Online Disease Management System Supports Improvement of Patients with Diabetes

Diabetes patients who received a Web-based intervention that supported case management and dietary counseling improved their blood sugar levels over time, suggests an AHRQ-supported study. Patients who received online support from a nurse-led multidisciplinary team achieved greater improvement in their A1C levels than patients who received standard diabetes management from a primary care provider. The study, “Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial,” appeared in the November edition of the Journal of the American Medical Informatics Association. Select to access the abstract on PubMed.®

2012 Nov 20. [Epub ahead of print]

Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial.

Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, Hui SL, Hyde SM, Klieman LH, Mitchell CJ, Perkins AJ, Qureshi LS, Waltimyer TA, Winters LJ, Young CY.

Source

Innovation Center, Palo Alto Medical Foundation, Palo Alto, California, USA.

Abstract

OBJECTIVE:

To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes.

MATERIALS AND 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 -0.95="" .001="" 12="" analysis="" at="" control="" diabetes="" differences="" had="" hoc="" improved="" in="" int="" months="" more="" not="" p="0.133)." patients="" post="" significant="" significantly="" the="" uc="" vs="" were="">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.