The reduction of sodium intake to levels below the current recommendation of 100 mmol per day and the DASH diet both lower blood pressure substantially, with greater effects in combination than singly. Long-term health benefits will depend on the ability of people to make long-lasting dietary changes and the increased availability of lower-sodium foods.

ESPITE WIDESPREAD CONSENsus that a reduced intake of saturated fat lowers cardiovascular disease (CVD) risk, the optimal type of macronutrient (protein, unsaturated fat, or carbohydrate) that should replace saturated fat is uncertain. In the absence of convincing evidence that favors one macronutrient, reports from the Institute of Medicine 1 and the Adult Treatment Panel III 2 concluded that a wide range of macronutrients is acceptable.Two major goals of dietary recommendations are to lower blood pressure and improve serum lipids, 2 of the primary determinants of CVD risk. A persuasive body of evidence has impli-cated several aspects of diet in the etiology of elevated blood pressure. Early research documented the adverse effects of increased salt, insufficient potassium, elevated weight, and excess alcohol intake, and the beneficial effects of vegetarian dietary patterns. 3,4 Subsequently, in the Dietary Approaches to Stop Hypertension (DASH) trials, 5,6 a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy prod-For editorial comment see p 2497.

The DASH diet plus reduced sodium intake is recommended to control blood pressure in diverse subgroups.

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 ...