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
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.
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.
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.
- 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
- Visual impairment that affects ability to read
Paul R. Conlin, MD
VA Boston Healthcare System Brockton Campus, Brockton, MA