Diabetes Case Management Effects on Glycemic Control
Name: Patricia Kelley
Rank: LCDR, USN
Organization: Henry Jackson Foundation
Performance Site: National Naval Medical Center, Bethesda, MD
Year Published: 2000
Abstract Status: Final
Diabetes is one of the most prevalent and costly chronic diseases in the U.S. and barriers to glycemic control pose a significant challenge. This study investigated the effectiveness of a patient-centered hybrid case-management intervention in a large military academic hospital, using a 1-year randomized, controlled, longitudinal design.The intervention was a separate diabetes clinical assessment by nurse practitioners with subsequent nurse case management, including ongoing contact (in person or via telephone) with the case manager who coordinated care with the primary care physician. The population was higher risk diabetes patients (HbA1c > 8%); 81 participants were enrolled, with 43 randomized to case management and 38 to usual care. Primary outcomes were compliance with ADA-recommended diabetes care measures, including quarterly HbA1c measurement when above target value, pneumococcal and influenza vaccination, microalbuminuria screening, and monofilament foot exams. Change in HbA1c level was also measured. After 12 months, 20 participants were interviewed to assess perceptions.The groups were statistically similar in age, gender, co-morbidities, and initial HbA1c levels. Data were obtained from 39 case-managed and 35 control participants. HbA1c screening compliance (>= 3 tests in study year) was significantly greater in the case management group (97.4% vs. 37.1%) and mean HbA1c improved from 10.27% to 7.95% (noncompliance in controls prevented comparison). The case-management group had clinically and statistically improved compliance for pneumococcal (74.4% vs. 44.1%) and influenza (69.2% vs. 47.1%) vaccinations, monofilament foot exams (71.8% vs. 45.5%), and microalbuminuria screening (89.5% vs. 71.4%). Interviewed case-management patients most commonly reported: greater sense of self-care mastery, the importance of a nurse/coach, feeling better, and the importance of partnership with providers in self-care.A primary care-based nurse case-management program improved glycemic control and diabetes care outcomes. Patients educated and empowered by working with nurse partners are healthy and successful living with diabetes.