Diabetes nurse case management and motivational interviewing for change (DYNAMIC): results of a 2-year randomized controlled pragmatic trial.
BACKGROUND
The aim of the present study was to determine whether the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high-risk type 2 diabetes patients.


METHODS
A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n=313) or those who received the intervention (n=232) with additional practice-embedded NCM care, including MI-guided behavior change counseling. The NCMs received intensive MI training with ongoing fidelity assessment.


RESULTS
Systolic blood pressure (SBP) was better in the intervention than usual care group (131 ± 15 vs. 135 ± 18 mmHg, respectively; P<0.05). Improvements were seen in both the control and intervention groups in terms of HbA1c (from 9.1% to 8.0% and from 8.8% to 7.8%, respectively), low-density lipoprotein (LDL; from 127 to 100 mg/dL and from 128 to 102 mg/dL, respectively), and diastolic blood pressure (from 78 to 74 mmHg and from 80 to 74 mmHg, respectively). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance.


CONCLUSIONS
The NCMs and MI improved SBP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia may also be needed.
Penn State Hershey Diabetes Institute, Pennsylvania, USA. rgabbay@hmc.psu.edu
Robert A
RA
Gabbay
Raquel M
RM
Añel-Tiangco
Cheryl
C
Dellasega
David T
DT
Mauger
Alan
A
Adelman
Deborah H A
DH
Van Horn
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D019090:Case Management; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009726:Nurses; D017063:Outcome Assessment, Health Care / Q000379:methods; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL
behavior change; motivational interviewing; nurse case management; 行为改变，动机性会谈，护士病例管理