Diabetes Mellitus, Hypertension
Conditions
Keywords
Diabetes mellitus, Hypertension, Telemedicine, Case management
Brief summary
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.
Detailed description
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
Interventions
PROCEDUREWeb-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
PROCEDURETelephone and face-to-face care management
Participants interact with a care manager via face-to-face and telephone contact
PROCEDUREInternet access alone
Participants are given internet access and encouraged to seek diabetes information to help in their self management
Sponsors
US Department of Veterans Affairs
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
25 Years to 79 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in HbA1c at 12 months | 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Change in blood pressure, lipid profile and diabetes-related stress (self-report) at 12 months; cost-effectiveness analysis of the interventions. | 12 months |
Countries
United States
Outcome results
None listed