Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial
- Paul C Tang1,2,
- J Marc Overhage3,
- Albert Solomon Chan1,
- Nancy L Brown1,
- Bahar Aghighi1,
- Martin P Entwistle1,
- Siu Lui Hui3,
- Shauna M Hyde1,
- Linda H Klieman1,
- Charlotte J Mitchell1,
- Anthony J Perkins3,
- Lubna S Qureshi1,
- Tanya A Waltimyer1,
- Leigha J Winters1,
- Charles Y Young1
- 1Innovation Center, Palo Alto Medical Foundation, Palo Alto, California, USA
- 2Department of Medicine, Stanford University, Stanford, California, USA
- 3Indiana University, Indianapolis, Indiana, USA
- Correspondence to Dr Paul C Tang, Palo Alto Medical Foundation, 2350 W El Camino Real, Mountain View, CA 94040, USA;
- Received 10 August 2012
- Accepted 19 October 2012
- Published Online First 20 November 2012
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