title: Nursing Case Management and Glycemic Control Among Brazilians With Type 2 Diabetes: Pragmatic Clinical Trial.
abstract: BACKGROUND
  Type 2 diabetes mellitus is a chronic condition that requires ongoing, life-long care in order to be controlled.
  
  
  OBJECTIVE
  The aims of the study were to assess the effect of nursing case management on glycated hemoglobin (HbA1c) levels compared to usual care in people with type 2 diabetes mellitus and to determine if effects of nursing case management varied by gender, age, duration of disease, education, and income.
  
  
  METHODS
  This is a pragmatic clinical trial, conducted in the municipality of Bandeirantes, Paraná, Brazil, in 2011 and 2012. Eighty individuals were recruited and randomized equally to receive nursing case management or usual care. Covariates were sociodemographic and clinical factors. The outcome was HbA1c measured at baseline, 6 months, and 12 months.
  
  
  RESULTS
  The sample consisted predominately of women; most had been diagnosed with type 2 diabetes mellitus within the previous 5 years. Mean age was 50.14 (SD = 7.00), with 5.27 (SD = 4.39) years of schooling and an average HbA1c of 9.90% (SD = 2.49). Hemoglobin A1c was reduced from an average of 10.33% to 9.0% (p < .01) in the nursing case management group and from 9.57% to 8.93% (p = .05) in the usual care group; the group by time effect was not significant. Case management effects varied by younger age (p = .05), duration of type 2 diabetes less than 5 years (p = .03), up to 4 years of schooling (p = .04), and being in the lowest-income stratum (p = .02).
  
  
  CONCLUSIONS
  Both groups showed a statistically significant reduction of HbA1c at 6 and 12 months following baseline. The difference in proportional reduction of HbA1c between groups was not statistically significant.
authors.affiliation: Ricardo Castanho Moreira, PhD, RN, is Professor, School of Nursing, State University of Northern Paraná, Bandeirantes, Brazil. Maria de Fátima Mantovani, PhD, RN, is Professor, School of Nursing, Federal University of Paraná, Curitiba, Brazil. José Verdú Soriano, PhD, RN, is Professor, School of Nursing, University of Alicante, Spain.
authors.forename: Ricardo Castanho
authors.initials: RC
authors.lastname: Moreira
authors.forename: Maria de Fátima
authors.initials: Mde F
authors.lastname: Mantovani
authors.forename: José Verdú
authors.initials: JV
authors.lastname: Soriano
mesh_terms: D000328:Adult; D000367:Age Factors; D001938:Brazil; D019090:Case Management / Q000458:organization & administration*; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000451:nursing*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D012648:Self Care; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents