title: Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial.
abstract: OBJECTIVE
  To determine whether nurse case management with a therapeutic algorithm could effectively improve rates of control for hypertension, hyperglycemia, and hyperlipidemia compared with usual care among veterans with diabetes.
  
  
  METHODS
  A randomized controlled trial of diabetic patients that had blood pressure (BP) >140/90 mmHg, hemoglobin A(1c) (HbA(1c)) >9.0%, or LDL >100 mg/dL. Intervention patients received case management (n = 278) versus usual care (n = 278) over a 1-year period. The primary outcome was the percentage of patients achieving simultaneous control of all three parameters (defined by BP <130/80 mmHg, HbA(1c) <8.0%, and LDL <100 mg/dL) at 1 year. Secondary outcomes included improvements within each individual component of the composite primary outcome. Differences between groups were analyzed using t tests, Pearson χ(2) tests, and linear and logistic regression.
  
  
  RESULTS
  A greater number of individuals assigned to case management achieved the primary study outcome of having all three outcome measures under control (61 [21.9%] compared with 28 [10.1%] in the usual care group [P < 0.01]). In addition, a greater number of individuals assigned to the intervention group achieved the individual treatment goals of HbA(1c) <8.0% (73.7 vs. 65.8%, P = 0.04) and BP <130/80 mmHg (45.0 vs. 25.4%, P < 0.01), but not for LDL <100 mg/dL (57.6 vs. 55.4%, P = 0.61), compared with those in the usual care group.
  
  
  CONCLUSIONS
  In patients with diabetes, nurse case managers using a treatment algorithm can effectively improve the number of individuals with control of multiple cardiovascular risk factors at 1 year.
authors.affiliation: Minneapolis VA Health Care System, Minneapolis, MN, USA. isha0012@umn.edu
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: Nancy
authors.initials: N
authors.lastname: Greer
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Laurie
authors.initials: L
authors.lastname: Kubes
authors.forename: Paula
authors.initials: P
authors.lastname: Cole
authors.forename: Melissa
authors.initials: M
authors.lastname: Atwood
authors.forename: Barbara
authors.initials: B
authors.lastname: Clothier
authors.forename: Nacide
authors.initials: N
authors.lastname: Ercan-Fang
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000378:metabolism; D019090:Case Management; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009726:Nurses; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin