There is so much information on the World Wide Web that people sometimes forget it is only one part of the Internet. Even today more people use the Internet to exchange e-mail and newsgroup messages than they do to read Web pages.
As the Internet grew slowly during the 1970s and 1980s, it was the exclusive province of government and academia. Government officials and scholars used it to send messages and documents back and forth.
The Internet is the best way to reach people with diabetes.
The transformation of the Internet began when the Web became available in 1991. Tim Berners-Lee, who then worked at CERN, the European Laboratory for Particle Physics in Geneva, Switzerland, created the Web to improve communications within the high-energy physics community. His idea was to let users jump easily from one page to another by simply clicking on hyperlinks.
But it wasn’t until 1993 that the popularity of the Web took off. The Mosaic browser programme allowed text and graphics to be easily combined on the same Web page. Nowadays, most people use even more sophisticated programmes like Microsoft Internet Explorer or Netscape Navigator to read Web pages.
If you wanted to find everything you could on the Web about diabetes, you could log on with your browser and use one of several automated search engines, which are themselves Web pages. All you would need would be a lot of patience and a little knowledge of search strategies.
But the real problem is that unless you were looking for something a lot more specific than diabetes, there is just too much information out there. For example, the comprehensive AltaVista search engine, http://www.altavista.com/, gives you a list of more than one million pages about diabetes.
Much more helpful is to have people to check out the most useful Web sites dealing with diabetes for you. That’s why I started keeping track of “On-line Diabetes Resources” at my Web site in February 1995. I had just been diagnosed with type 2 diabetes and found that I learned more about the disease online than anywhere else.
It was easy then
In those days it was easy to keep track of the diabetes resources. Then, the Internet had just two mailing lists, two newsgroups, and two other Web sites dealing with diabetes. My one resources page has now expanded to 14 separate pages, starting at http://www.mendosa.com/faq.htm. Those pages now link and describe more than 75 mailing lists, 8 newsgroups, and 800 Web sites. And these are just the sites with substantive information about diabetes.
Too many sites
Even that is too many for most busy people to go through. That’s why this booklet selects the some of the more informative Internet resources about diabetes.
Companies make up the largest group of sites and often have information not only about their products but also about the disease. Almost every company selling anything to health-care professionals and individuals with diabetes has a Web site.
Organizations, whether international, national, or local, are also well represented on the Web. In the past two years I‘ve seen a large growth in the number of Web sites maintained by universities, hospitals, and physicians specializing in diabetes. Many individuals too have diabetes-related Web sites. Less well represented are governments and international organizations.
Most Web pages are in English, reflecting the number of English-speakers using this medium. But the number of diabetes-related Web pages in languages other than English, particularly in German and Spanish, has grown rapidly in the past two years. Also represented are pages in Chinese, Croatian, Danish, Dutch, French, Italian, Japanese, Korean, Russian, Portuguese, Norwegian, and Swedish.
How many visitors?
Few site mangers are forthcoming about who and how many people use their sites or even keep good records. One exception is Jeff Hitchcock, who runs the tremendously popular “Children with Diabetes” site at http://www.childrenwithdiabetes.com. When I interviewed him in June 1997 for my column “About the Internet” on the American Diabetes Association's Web site, http://www.diabetes.org, he told me that the site was averaging more than 10,000 hits per day from about 1000 user sessions. By October 1999 the average daily hits had increased to more than 75,000 from about 3800 user sessions. More than 78 per cent of these were from the United States, about 10 per cent were international, and the rest were unknown. The site had visitors from 108 countries.
Like Jeff, whose daughter has type 1 diabetes, most people—61 per cent—who visited his site are a parent of a child with diabetes. Only two per cent described themselves in a recent poll of site users as health-care professionals.
Certainly, there are many more people with diabetes than there are healthcare professionals. But it's probably true that health-care professionals have generally lagged behind their patients in taking advantage of the information resources that the Internet offers.
Other sites have professional journal articles online and therefore see heavier professional use than “Children with Diabetes.” This includes the ADA, the European Association for the Study of Diabetes (EASD) at , The Society for Endocrinology at http://www.endocrinology.org/default.htm, and The Endocrine Society at http://www.endo-society.org/.
Big changes ahead
The big changes that I expect to see on the Internet in the next year or two specifically include more professional journal articles readily available to more users. As publishers implement ways for users to pay for individual articles, more of them will be available without having to subscribe to the journal.
The available statistics about diabetes-related resources indicate that the number of sites, users, and messages increases 100 per cent or more every year. While growth of that magnitude obviously can't continue indefinitely, such rapid growth will certainly introduce unpredictable consequences.
One change will be the further development of specialized sites and forums with a narrower focus than they generally have today. This will be something like “people with diabetes living in the U.S. state of Maine” or “those using insulin pumps,” to cite two recently created mailing lists.
You will see more Web sites, mailing lists, and newsgroups with a local or regional focus. There will also be many more in languages other than English, as the critical mass of users with those languages gets Internet connections.
A slightly edited version of this article appeared as the introduction to Diabetes Online, a booklet published in 2000 by the International Diabetes Federation (ISBN 2-930229-09-8), pages 7-9.
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