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Randomized Controlled Trial
. 2009 Apr;11(4):211-7.
doi: 10.1089/dia.2008.0063.

Web-based collaborative care for type 1 diabetes: a pilot randomized trial

Kelly P McCarrier  1 , James D Ralston, Irl B Hirsch, Ginny Lewis, Diane P Martin, Frederick J Zimmerman, Harold I Goldberg
Affiliations
Randomized Controlled Trial

Web-based collaborative care for type 1 diabetes: a pilot randomized trial

Kelly P McCarrier et al. Diabetes Technol Ther. 2009 Apr.

Abstract

Background: To determine whether a Web-based diabetes case management program based in an electronic medical record can improve glycemic control (primary outcome) and diabetes-specific self-efficacy (secondary outcome) in adults with type 1 diabetes, a pilot randomized controlled trial was conducted.

Methods: A 12-month randomized trial tested a Web-based case management program in a diabetes specialty clinic. Patients 21-49 years old with type 1 diabetes receiving multiple daily injections with insulin glargine and rapid-acting analogs who had a recent A1C >7.0% were eligible for inclusion. Participants were randomized to receive either (1) usual care plus the nurse-practitioner-aided Web-based case management program (intervention) or (2) usual clinic care alone (control). We compared patients in the two study arms for changes in A1C and self-efficacy measured with the Diabetes Empowerment Scale.

Results: A total of 77 patients were recruited from the diabetes clinic and enrolled in the trial. The mean baseline A1C among study participants was 8.0%. We observed a nonsignificant decrease in average A1C (-0.48; 95% confidence interval -1.22 to 0.27; P = 0.160) in the intervention group compared to the usual care group. The intervention group had a significant increase in diabetes-related self-efficacy compared to usual care (group difference of 0.30; 95% confidence interval 0.01 to 0.59; P = 0.04).

Conclusions: Use of a Web-based case management program was associated with a beneficial treatment effect on self-efficacy, but change in glycemic control did not reach statistical significance in this trial of patients with moderately poorly controlled type 1 diabetes. Larger studies may be necessary to further clarify the intervention's impact on health outcomes.

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Figures

FIG. 1.
FIG. 1.
Flow of participants through the trial. *Primary analysis of A1C change was performed with an intent-to-treat approach using multiple imputation of missing follow-up values.
See this image and copyright information in PMC

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