--- title: "Online disease management of diabetes: EMPOWER-D. | Sutter Health" description: "To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes." url: "https://www.sutterhealth.org/research/publications/online-disease-management-of-diabetes-1055312685" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Online disease management of diabetes: EMPOWER-D. # Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial. Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, Hui SL, Hyde SM, Klieman LH, Mitchell CJ, Perkins AJ, Qureshi LS, Waltimyer TA, Winters LJ, & Young CY. _J Am Med Inform Assoc. 20(3):526-34. doi: 10.1136/amiajnl-2012-001263. Epub 2012 Nov 20._ 2013-05-01 ## Abstract OBJECTIVE: To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes. MATERIALS AND METHODS: Engaging and Motivating Patients Online With Enhanced Resources for Diabetes was a 12-month parallel randomized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin (A1C) values ≥7.5% from primary care sites sharing an electronic health record. The intervention included: (1) wirelessly uploaded home glucometer readings with graphical feedback; (2) comprehensive patient-specific diabetes summary status report; (3) nutrition and exercise logs; (4) insulin record; (5) online messaging with the patient's health team; (6) nurse care manager and dietitian providing advice and medication management; and (7) personalized text and video educational 'nuggets' dispensed electronically by the care team. A1C was the primary outcome variable. RESULTS: Compared with usual care (UC, n=189), patients in the intervention (INT, n=193) group had significantly reduced A1C at 6 months (-1.32% INT vs -0.66% UC; p<0.001). At 12 months, the differences were not significant (-1.14% INT vs -0.95% UC; p=0.133). In post hoc analysis, significantly more INT patients had improved diabetes control (>0.5% reduction in A1C) than UC patients at 12 months (69.9 (95% CI 63.2 to 76.5) vs 55.4 (95% CI 48.4 to 62.5); p=0.006). CONCLUSIONS: A nurse-led, multidisciplinary health team can manage a population of diabetic patients in an online disease management program. INT patients achieved greater decreases in A1C at 6 months than UC patients, but the differences were not sustained at 12 months. More INT than UC patients achieved improvement in A1C (>0.5% decrease). Trial registered in clinical trials.gov: #NCT00542204. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/23171659) ## Research topics - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Applying the Pragmatic-Explanatory Continuum Indicator Summary model in a primary care-based lifestyle intervention trial.](https://www.sutterhealth.org/research/publications/apply-precis-model-primary-care-intervention-trial-1055312930) Rosas LG, Lv N, Azar K, Xiao L, Yank V, Ma J. Am J Prev Med. 49(3 Suppl 2):S208-14. doi: 10.1016/j.amepre.2015.05.011. 2015 Sep 01 - Publication ### [Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.](https://www.sutterhealth.org/research/publications/initiation-tx-incident-diabetes-ehrs-primary-care-1055312897) Chung S, Zhao B, Lauderdale D, Linde R, Stafford R, Palaniappan L. Prim Care Diabetes. 9(1):23-30. doi: 10.1016/j.pcd.2014.04.005. Epub 2014 May 5. 2015 Feb 01 - Publication ### [Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care.](https://www.sutterhealth.org/research/publications/obesity-status-modifies-dpp-program-for-wt-mgmt-1055312603) Azar KM, Xiao L, Ma J. Biomed Res Int. 2013:191209. doi: 10.1155/2013/191209. Epub 2013 Dec 4. 2013 Dec 04 - Publication ### [Nudging physicians and patients with autopend clinical decision support to improve diabetes management.](https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391) Panattoni L, Chan A, Yang Y, Olson C, Tai-Seale M. Am J Manag Care. 24(10):479-483. 2018 Oct 01 - Publication ### [Baseline reach and adoption characteristics in a randomized controlled trial of two weight loss interventions translated into primary care: A structured report of real-world applicability](https://www.sutterhealth.org/research/publications/weight-loss-interventions-translated-into-pc-1055312588) Yank V, Stafford RS, Rosas LG, Ma J. Contemp Clin Trials. 34(1):126-35. doi: 10.1016/j.cct.2012.10.007. Epub 2012 Oct 31. 2013 Jan 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/online-disease-management-of-diabetes-1055312685#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Online disease management of diabetes: EMPOWER-D."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/online-disease-management-of-diabetes-1055312685#medicalscholarlyarticle","name":"Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial.","headline":"Online disease management of diabetes: EMPOWER-D.","abstract":"OBJECTIVE: To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes. MATERIALS AND METHODS: Engaging and Motivating Patients Online With Enhanced Resources for Diabetes was a 12-month parallel randomized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin (A1C) values ≥7.5% from primary care sites sharing an electronic health record. The intervention included: (1) wirelessly uploaded home glucometer readings with graphical feedback; (2) comprehensive patient-specific diabetes summary status report; (3) nutrition and exercise logs; (4) insulin record; (5) online messaging with the patient's health team; (6) nurse care manager and dietitian providing advice and medication management; and (7) personalized text and video educational 'nuggets' dispensed electronically by the care team. A1C was the primary outcome variable. RESULTS: Compared with usual care (UC, n=189), patients in the intervention (INT, n=193) group had significantly reduced A1C at 6 months (-1.32% INT vs -0.66% UC; p\u003c0.001). At 12 months, the differences were not significant (-1.14% INT vs -0.95% UC; p=0.133). In post hoc analysis, significantly more INT patients had improved diabetes control (>0.5% reduction in A1C) than UC patients at 12 months (69.9 (95% CI 63.2 to 76.5) vs 55.4 (95% CI 48.4 to 62.5); p=0.006). CONCLUSIONS: A nurse-led, multidisciplinary health team can manage a population of diabetic patients in an online disease management program. INT patients achieved greater decreases in A1C at 6 months than UC patients, but the differences were not sustained at 12 months. More INT than UC patients achieved improvement in A1C (>0.5% decrease). 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