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

Autor: Linda H Klieman, Lubna Qureshi, Nancy L. Brown, Anthony J. Perkins, Tanya A Waltimyer, Shauna M Hyde, Charlotte J. Mitchell, Leigha Winters, Bahar Aghighi, Paul C. Tang, Charles Y. Young, Martin Entwistle, J. Marc Overhage, Albert S. Chan, Siu Lui Hui
Rok vydání: 2013
Předmět:
Zdroj: Journal of the American Medical Informatics Association. 20:526-534
ISSN: 1527-974X
1067-5027
DOI: 10.1136/amiajnl-2012-001263
Popis: To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes.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.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; p0.001). 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).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.
Databáze: OpenAIRE