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 ...

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.

Online, telephone-based care management, and Web training for diabetes patients with elevated A1c were each associated with a substantial improvement in A1c over a 1-year period. Internet access and training alone may be as effective as care management in patients with poorly controlled diabetes.

Patients with elevated HbA(1c) levels who were receptive to education had substantial improvement in HbA(1c) levels after receiving an educational intervention. In this population, intensive or passive methods of delivering patient education seemed to have similar effect on improving glycemic control.

We put forward a model based on item response theory that highlights the role of latent features called "proficiency" and "propensity". The model is adjusted to data from the decisions made in a high-stakes exam taken by 10,822 Brazilian high school students. Our model aims to recover information regarding the role the latent features (proficiency and propensity) play in a decision. We find that the decision of responding or not and also the decision of responding correctly or not in a group of items can be described by a two-dimensional logistic model, even if there are imperfections from an item-by-item adjustment. Not only proficiency, but also refraining from responding is found to depend on both the characteristics of the items and the latent features of the students. In particular, the least proficient students prefer to leave an item blank, rather than respond it incorrectly. There is a negative linear correlation between scoring in the exam and propensity, and scoring and proficiency are positively correlated although nonlinear.

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