An online disease management system for patients with uncontrolled type 2 diabetes resulted in significantly reduced A1C levels and improved diabetes control after 6 months but that improvement was not sustained after 12 months, according to a study published in the March issue of the Journal of the American Medical Informatics Association.
Engaging and Motivating Patients Online With Enhanced Resources for Diabetes (EMPOWER-D), developed by the Palo Alto Medical Foundation (PAMF), was a 12-month parallel randomized controlled trial of 415 patients with type 2 diabetes. The intervention included: wirelessly uploaded home glucometer readings with graphical feedback; comprehensive patient-specific diabetes summary status report; nutrition and exercise logs; insulin records; online messaging with the patient's health team; nurse care manager and dietitian providing advice and medication management; and personalized text and video educational ‘nuggets’ dispensed electronically by the care team. A1C was the primary outcome variable.
Compared with usual care, patients in the intervention group had significantly reduced A1C at 6 months but at 12 months, the differences were not significant.
"PAMF has been using an EHR with extensive clinical decision support, shown to improve care of diabetic patients, and high-performing medical groups that use a robust EHR have a higher rate of improvement," according to Paul C. Tang, MD, and colleagues. "Conducting our clinical trial under these circumstances may have limited our ability to detect a statistically significant difference between the [intervention] group and the constantly improving [control] group. The magnitude of the overall reduction in A1C (1.14%) might have been more meaningful in a different setting. Finally, regression to the mean may have contributed to A1C reduction in both groups."
Patients demonstrating continuous engagement through sustained uploading of glucose readings achieved better results, the authors wrote. "Further study is required to evaluate whether online disease management by multidisciplinary teams can reduce the frequency of physician visits while improving control of diabetes."