title: Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes.
  
  
  METHODS
  Engaging and Motivating Patients Online With Enhanced Resources for Diabetes was a 12-month parallel randomized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin (A1C) values ≥7.5% from primary care sites sharing an electronic health record. The intervention included: (1) wirelessly uploaded home glucometer readings with graphical feedback; (2) comprehensive patient-specific diabetes summary status report; (3) nutrition and exercise logs; (4) insulin record; (5) online messaging with the patient's health team; (6) nurse care manager and dietitian providing advice and medication management; and (7) personalized text and video educational 'nuggets' dispensed electronically by the care team. A1C was the primary outcome variable.
  
  
  RESULTS
  Compared with usual care (UC, n=189), patients in the intervention (INT, n=193) group had significantly reduced A1C at 6 months (-1.32% INT vs -0.66% UC; p<0.001). At 12 months, the differences were not significant (-1.14% INT vs -0.95% UC; p=0.133). In post hoc analysis, significantly more INT patients had improved diabetes control (>0.5% reduction in A1C) than UC patients at 12 months (69.9 (95% CI 63.2 to 76.5) vs 55.4 (95% CI 48.4 to 62.5); p=0.006).
  
  
  CONCLUSIONS
  A nurse-led, multidisciplinary health team can manage a population of diabetic patients in an online disease management program. INT patients achieved greater decreases in A1C at 6 months than UC patients, but the differences were not sustained at 12 months. More INT than UC patients achieved improvement in A1C (>0.5% decrease). Trial registered in clinical trials.gov: #NCT00542204.
authors.affiliation: Innovation Center, Palo Alto Medical Foundation, Palo Alto, CA 94040, USA. tangp@pamf.org
authors.forename: Paul C
authors.initials: PC
authors.lastname: Tang
authors.forename: J Marc
authors.initials: JM
authors.lastname: Overhage
authors.forename: Albert Solomon
authors.initials: AS
authors.lastname: Chan
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Brown
authors.forename: Bahar
authors.initials: B
authors.lastname: Aghighi
authors.forename: Martin P
authors.initials: MP
authors.lastname: Entwistle
authors.forename: Siu Lui
authors.initials: SL
authors.lastname: Hui
authors.forename: Shauna M
authors.initials: SM
authors.lastname: Hyde
authors.forename: Linda H
authors.initials: LH
authors.lastname: Klieman
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Mitchell
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: Lubna S
authors.initials: LS
authors.lastname: Qureshi
authors.forename: Tanya A
authors.initials: TA
authors.lastname: Waltimyer
authors.forename: Leigha J
authors.initials: LJ
authors.lastname: Winters
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012648:Self Care; D017216:Telemedicine; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human