OBJECTIVE -To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes.RESEARCH DESIGN AND METHODS -For this study, 104 patients with diabetes and HbA 1c (A1C) Ն9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n ϭ 52) or receive web-based care management (n ϭ 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager.RESULTS -Participants receiving web-based care management had lower A1C over 12 months (P Ͻ 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (Ϫ1.9 vs. Ϫ1.2%; P ϭ 0.051) or education and usual care (Ϫ1.4%; P Ͻ 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile Ϫ2.1%, lowest tertile Ϫ1.0%; P Ͻ 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P Ͻ 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P Ͻ 0.05).CONCLUSIONS -Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes. Diabetes Care 28:1624 -1629, 2005D iabetes care is facilitated by a patient's being engaged in a selfmanagement program with the advice and counsel of physicians and allied health professionals (1). Care management has been advocated in diabetic patients as a means of facilitating easier, time-efficient communication between clinicians and patients, with the goal of improving care and reducing healthcare expenditures.Healthcare systems have adopted care management for individuals with highrisk diseases, particularly patients with diabetes (2-5). Scheduling and/or travel may be barriers to a patient's engaging with a care provider, thereby limiting uptake and resulting in a failure to maximize potential health gains (6). Care management has been studied in diabetic patients, but the results have been mixed; some have noted significant improvement in HbA 1c (A1C) (7-9), but a recent study found no effect (10).Patients are accessing medical content on the Internet with increasing frequency (11-14). In a survey of patients in a primary care practice, 54% reported using the Internet for medical information and 60% felt that the information was the same or better than what they received from their doctor (11). Few studies have examined the effects of web-based interventions that provide an interactive component; that is, websites that deliver content as well as feedback to participants (15-17). Our goal was to test the hypothesis that diabetes care management using a ...

These results demonstrate a significant treatment effect from the MyCareTeam application. A larger randomized control trial is under way at the Boston Veterans Administration Healthcare System. If these results are confirmed as expected, then web-based diabetes management may prove to be the link to achieving target American Diabetes Association glycemic goals in patients with poorly controlled diabetes.

These results suggest that patient-HCP interaction and, in particular, more personalized interactions increases patient frequency of BG monitoring.

II.