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

Research output: Contribution to journalArticle

97 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)526-534
Number of pages9
JournalJournal of the American Medical Informatics Association
Volume20
Issue number3
DOIs
StatePublished - Aug 29 2013

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Disease Management
Randomized Controlled Trials
Type 2 Diabetes Mellitus
Nurses
Nutritionists
Electronic Health Records
Health
Glycosylated Hemoglobin A
Reading
Primary Health Care
Clinical Trials
Exercise
Insulin
iodonitrotetrazolium

ASJC Scopus subject areas

  • Health Informatics

Cite this

Online disease management of diabetes : Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. / Tang, Paul C.; Overhage, J. Marc; Chan, Albert Solomon; Brown, Nancy L.; Aghighi, Bahar; Entwistle, Martin P.; Hui, Siu Lui; Hyde, Shauna M.; Klieman, Linda H.; Mitchell, Charlotte J.; Perkins, Anthony J.; Qureshi, Lubna S.; Waltimyer, Tanya A.; Winters, Leigha J.; Young, Charles Y.

In: Journal of the American Medical Informatics Association, Vol. 20, No. 3, 29.08.2013, p. 526-534.

Research output: Contribution to journalArticle

Tang, PC, Overhage, JM, Chan, AS, Brown, NL, Aghighi, B, Entwistle, MP, Hui, SL, Hyde, SM, Klieman, LH, Mitchell, CJ, Perkins, AJ, Qureshi, LS, Waltimyer, TA, Winters, LJ & Young, CY 2013, 'Online disease management of diabetes: Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial', Journal of the American Medical Informatics Association, vol. 20, no. 3, pp. 526-534. https://doi.org/10.1136/amiajnl-2012-001263
Tang, Paul C. ; Overhage, J. Marc ; Chan, Albert Solomon ; Brown, Nancy L. ; Aghighi, Bahar ; Entwistle, Martin P. ; Hui, Siu Lui ; Hyde, Shauna M. ; Klieman, Linda H. ; Mitchell, Charlotte J. ; Perkins, Anthony J. ; Qureshi, Lubna S. ; Waltimyer, Tanya A. ; Winters, Leigha J. ; Young, Charles Y. / Online disease management of diabetes : Engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. In: Journal of the American Medical Informatics Association. 2013 ; Vol. 20, No. 3. pp. 526-534.
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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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AU - Brown, Nancy L.

AU - Aghighi, Bahar

AU - Entwistle, Martin P.

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AU - Hyde, Shauna M.

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AU - Mitchell, Charlotte J.

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N2 - 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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