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 findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via glucagon-like peptide 1-mediated pathways.

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BACKGROUND: Medical educators have raised serious concerns about the decline in bedside teaching and the effect of this decline on trainee skills. We investigated the fraction of time hospitalist attending physicians spend at the bedside during teaching rounds and how often physical examination skills are demonstrated. METHODS: In a prospective, observational study, the authors investigated the rounding behavior of members of Brigham and Women's Hospitalist Service. For 5 weeks from December 2007 to January 2008, interns and residents rotating on the hospitalist service reported in a daily e‐mail (1) total time spent with their attending during attending rounds, (2) time spent inside patient rooms during attending rounds, and (3) whether or not a physical examination finding or technique was demonstrated by their hospitalist attending. RESULTS: A total of 61 observations were reported (66% response). Hospitalists spent an average of 101 minutes on teaching rounds and an average of 17 minutes inside patient rooms or 17% of their teaching time at the bedside. Bedside teaching occurred during 61% of teaching sessions and physical examination teaching occurred during 38% of teaching sessions. Rounds that included time spent at the bedside were longer on average than rounds that did not include time spent at the bedside (122 vs. 69 minutes, P < 0.001). CONCLUSIONS: Bedside teaching makes up approximately 17% of the time that hospitalists at this medical center spend on teaching rounds. Physical examination teaching has become infrequent. Research to clarify optimal strategies to improve bedside teaching and its value in patient care is needed. Journal of Hospital Medicine 2009;4:304–307. © 2009 Society of Hospital Medicine.

Patients with diabetes who were randomized to an online game delivering DSME demonstrated sustained and meaningful HbA improvements. Among patients with poorly controlled diabetes, the DSME game reduced HbA by a magnitude comparable to starting a new diabetes medication. Online games may be a scalable approach to improve outcomes among geographically dispersed patients with diabetes and other chronic diseases.

As compared with a traditional inpatient care model, an experimental model characterized by reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities.

Participation in IBCM varies by initial diabetes distress, with people with less distress participating more. For people who participate, IBCM further mitigates diabetes distress. There is also a relationship between achievements in glycemic control and subsequent lowering of diabetes distress. Future research should identify how to maximize fit between patient needs and the provisions of IBCM, with the aim of increasing patient engagement in the active management of their health using this care modality. A key to maximizing fit might be first addressing metabolic control aggressively and then using IBCM for sustainment of health.

Behavior modification is vital to the prevention or amelioration of lifestyle-related disease. Health and wellness coaching is emerging as a powerful intervention to help patients initiate and maintain sustainable change that can be critical to physiatry practice. The coach approach delivers a patient-centered collaborative partnership to create an engaging and realistic individualized plan. The coaching process builds the psychologic skills needed to support lasting change, including mindfulness, self-awareness, self-motivation, resilience, optimism, and self-efficacy. Preliminary studies indicate that health and wellness coaching is a useful and potentially important adjunct to usual care for managing hyperlipidemia, diabetes, cancer pain, cancer survival, asthma, weight loss, and increasing physical activity. Physiatrists can benefit from the insights of coaching to promote effective collaboration, negotiation, and motivation to encourage patients to take responsibility for their recovery and their future wellness by adopting healthy lifestyles.