title: 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.
abstract: 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.
authors.affiliation: Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. tgary@jhsph.edu
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Gary
authors.forename: Lee R
authors.initials: LR
authors.lastname: Bone
authors.forename: Martha N
authors.initials: MN
authors.lastname: Hill
authors.forename: David M
authors.initials: DM
authors.lastname: Levine
authors.forename: Maura
authors.initials: M
authors.lastname: McGuire
authors.forename: Christopher
authors.initials: C
authors.lastname: Saudek
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: 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