Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial
Paul C Tang, J Marc Overhage, Albert Solomon Chan, Nancy L Brown, Bahar Aghighi, Martin P Entwistle, Siu Lui Hui, Shauna M Hyde, Linda H Klieman, Charlotte J Mitchell, Anthony J Perkins, Lubna S Qureshi, Tanya A Waltimyer, Leigha J Winters, Charles Y Young, Paul C Tang, J Marc Overhage, Albert Solomon Chan, Nancy L Brown, Bahar Aghighi, Martin P Entwistle, Siu Lui Hui, Shauna M Hyde, Linda H Klieman, Charlotte J Mitchell, Anthony J Perkins, Lubna S Qureshi, Tanya A Waltimyer, Leigha J Winters, Charles Y Young
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<0.001). 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.
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References
- Cheung BM, Ong KL, Cherny SS, et al. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med 2009;122:443–53
- Engelgau MM, Geiss LS, Saaddine JB, et al. The evolving diabetes burden in the United States. Ann Intern Med 2004;140:945–50
- Hoerger TJ, Segel JE, Gregg EW, et al. Is glycemic control improving in U.S. adults? Diabetes Care 2008;31:81–6
- Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996;74:511–44
- Wagner EH. The role of patient care teams in chronic disease management. BMJ 2000;320:569–72
- Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006;13:121–6
- Tang PC, Lansky D. The missing link: bridging the patient-provider health information gap. Health Aff (Millwood) 2005;24:1290–5
- Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008;15:1–7
- Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288:1775–9
- Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001;39:II2–45
- Pocock SJ. Clinical trials, a practical approach. Chichester: John Wiley and Sons, 1991
- Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care 2012;35(Suppl 1):S101–8
- Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32: 193–203
- Polonsky WH, Anderson BJ, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care 1995;18:754–60
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13
- Cebul RD, Love TE, Jain AK, et al. Electronic health records and quality of diabetes care. N Engl J Med 2011;365:825–33
- Seitz P, Rosemann T, Gensichen J, et al. Interventions in primary care to improve cardiovascular risk factors and glycated haemoglobin (HbA1c) levels in patients with diabetes: a systematic review. Diabetes Obes Metab 2011;13:479–89
- Franc S, Daoudi A, Mounier S, et al. Telemedicine and diabetes: achievements and prospects. Diabetes Metab 2011;37:463–76
- Shea S, Weinstock RS, Starren J, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus. J Am Med Inform Assoc 2006;13:40–51
- Shea S, Weinstock RS, Teresi JA, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc 2009;16:446–56
- Ralston JD, Hirsch IB, Hoath J, et al. Web-based collaborative care for type 2 diabetes: a pilot randomized trial. Diabetes Care 2009;32:234–9
- Quinn CC, Shardell MD, Terrin ML, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care 2011;34:1934–42
- McMahon GT, Gomes HE, Hickson HS, et al. Web-based care management in patients with poorly controlled diabetes. Diabetes Care 2005;28:1624–9
- Yarnall KS, Pollak KI, Ostbye T, et al. Primary care: is there enough time for prevention? Am J Public Health 2003;93:635–41
- Ostbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3: 209–14
Source: PubMed