title: A randomized comparison of online- and telephone-based care management with internet training alone in adult patients with poorly controlled type 2 diabetes.
abstract: OBJECTIVE
  Care management may improve the quality of diabetes care by enhancing contact between high-risk patients and their providers. This prospective, longitudinal, randomized trial sought to investigate whether telephone or online care management improves diabetes-related outcomes over time compared with usual care supplemented with Internet access and training.
  
  
  METHODS
  One hundred fifty-one adult subjects with type 2 diabetes mellitus and an elevated hemoglobin A1c (A1c) level (≥8.5%) were randomly assigned to online care management (n=51), telephone-based care management (n=51), or Web training (n=49) groups. Online and telephone participants interacted with a care manager through a diabetes education and care management Web site and by telephone, respectively. The Web training group was provided with online diabetes self-management resources but no care management support. The primary outcome measure was A1c measured every 3 months for a year.
  
  
  RESULTS
  A1c declined significantly and substantially in all groups over 12 months. A1c declined linearly at a rate of 0.32% (P<0.0001) per quarter for the online group, 0.36% (P<0.0001) for the telephone group, and 0.41% for the Web training group (P<0.0001). The rate of change over time did not differ significantly among groups. The groups converged at 12 months with average absolute A1c difference of -1.5%. The number of interactions with care providers was not significantly associated with the change in A1c. Blood pressure, weight, lipid levels, and diabetes distress did not differ among groups over time.
  
  
  CONCLUSIONS
  Online, telephone-based care management, and Web training for diabetes patients with elevated A1c were each associated with a substantial improvement in A1c over a 1-year period. Internet access and training alone may be as effective as care management in patients with poorly controlled diabetes.
authors.affiliation: Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA. gmcmahon@partners.org
authors.forename: Graham T
authors.initials: GT
authors.lastname: McMahon
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Fonda
authors.forename: Helen E
authors.initials: HE
authors.lastname: Gomes
authors.forename: George
authors.initials: G
authors.lastname: Alexis
authors.forename: Paul R
authors.initials: PR
authors.lastname: Conlin
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003194:Computer-Assisted Instruction; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012648:Self Care; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
chemical_list: D001786:Blood Glucose