An internet-based diabetes management platform improves team care and outcomes in an urban Latino population

• Published in: Diabetes care Vol. 38; no. 4; pp. 561 - 567
• Main Authors: Welch, Garry, Zagarins, Sofija E, Santiago-Kelly, Paula, Rodriguez, Zoraida, Bursell, Sven-Erik, Rosal, Milagros C, Gabbay, Robert A
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.04.2015
• Subjects: Adult; Aged; Blood Glucose - metabolism; Clinical Care/Education/Nutrition/Psychosocial Research; Clinical outcomes; Comprehensive Health Care - methods; Decision support systems; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - therapy; Disease management; Female; Hispanic Americans; Hispanic Americans - statistics & numerical data; Humans; Internet; Male; Medical personnel; Middle Aged; Patient Care Team - organization & administration; Patient Care Team - standards; Self Care - standards; Self Care - statistics & numerical data; Standard of Care; Treatment Outcome; Urban Population - statistics & numerical data
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc14-1412

To compare usual diabetes care (UDC) to a comprehensive diabetes care intervention condition (IC) involving an Internet-based "diabetes dashboard" management tool used by clinicians. We used a parallel-group randomized design. Diabetes nurses, diabetes dietitians, and providers used the diabetes dashboard as a clinical decision support system to deliver a five-visit, 6-month intervention to 199 poorly controlled (HbA1c >7.5% [58 mmol/mol]) Latino type 2 diabetic (T2D) patients (mean age 55 years, 60% female) at urban community health centers. We compared this intervention to an established, in-house UDC program (n = 200) for its impact on blood glucose control and psychosocial outcomes. Recruitment and retention rates were 79.0 and 88.5%, respectively. Compared with UDC, more IC patients reached HbA1c targets of <7% (53 mmol/mol; 15.8 vs. 7.0%, respectively, P < 0.01) and <8% (64 mmol/mol; 45.2 vs. 25.3%, respectively, P < 0.001). In multiple linear regression adjusting for baseline HbA1c, adjusted mean ± SE HbA1c at follow-up was significantly lower in the IC compared with the UDC group (P < 0.001; IC 8.4 ± 0.10%; UDC 9.2 ± 0.10%). The results showed lower diabetes distress at follow-up for IC patients (40.4 ± 2.1) as compared with UDC patients (48.3 ± 2.0) (P < 0.01), and also lower social distress (32.2 ± 1.3 vs. 27.2 ± 1.4, P < 0.01). There was a similar, statistically significant (P < 0.01) improvement for both groups in the proportion of patients moving from depressed status at baseline to nondepressed at follow-up (41.8 vs. 40%; no significance between groups). The diabetes dashboard intervention significantly improved diabetes-related outcomes among Latinos with poorly controlled T2D compared with a similar diabetes team condition without access to the diabetes dashboard.