Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans.
BACKGROUND
African Americans suffer disproportionately from diabetes complications, but little research has focused on how to improve diabetic control in this population. There are also few or no data on a combined primary care and community-based intervention approach.


METHODS
We randomly assigned 186 urban African Americans with type 2 diabetes (76% female, mean A SD age 59 A 9 years) to 1 of 4 parallel arms: (1) usual care only; (2) usual care + nurse case manager (NCM); (3) usual care + community health worker (CHW); (4) usual care + nurse case manager/community health worker team. Using the framework of the Precede-Proceed behavioral model, interventions included patient counseling regarding self-care practices and physician reminders.


RESULTS
The 2-year follow-up visit was completed by 149 individuals (84%). Compared to the Usual care group, the NCM group and the CHW group had modest declines in HbA(1c) over 2 years (0.3 and 0.3%, respectively), and the combined NCM/CHW group had a greater decline in HbA(1c) (0.8%. P = 0.137). After adjustment for baseline differences and/or follow-up time, the combined NCM/CHW group showed improvements in triglycerides (-35.5 mg/dl; P = 0.041) and diastolic blood pressure, compared to the usual care group (-5.6 mmHg; P = 0.042).


CONCLUSIONS
Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes. Although results were clinically important, they did not reach statistical significance. This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans.
Gary
Tiffany L
TL
Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. tgary@jhsph.edu
Bone
Lee R
LR
Hill
Martha N
MN
Levine
David M
DM
McGuire
Maura
M
Saudek
Christopher
C
Brancati
Frederick L
FL
D015142:Baltimore; D044383:Black People; D003150:Community Health Workers; D003376:Counseling / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009745:Nursing, Supervisory; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014505:Urban Population; D001741:Black or African American