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Author List:
Conlin PR (VA Boston Healthcare System)
McMahon G (VA Boston Healthcare System)
Gomes H (VA Boston Healthcare System)
Hohne S (VA Boston Healthcare System)
Levine B (Georgetown University Medical Center)
Objectives:
Patients with poorly controlled diabetes mellitus may benefit from care management. A web-based care management program might neutralize access barriers such as scheduling and travel to appointments and help patients improve their diabetes care. We assessed the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes mellitus.
Methods:
We enrolled 104 patients with diabetes mellitus and HbA1c >9.0%. All participants completed a diabetes education class and were then randomized to continue with usual care (n = 52) or participate in a web-based care management program (n = 52). The care management group received a notebook computer, glucose and blood pressure monitoring devices and access to a care management website. The website had educational modules, accepted uploads from monitoring devices, and had an internal messaging system for communication between the patient and the care manager. Algorithms were used to initiate and adjust medications in conjunction with the patients’ primary care providers.
Results:
The mean age of participants was 63 years; nearly all were male. Many had attended college (63%), yet a minority (29%) had prior Internet access. Mean HbA1c was 9.9% (SD 1.0) and mean blood pressure was 140 (SD 20)/80 (SD 10) mm Hg. Participants receiving web-based care management had persistently lower HbA1c over 12 months (P<0.05) when compared to those receiving usual care. Persistent users of the website had greater improvement in HbA1c than intermittent users (-1.9% [n=30] vs. -1.2% [n=22], P<0.05). Greater numbers of website logins were associated with larger declines in HbA1c (P<0.05). Hypertensive participants in the web-based care management group had a greater reduction in systolic blood pressure (P<0.01). HDL cholesterol rose (P<0.05) and triglyceride levels (P<0.01) fell in the web-based care management group.
Implications:
Patients with poorly controlled diabetes mellitus can be successfully managed remotely using web-based care management and achieve improved HbA1c, blood pressure and lipid profiles.
Impacts:
Many patients with diabetes willingly adopt computer use and web-based methods of care coordination. Such an initiative may decrease the need for clinic visits yet increase adherence with clinical guidelines, potentially reducing healthcare utilization of such high-risk patients.
