Internet-based Diabetes Education and Case Management

This study is comparing the effectiveness of web-based care management to either telephone-based care management or internet access alone, in patients with poorly controlled diabetes mellitus.

Background:

Patients with diabetes and elevated hemoglobin A1c (HbA1c) are at risk for diabetes-related complications. Care-management may be helpful in these patients, by providing direct contact between such high-risk patients and the healthcare system. Web-based systems have previously shown promise as a means of neutralizing access barriers such as scheduling and travel to appointments and may be of particular help in improving diabetes care.

Objectives:

We examined the efficacy of two methods of diabetes education and care management: (1) a traditional model that involved telephone contact and face-to-face encounters (2) a web-based model with access to a diabetes care management web site. We compared these interventions to a study group that received no education or care management but was provided with a computer and access to diabetes self-management websites.

Methods:

This study employed a randomized, parallel group design involving patients with diabetes mellitus and an elevated HbA1c ( 8.5%). Participants assigned to web-based care management received a notebook computer, Internet access and interacted with a care manager through a diabetes education and care management website. Participants receiving telephone-based care management interacted with a care manager using telephone and face-to-face contact. Both care management models employed medication algorithms to improve glucose and BP control. These care management groups were compared to a study group that had no care management but received a notebook computer and Internet access with their "home page" containing links to a series of diabetes self-management websites (i.e. computer only group). The primary outcome measures were HbA1c, blood pressure, and scores on the Problem Areas in Diabetes (PAID) questionnaire, each measured over 12-months.

Status:

Complete

• Diabetes Mellitus
• Hypertension

• Procedure: Web-based care management
  Participants interact with a care manager, sending and receiving messages using an internet portal that accepts uploads from glucose and BP meters
• Procedure: Telephone and face-to-face care management
  Participants interact with a care manager via face-to-face and telephone contact
• Procedure: Internet access alone
  Participants are given internet access and encouraged to seek diabetes information to help in their self management

• Experimental: Arm 1
  Intervention group
  Intervention: Procedure: Web-based care management
• Active Comparator: Arm 2
  Comparator
  Intervention: Procedure: Telephone and face-to-face care management
• Sham Comparator: Arm 3
  Comparator
  Intervention: Procedure: Internet access alone

• Conlin PR. Genes and environment in blood pressure control--salt intake again shows its importance. Am J Clin Nutr. 2008 Aug;88(2):255-6. No abstract available.
• Kerfoot BP, Conlin PR, Travison T, McMahon GT. Patient safety knowledge and its determinants in medical trainees. J Gen Intern Med. 2007 Aug;22(8):1150-4. Epub 2007 Jun 6.

Inclusion Criteria:

• Diagnosis of diabetes mellitus
• Age 25-79 years
• HbA1c >=8.5%
• Ability to speak and understand English
• Telephone access
• VA-based primary care provider
• Interest in using a glucose and BP monitor and notebook computer

Exclusion Criteria:

• Visual impairment that affects ability to read