title: Web-based collaborative care for type 1 diabetes: a pilot randomized trial.
abstract: BACKGROUND
  To determine whether a Web-based diabetes case management program based in an electronic medical record can improve glycemic control (primary outcome) and diabetes-specific self-efficacy (secondary outcome) in adults with type 1 diabetes, a pilot randomized controlled trial was conducted.
  
  
  METHODS
  A 12-month randomized trial tested a Web-based case management program in a diabetes specialty clinic. Patients 21-49 years old with type 1 diabetes receiving multiple daily injections with insulin glargine and rapid-acting analogs who had a recent A1C >7.0% were eligible for inclusion. Participants were randomized to receive either (1) usual care plus the nurse-practitioner-aided Web-based case management program (intervention) or (2) usual clinic care alone (control). We compared patients in the two study arms for changes in A1C and self-efficacy measured with the Diabetes Empowerment Scale.
  
  
  RESULTS
  A total of 77 patients were recruited from the diabetes clinic and enrolled in the trial. The mean baseline A1C among study participants was 8.0%. We observed a nonsignificant decrease in average A1C (-0.48; 95% confidence interval -1.22 to 0.27; P = 0.160) in the intervention group compared to the usual care group. The intervention group had a significant increase in diabetes-related self-efficacy compared to usual care (group difference of 0.30; 95% confidence interval 0.01 to 0.59; P = 0.04).
  
  
  CONCLUSIONS
  Use of a Web-based case management program was associated with a beneficial treatment effect on self-efficacy, but change in glycemic control did not reach statistical significance in this trial of patients with moderately poorly controlled type 1 diabetes. Larger studies may be necessary to further clarify the intervention's impact on health outcomes.
authors.affiliation: Department of Health Services, University of Washington , Seattle, Washington 98195, USA. kpm25@u.washington.edu
authors.forename: Kelly P
authors.initials: KP
authors.lastname: McCarrier
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
authors.forename: Ginny
authors.initials: G
authors.lastname: Lewis
authors.forename: Diane P
authors.initials: DP
authors.lastname: Martin
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Zimmerman
authors.forename: Harold I
authors.initials: HI
authors.lastname: Goldberg