Web-based care management in patients with poorly controlled diabetes.
OBJECTIVE
To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes.


METHODS
For this study, 104 patients with diabetes and HbA(1c) (A1C) > or =9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager.


RESULTS
Participants receiving web-based care management had lower A1C over 12 months (P < 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (-1.9 vs. -1.2%; P = 0.051) or education and usual care (-1.4%; P < 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile -2.1%, lowest tertile -1.0%; P < 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P < 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P < 0.05).


CONCLUSIONS
Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
Graham T
GT
McMahon
Helen E
HE
Gomes
Sara
S
Hickson Hohne
Tang Ming-Jye
TM
Hu
Betty A
BA
Levine
Paul R
PR
Conlin
D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001900:Boston; D003194:Computer-Assisted Instruction; D003920:Diabetes Mellitus / Q000534:rehabilitation / Q000628:therapy*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006787:Hospitals, Veterans; D006801:Humans; D020407:Internet; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids