title: Nurse case management improves blood pressure, emotional distress and diabetes complication screening.
abstract: We studied the impact of nurse case management (NCM) on blood pressure (BP), hemoglobin A1C, lipids, and diabetes complication screening. A 1-year randomized-controlled trial was conducted in two primary care clinics of the Penn State Hershey Medical Center. Diabetes patients were randomized to control group (CG) (n=182) who received usual care by their primary care provider and intervention group (IG) (n=150) who received additional NCM care, including self-management education, and implementation of diabetes guidelines. Primary outcomes included BP, A1C, lipid, process measures, and secondary outcome was diabetes-related emotional distress as assessed by Problem Areas in Diabetes (PAID). BP significantly decreased from 137/77 to 129/72 in IG as compared to an increase from 136/77 to 138/79 in CG after 1 year. PAID scores improved significantly in IG (from 23 to 10) due to reduced emotional stress. A1C (7.4) and LDL (105) were unaffected. Complications screening significantly improved in IG compared to CG: opthalmologic exam 26 to 68%, foot exam 47 to 64%, and nephropathy screening 34 to 72%. NCM improved BP, diabetes-related emotional distress, and process measures in primary care. Unchanged A1C and lipids might be due to a threshold effect. Intervention based upon initial risk assessment may prove more cost-effective.
authors: The Penn State College of Medicine, Penn State Diabetes Center, Department of Endocrinology, Diabetes and Metabolism, 500 University Drive, HO44, Hershey, PA 17033, USA. rgabbay@psu.edu
authors: Robert A
authors: RA
authors: Gabbay
authors: Irina
authors: I
authors: Lendel
authors: Tipufaiz M
authors: TM
authors: Saleem
authors: Gregory
authors: G
authors: Shaeffer
authors: Alan M
authors: AM
authors: Adelman
authors: David T
authors: DT
authors: Mauger
authors: Mary
authors: M
authors: Collins
authors: Rosemary C
authors: RC
authors: Polomano
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D019090:Case Management; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000451:nursing*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin