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Web-Based Care Management in Patients With Poorly Controlled Diabetes

¹ Division of Endocrinology, Diabetes, and Hypertension Division, Brigham and Women’s Hospital, Boston, Massachusetts
² Medical Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
³ Imaging Science and Information Systems Center, Georgetown University Medical Center, Washington, D.C

Address correspondence and reprint requests to Paul R. Conlin, MD, VA Boston Healthcare System (151-DIA), 150 S. Huntington Ave., Boston, MA 02130. E-mail: paul.conlin{at}med.va.gov

OBJECTIVE—To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes.

RESEARCH DESIGN AND METHODS—For this study, 104 patients with diabetes and HbA_1c (A1C) 9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager.

RESULTS—Participants receiving web-based care management had lower A1C over 12 months (P < 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (–1.9 vs. –1.2%; P = 0.051) or education and usual care (–1.4%; P < 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile –2.1%, lowest tertile –1.0%; P < 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P < 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P < 0.05).

CONCLUSIONS—Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.

Abbreviations: VA, Department of Veterans Affairs

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