St. Mary’s evaluates the potential to manage diabetes online


Is the management of diabetes a click away? In late 2004 St. Mary’s General Hospital (Kitchener) announced the results of a two-year clinical trial of an Internet based diabetes disease management program that was conducted along with partners Cambridge Memorial Hospital, Grand River Hospital and MicoHealth. This innovative project evaluated the delivery and outcomes of an Internet Diabetes Program for adults. The health outcomes of the Internet program were compared to a traditional diabetes education program, and the effectiveness of both Internet and traditional programs were also compared to individuals receiving usual community care, in a randomized control trial. Dr. Erin Tjam, Director of Research, led the study, which included co-investigators from the University of Waterloo and St. Mary’s.

The number of people who are receiving diabetic care is not matching the prevalence of the disease; therefore new methods of care are needed to meet that gap. “Using the Internet to assist in disease management is a likely solution. Internet disease management has the potential to support self-care and reduce existing diabetes care burden,” says Dr. Tjam.

The objectives of the study were to improve patient’s glycemic control, disease management behaviors, health status, and short-term clinical outcomes for type 2 diabetes. Patients were recruited from two diabetes education centers (DEC) in Waterloo Region, and all patients recruited received initial consultation, education, and assessment at the DEC’s. The Internet group then used an online diabetes management program via the Internet as their follow up service to monitor and manage the disease, where the control group continued with the traditional face-to-face clinical follow up.

MicoHealth, a developer of wellness and care informatics solutions, provided its online disease management program for the clinical trial. Diabetics in the Internet-group utilized the MicoHealth system to submit a range of health data, including blood glucose levels, medication usage, and diet and exercise regimens. A nurse case manager then analyzed the data to monitor patient health and, when required, offered disease management advice of a non-emergent nature via MicoHealth’s communication tools, such as secure messaging and a moderated chat room.

“MicoHealth’s online disease management system will help diabetes clinics to empower their outpatients and facilitate the provision of care, leading to better outcomes and reduce the burden on a hospital’s professional and financial resources,” says Michael Cowan, MicoHealth President and CEO.

Outcomes of the study concluded that the Internet group experienced: enhanced quality of life, increased empowerment and self-management, and reduced health-care expenditures in the management of diabetes. The Internet group also made significant improvement in self-efficacy and self-management measures, such as managing the psychosocial aspects of diabetes, readiness to change, less negative attitude, and ability to care for their diabetes, compared to its own baseline. The Internet group was also more satisfied with their diabetes care as they progressed in using online diabetes management system.

“Given the efficacy of the Internet Program, it’s feasibility to follow diabetes patients in a real health-care setting should be explored as a means to reduce burden and improve diabetes outcomes,” says Tjam.

The project, sponsored by a $100,000 grant from the Change Foundation, represents a health-industry-university collaboration that contributed to the knowledge and management of diabetes care on the Internet. Diabetes is a major cause of coronary disease, the leading cause of blindness and kidney disease and accounts for one of every seven health-care dollars spent. St. Mary’s is proud to have led this study and is committed to using research and technology to help understand and enhance patient care.