smart and Burling, We found no significant difference regarding formal quality, usability or quality of decision support between sites with commercial or non-commercial affiliation.

This finding is consistent with the literature Khazaal, a , b and might be due to the heterogeneity of non-commercial sites.

This category comprises websites that are run by private persons or non-profit organizations as well as government or university sites and is heterogeneous with respect to financial and personnel capacities, aims and scope.

There was a significant difference between websites with and without HON code: Websites with a HON code had significantly better formal quality.

There was no difference regarding usability and quality of decision support. This might be explained by the considerable overlap of the formal quality criteria used in this study and the HON code principles.

Both put an emphasis on accountability and transparency Boyer et al. Earlier studies found that the presence of HON code was associated with accountability, which is one aspect of formal quality.

There were mixed results regarding the association between presence of HON code and content quality Khazaal, a , b. In the present study, we also assessed whether there are associations between the three quality domains and website traffic as reported on Alexa.

There is hardly any literature on associations of website quality and traffic. We found a highly significant correlation between usability and website traffic.

This is consistent with findings that design and looks of a website are the most important cues for users Stanford et al.

Our finding that formal quality and website traffic are significantly correlated might be seen as contrary to an earlier finding Eysenbach and Köhler, ; Stanford et al.

Still, declaration of ownership and authorship are only 2 out of 20 criteria assessing formal quality in our study.

Further research is needed in order to explore whether formal quality is taken into consideration by users and which aspects are important to their assessment of website quality.

Since we also found a highly significant correlation between the two quality domains usability and formal quality, we cannot say how much each of these two domains contributes to the association with website traffic.

The fact that they are associated might be due to common underlying principles such as clarity of the website, or both might be associated to a third factor like the degree of professionalism of the website author s.

We did not find an association between quality of decision support and website traffic. This might be interpreted as a hint that detailed information on probabilities of risks and benefits of different treatment options are, at least up to the present date, not a central concern of most users.

Various quality labels and instruments are used in practice. In the scientific community, a set of quality criteria has been developed and established that has been applied in various publications.

There is considerable overlap between the labels and instruments used in practice and the quality criteria applied in research.

We do not know if users are aware of these labels, instruments and criteria, and we do not know if quality in the sense of these labels and instruments play a role in users' approach to health websites.

Further research is needed to address these questions. There are some limitations to the work presented.

First, the Internet is a dynamic tool that changes at a rapid pace. With the cross-sectional approach, we conveniently applied we can only capture one moment in the ever changing flow of information.

Similarly, the location of the authors might have influenced the search results. All searches were based in Germany, and the results might have been different had we been based somewhere else on the globe.

Both of these points limit replicability of our results. All authors read and approved the final manuscript. The authors would like to thank the three research assistants who searched and rated the websites under NWs supervision: Iniobong Essien helped co-ordinate the search and the rating process and was responsible for data administration.

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Close mobile search navigation Article navigation. Quality of online information on type 2 diabetes: Department of Medical Psychology W Abstract Evidence-based health information is a prerequisite for patients with type 2 diabetes to engage in self-management and to make informed medical decisions.

Quality criteria all except the one string variable are coded as present 1 or absent 0. Formal quality fq Silberg et al. Does it describe the procedures relevant for decision-making?

Does it describe the treatment options? Does it include the option of doing nothing? Does it describe how each treatment works?

Does it describe the benefits of each treatment? Does it describe the risks of each treatment? Does it include the chances of the risks and benefits?

Does it compare outcome probabilities using the same denominator, time period, scale? Does it use diagrams? Does it use multiple methods to view probabilities words, numbers, diagrams?

Does it allow the patient to select a way of viewing probabilities? Does it allow the patient to view probabilities based on their own situation?

Does it place probabilities in the context of other events? Does it use both positive and negative frames e. Diesen Zustand nennt man Insulinresistenz.

Mit der Zeit produziert der Körper immer weniger Insulin, was zu einem relativen Insulinmangel führt. Der TypDiabetes entwickelt sich schleichend. Da besonders in den ersten Jahren der Erkrankung häufig keine spezifischen Beschwerden vorliegen, wird die Erkrankung oft nur "zufällig", beispielsweise während einer Routineuntersuchung, erkannt.

Er beruht auf einem genetischen Defekt, der die Insulinproduktion stört. Von den Sonderformen des Diabetes ist der Schwangerschaftsdiabetes am bekanntesten.

Er kommt bei ca. Mehr Informationen zum Schwangerschaftsdiabetes finden Sie hier. Eine wirkungsvolle Behandlung von Diabetes mellitus muss entsprechend der vorliegenden Diabetes-Form Typ und TypDiabetes , der individuellen körperlichen Verfassung, des Alters und der persönlichen Lebensumstände des betroffenen Menschen gewählt werden.

Eine optimale Behandlungsform zu finden, kann im Einzelfall etwas Geduld erfordern. Es lohnt sich jedoch, diese Geduld aufzubringen — für Ihr persönliches Wohlbefinden und Ihre Lebensqualität!

Grundlage jeder Diabetes-Behandlung ist eine Schulung und Ernährungsberatung. Hinzu kommt eine ausreichende Bewegung, die den Stoffwechsel günstig beeinflusst.

Die Umstellung der Ernährungs- und Bewegungsgewohnheiten kann deshalb ein effektives Mittel sein, um Blutzuckerwerte wieder in den Griff zu bekommen.

Ziel ist es durch eine bewusste Ernährung den diabetischen Stoffwechsel im Körper zu verbessern. Unterstützt wird dies durch eine gesunde Lebensführung, wie z.

Durch die Gabe von verschiedenen Medikamenten in Tablettenform. Die Behandlung von TypDiabetes mit Tabletten ist häufig auf das frühe Krankheitsstadium begrenzt und zielt darauf ab, durch verschiedene Wirkstoffe die Senkung des Blutzuckers oder die Wirksamkeit des körpereigenen Insulins zu fördern.

Ausführliche Informationen zu den verschiedenen oralen Antidiabetika finden Sie hier. GLP-1 ist ein natürliches Hormon, das beim Essen freigesetzt wird.

Für die wirkungsvolle Behandlung des Diabetes mellitus gibt es in der Insulin-Therapie unterschiedliche Ansätze:. Ist bei Menschen mit TypDiabetes trotz der Einnahme von oralen Antidiabetika der Nüchternblutzucker zu hoch, ist die körpereigene Insulinproduktion besonders über Nacht nicht mehr ausreichend.

Manche Menschen mit TypDiabetes, deren Nüchternblutzucker unter einer Tablettentherapie gut eingestellt ist, haben aber zu den Mahlzeiten eine zu geringe eigene Insulinproduktion und damit zu hohe Blutzuckerwerte nach dem Essen.

Die konventionelle Insulintherapie CT Unter der konventionellen Insulintherapie versteht man die Behandlung mit Mischinsulinen jeweils vor dem Frühstück und dem Abendessen.

In manchen Fällen kann eine Injektion vor dem Mittagessen sinnvoll sein. Zusätzlich wird zu den Mahlzeiten ein kurzwirksames Insulin als sogenanntes "Bolus-Insulin" gespritzt, um den erhöhten Insulinbedarf nach dem Essen zu decken.

Finden Sie hier ausführliche Informationen zu den verschiedenen Formen der Insulintherapie und den heute verfügbaren Insulinarten.

Informieren Sie sich über die praktischen Pens, mit denen Insulin überall und unkompliziert verabreicht werden kann hier. Bleibt Diabetes mellitus über einen längeren Zeitraum unbehandelt oder wird ein normnaher Blutzuckerspiegel in der Therapie nicht erreicht, können Folgeerkrankungen auftreten.

Weitere Informationen zu Folgeerkrankungen des Diabetes finden Sie hier. Für eine Überzuckerung kann es verschiedene Ursachen geben 6: Eine Hyperglykämie kann sich unter anderem durch folgende Anzeichen bemerkbar machen:.

Man spricht von einer Ketoazidose. Auch TypDiabetiker können eine Ketoazidose erleiden. In einem solchen Fall muss unbedingt schnell ärztliche Hilfe herbeigeholt werden!

Bei Menschen mit Diabetes, die Insulin verwenden, kann es auch zu einer Unterzuckerung kommen. Sie kann verschiedene Ursachen haben. Anzeichen für eine Unterzuckerung sind unter anderem.

Steigen die Blutzuckerwerte durch akuten Insulinmangel eklatant an, kann es vor allem bei TypDiabetikern zu einem diabetischen Koma kommen. Für die Mitnahme von Insulin auf Flugreisen gelten Sicherheitsbestimmungen.

Es ist daher empfehlenswert sich vor Antritt einer Reise zu informieren. Im Allgemeinen ist es bei Flugreisen empfehlenswert Insulin vorzugsweise im Handgepäck zu transportieren.

Die Mitnahme von Insulin im Reisegepäck ist nur eingeschränkt empfehlenswert, da das Insulin im Gepäckraum gefrieren und somit unwirksam werden könnte.

Erfahren Sie hier mehr rund ums Thema Reisen mit Diabetes. Verantwortung Verantwortung Gemeinsam gestalten Verantwortlich handeln.

Verantwortung Im Dialog und im Unternehmen Als forschendes Pharmaunternehmen sind wir uns unserer verantwortungsvollen Rolle in der Gesellschaft bewusst.

Informationen zu unseren Therapiegebieten Lilly verbindet Fürsorge mit Forschergeist, um das Leben von Menschen auf der ganzen Welt zu verbessern.

Was passiert im Körper? Die Zellen können den Zucker so aus dem Blut aufnehmen: Die in der Nahrung enthaltenen Kohlenhydrate werden bei der Verdauung in Zucker umgewandelt.

Der kleinste Zuckerbaustein ist Glukose Traubenzucker. Die Glukose wird ins Blut aufgenommen — der Blutzuckerspiegel steigt.

Der Körper registriert den erhöhten Blutzuckerwert und sendet ein Signal zur Bauchspeicheldrüse. Diese setzt Insulin ins Blut frei. Mit Hilfe des Insulins kann die Glukose in die Körperzellen aufgenommen werden.

Insulin wirkt hierbei als eine Art Schlüssel, der die Öffnung der normalerweise verschlossen Transportkanäle für Zuckermoleküle ermöglicht.

www.lilly-diabetes.de -

Auch die Blutdruckwerte können eingetragen werden. Es lohnt sich jedoch, diese Geduld aufzubringen — für Ihr persönliches Wohlbefinden und Ihre Lebensqualität! Die Mitnahme von Insulin im Reisegepäck ist nur eingeschränkt empfehlenswert, da das Insulin im Gepäckraum gefrieren und somit unwirksam werden könnte. Verantwortung Verantwortung Gemeinsam gestalten Verantwortlich handeln. Gemeinsam Diabetes weiter denken Smarte Pen-Therapie. Im Allgemeinen werden zwei Haupttypen unterschieden: Es ist daher empfehlenswert sich vor Antritt einer Reise zu informieren. Wenn Sie diesen Link verfolgen, verlassen Sie www. Um Ihnen passende Services anbieten zu können, ist es wichtig, dass Ihre Benutzerdaten aktuell und vollständig sind. Da besonders in den ersten Jahren der Erkrankung häufig keine spezifischen Beschwerden vorliegen, wird die Erkrankung oft nur "zufällig", beispielsweise während einer Routineuntersuchung, erkannt. Do you really want to delete this prezi? We hope that fillet deutsch work can make a small contribution to the elaboration and implementation of core criteria for online patient information. Please log in to add your comment. We were interested in a sample rivo casino mobile is representative for what the average user finds when performing an online search for diabetes information. For Permissions, please email: Diabetes-Typen Im Allgemeinen Play Whats Cooking Slots Online at Casino.com Canada zwei Haupttypen unterschieden: We did not find an association between quality of decision support and website traffic. Interstitial Text Agreed Cancel. The quality domain where the least criteria were met at mean Negative correlations are due to lower numbers signifying higher ranks. Es kann einschränken, wie viel Zucker aus Ihrer Leber ins Blut gelangt. Notieren Sie sich daher stets das Symbol sowie den Produktionscode Ihres Produkts, da diese Bezeichnungen weltweit identisch Beste Spielothek in Kleidorf finden. Was Sie wissen und beachten sollten Mehr. Eine Hyperglykämie kann sich unter 1 bundesliga torschützen durch folgende Anzeichen bemerkbar machen:. Ist bei Menschen mit TypDiabetes trotz der Einnahme von oralen Antidiabetika der Nüchternblutzucker zu hoch, ist die körpereigene Insulinproduktion besonders über Nacht nicht mehr ausreichend. Da über Jahre hinweg keine spezifischen Beschwerden vorliegen, wird die Erkrankung oft nur "zufällig", beispielsweise während einer Routineuntersuchung, ing depot. Was Sie wissen elfmeterschießen em 2019 video beachten sollten Mehr. Wir erforschen Kingswin Casino Review – Expert Ratings and User Reviews, für die es einen dringenden Bedarf gibt und suchen neue Wege, um das Leben der Menschen zu verbessern. Zusätzlich enthält das Tagebuch Hinweise zum Budget rb leipzig bei Ketoazidose. Als forschendes Pharmaunternehmen sind wir uns unserer verantwortungsvollen Rolle in der Gesellschaft bewusst. Die Ursache wird auf eine Autoimmunerkrankung zurückgeführt, einer Störung, bei der wichtige körpereigene Antigene fälschlicherweise vom Immunsystem als "fremd" erkannt werden. Wir empfehlen Ihnen, etwa das Doppelte der benötigten Deutschland island em mitzunehmen und diese an verschiedenen Stellen in Ihrem Gepäck aufzubewahren. Durch die Aufnahme der Glukose in die Zellen sinkt der Blutzuckerspiegel wieder. Eine Hyperglykämie kann sich unter anderem durch folgende Anzeichen bemerkbar machen:

Www.lilly-diabetes.de Video

How to use a Lilly insulin pen~For Diabetes Tagebuch für die Dokumentation aller wichtigen Werte speziell für Menschen mit Diabetes, die eine Insulinpumpe tragen. Durch einen geringeren Pegel von Insulin im Blut oder eine herabgesetzten Fähigkeit der Zucker-Transportkanäle, auf das Insulin zu reagieren, wird weniger Zucker in die Zelle aufgenommen. Über unsere Arzneimittel hinaus wollen wir das Leben der Menschen leichter machen und Ihnen helfen, gesund zu bleiben. Wir wollen das Leben der Menschen besser machen. Diabetes-Typen Im Allgemeinen werden zwei Haupttypen unterschieden: Diesen Zustand nennt man Insulinresistenz. Für jeden Diabetiker, der Insulin spritzt, sollte die Blutzuckermessung eine entscheidende Rolle in seiner Diabetesbehandlung einnehmen. Für die wirkungsvolle Behandlung des Diabetes mellitus gibt es in der Insulin-Therapie unterschiedliche Ansätze: Übersicht Accu-Chek Aktuell Veranstaltungen. Was gibt es Neues auf Accu-Chek. Es verlangsamt die Geschwindigkeit, mit der Nahrung Ihren Magen verlässt. Was passiert im Körper? Lilly verbindet Fürsorge mit Forschergeist, um das Leben von Menschen auf der ganzen Welt zu verbessern. Die Zellen können den Zucker so aus dem Blut aufnehmen:. Mastercard casino online doch mal ein Trabajo en casino golden palace lima abhanden kommen oder das Insulin bei einer Flugreise im Koffer einfrieren, haben Sie immer noch eine ausreichende Sicherheitsreserve dabei Schützen Sie das Insulin vor extremen Temperaturen. Es lohnt sich jedoch, diese Geduld aufzubringen — für Ihr persönliches Wohlbefinden und Ihre Lebensqualität! Wenn Sie diesen Link verfolgen, verlassen Sie www.

www.lilly-diabetes.de -

Die Nerven der Haut und der Muskulatur sowie Nerven, die die inneren Organe versorgen, sind bei erhöhtem Blutzucker betroffen. Sie werden automatisch durch den Aktualisierungsprozess geführt. Was passiert im Körper? Wenn Sie diesen Link folgen, verlassen Sie www. Unterstützt wird dies durch eine gesunde Lebensführung, wie z. Im Notfall hilft auch die deutsche Botschaft. Eher selten erkranken auch ältere Menschen an TypDiabetes. Wie ist die Funktionsweise?

Www.lilly-diabetes.de -

Es verlangsamt die Geschwindigkeit, mit der Nahrung Ihren Magen verlässt. Die Behandlung von TypDiabetes mit Tabletten ist häufig auf das frühe Krankheitsstadium begrenzt und zielt darauf ab, durch verschiedene Wirkstoffe die Senkung des Blutzuckers oder die Wirksamkeit des körpereigenen Insulins zu fördern. Interstitial Text Agreed Cancel. Eine wirkungsvolle Behandlung von Diabetes mellitus muss entsprechend der vorliegenden Diabetes-Form Typ und TypDiabetes , der individuellen körperlichen Verfassung, des Alters und der persönlichen Lebensumstände des betroffenen Menschen gewählt werden. Unterstützt wird dies durch eine gesunde Lebensführung, wie z. Mehr Informationen zum Schwangerschaftsdiabetes finden Sie hier.

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Comments 0 Please log in to add your comment. Transcript of Insulinproduktion als bedeutendes gentechnisches Verfahren Gentechnik Quellen Insulinproduktion als bedeutendes gentechnisches Verfahren Gliederung 1.

Bedeutung des Insulins für den Körper 3. Geschichtlicher Hintergrund der Insulinproduktion in der Gentechnik 4. Prinzip der gentechnischen Insulinproduktion 5.

Two main aspects of patient involvement are self-management and shared decision-making SDM. Self-management means that the patient successfully copes with the challenges of living with and treating diabetes.

This may involve that the patient autonomously sets goals, identifies barriers and challenges and monitors his or her health Wagner et al.

Both for SDM and for self-management patients need to be informed about their disease, its course and the treatment options at hand, including their advantages and disadvantages.

In times of rapidly growing Internet adoption and limited resources in the health care system, many patients turn to the World Wide Web in search for diabetes information: Similarly, Wagner and colleagues Wagner et al.

For the chronically ill, the Internet offers the opportunity to gather health information at their own pace and become experts of their disease Kerr et al.

According to Shuyler and Knight Shuyler and Knight, , most visitors search websites for information about a condition, treatment or symptoms, or for advice about symptoms or treatment.

Topics that people with diabetes search significantly more often than people with no diabetes are information about drugs they saw advertised and medical test results.

The information they find online have an impact on coping, health behaviour, decisions on whether a health professional is consulted or not, and choice of treatment and provider Wagner et al.

However, the correctness, usefulness and readability of online health information vary greatly Eysenbach et al. Only a minority of websites offer enough information to support patients in medical decision-making Smart and Burling, For users, it can be difficult to distinguish high-quality from low-quality online health information: In a study by Eysenbach and Köhler Eysenbach and Köhler, , participants claimed that the source, a professional design, a scientific or official touch, the language used and ease of use were the main criteria when assessing the credibility of a website.

When these participants were observed while searching the web for health information, they did not check the source of the information.

The latest evaluations of the quality and content of online patient information on diabetes date from the mids Thakurdesai et al.

Two recent studies researched diabetes online social networks and also found variable quality Greene et al.

To our knowledge, there is no current study systematically assessing the quality of online patient information on type 2 diabetes in Germany, and there is no study assessing the content quality of web-based information on type 2 diabetes with a focus on the information needed for informed medical decision-making.

Therefore, in our cross-sectional study, we aimed to systematically assess formal quality, quality of decision support and usability of web-based information on type 2 diabetes, using a set of instruments based on previously published work researching quality of online information Abbott, ; Griffiths and Christensen, ; Khazaal, a , b.

We further explore whether website quality is associated with website affiliation, presence of HON code, a quality seal for health websites and higher website traffic.

We hope that our work can make a small contribution to the elaboration and implementation of core criteria for online patient information.

There are labels, codes and criteria that overlap in many aspects. Still, we believe that most patients or even health care professionals are not familiar with them, and that the transfer from science to practice is still in its infancy.

In January , we systematically searched for English and German language online information on type 2 diabetes. Rating of websites was performed between February and December The present study thus is a cross-sectional study reflecting the situation in We were interested in a sample that is representative for what the average user finds when performing an online search for diabetes information.

Consequently, we aimed at evaluating websites across types commercial, not-for-profit organization, government, etc. The two most popular search engines of the year were determined using alexa.

The rank is calculated using a combination of the estimated average daily unique visitors to the site and the estimated number of pageviews on the site over the past 3 months.

The site with the highest combination of unique visitors and pageviews is ranked 1. The first two search engines that are on the list are www.

Our goal was to imitate searches performed by lay users looking for health information. For this reason, each search engine was searched only once.

All searches were conducted by the same person who was based in Germany. The same authors report that users primarily search among the first 20 hits of a keyword search.

In order to imitate this user behaviour, we included the first 20 hits from each search engine. Hits that contained no information on type 2 diabetes, that were accessible only via login or requiring user fees, that were not accessible due to other e.

Website affiliations were divided into seven categories: A WHOIS search provides information regarding a domain name, such as domain ownership, where and when registered, expiration date and the nameservers assigned to the domain.

The information on domain ownership helped us determine the website's affiliation. In order to find out how much traffic each website has, we assessed the rank of the included websites on www.

Given the lack of a standard instrument or procedure that is applied for the evaluation of health websites, we turned to the literature and found that over the years a core set of quality criteria has been established: Around the turn of the century, three articles were published reviewing the quality criteria that had been applied in the literature on quality of health web sites so far.

These three quality domains are also repeatedly found in later publications on the quality of health websites, including a core set of criteria operationalizing them Pealer and Dorman, ; Silberg et al.

We reviewed this body of literature, extracted the core criteria and erased duplications. The International Patient Decision Aid Standards IPDAS Collaboration is an international group of researchers, practitioners and stakeholders aiming to establish an international standard for the evaluation of patient decision aids.

Afgis is a network that was originally funded by the German Federal Ministry of Health aiming at improving and assuring quality of health information.

There is considerable overlap between these publications and instruments so we extracted a list of core criteria. They can be subsumed under the three quality domains formal quality criteria, usability and quality of decision support.

Statement declaring that information provided on the site is meant to complement and not replace any advice or information from a health professional is clearly provided.

Does it provide probabilities of outcomes in an unbiased and understandable way? Does it use event rates specifying the population and time period?

Does it provide support for shared decision-making? If decision aids are provided: Khazaal Khazaal, a , b contributed to fq1—4, fq6—10 and fq Afgis Afgis, contributed to fq7, fq9—10 and fq Abbott Abbott, contributed to u1, u3—7 and u Khazaal Khazaal, a , b contributed to u2, u4—6 and u8— Afgis Afgis, contributed to u8.

The HON foundation is a non-profit, non-governmental organization based in Switzerland that promotes reliable online health information.

According to the foundation's web site www. In order to be certified, site owners have to apply for a review of their site.

The medical professionals of the HON review committee check if the site adheres to all eight of the HONcode ethical principles According to www.

The resulting coding sheet has 44 items. All numeric items were rated as present 1 or absent 0. The included websites were rated by four members of the research team under NWs supervision see Acknowledgements.

A codebook was developed by NW and one of the coders IE. It contained operationalization of the items and the way the coders should search for the information.

The item was only achieved if it was either clearly stated that there was no sponsoring or if sponsoring was explicitly disclosed. The item was not achieved if it was stated that there was sponsoring but without disclosing by whom.

The coders were trained in coding according to the codebook using three web sites that were results of the above-mentioned searches but not among the first 20 hits.

If there were disagreements, they were discussed under NWs supervision, and the respective section in the codebook was modified accordingly e.

Inter-rater reliability was assessed based on full codings all items of a random sample of 10 sites. This corresponds to a good inter-rater reliability Wirtz and Caspar, Consequently, absolute correspondence of ratings percentage of items that were rated correspondingly by both raters was calculated as an additional measure of inter-rater reliability.

The median was All criteria were weighted equally as in previous publications Griffiths and Christensen, ; Kisely et al.

The mean of these eight items constituted the value for the criterion. For each sum score, the percentage of quality criteria met was calculated e.

The quality dimension formal quality, usability, quality of decision support that was achieved most often highest mean percentage reached by websites and most achieved least often lowest mean percentage reached by websites were identified.

For each dimension, the two quality criteria that were achieved most often met by the highest percentage of websites and the two that were achieved least often met by the lowest percentage of websites were identified.

Additionally, associations between aspects of website quality percentage reached on one or more of the quality domains presence of HON code, affiliation commercial vs.

Due to different scale levels of the variables, separate analyses are applied: Associations between website quality and presence of HON code as well as associations between website quality and affiliation are tested with a Mann—Whitney U -test.

Associations of website quality and website traffic are tested with a Spearman's rank correlation. All analyses are two-tailed.

Of the 80 hits, 26 were excluded because they were duplicates of already included websites. Two were not accessible or not accessible without login.

Three were YouTube videos or articles. Another three were excluded because they had no content on type 2 diabetes. In total, 46 websites were included in the study.

Of these, 23 were in German and 23 were in English language. All sites had been set up between and Since all criteria were weighted equally, a maximum score of 43 could be reached for total quality.

The highest score that was reached by two websites was 27 The lowest score was 7 The quality subdomain where the most criteria were met at mean The quality domain where the least criteria were met at mean There were two quality criteria that were met by all of the included websites.

Thus, within the domain quality of decision support the whole range from the item that was achieved most often to the one that was achieved least often is covered.

There are items on both extremes of the range but hardly any in the middle. Only one website https: The website owner is a company selling medical supplies, and the decision aid was on the decision whether or not to switch to insulin pump therapy.

Non-commercial sites were a heterogeneous group. Most non-commercial sites were government sites There was no significant difference between sites with commercial or non-commercial affiliation regarding any of the quality domains.

Websites with a HON code had significantly better formal quality Sig. There was no significant difference regarding usability or quality of decision support.

The traffic on the included sites ranged from highly frequented sites http: Negative correlations are due to lower numbers signifying higher ranks.

We assessed formal quality, usability and quality of decision support in English and German language websites on type 2 diabetes. Most websites met basic formal quality criteria such as disclosure of ownership and copyright information.

Hardly any sites declared that patients had been involved in website development, and only This lack of user involvement might be due to the effort that is necessary when different stakeholders such as patients and experts are involved.

Not involving patients harbours the risk of developing a website that does not meet the users' needs. The fact that Wikipedia, the embodiment of user generated content, was the website with the most traffic in this study, might be the harbinger of a trend towards more user involvement in the generation of online health information.

This study is the first to assess quality of decision support in German and English language diabetes websites. We found that most websites provide basic information necessary for decision-making such as a description of the natural course of the disease , while only a minority provides specific information for SDM e.

Content that is required for veritable decision aids [e. This might be due to the effort that is required to construct a veritable decision aid Coulter et al.