Diabetes Nurse Case Management in a Canadian Tertiary Care Setting: Results of a Randomized Controlled Trial.
OBJECTIVE
To examine the effects of a 6-month nurse case manager (NCM) intervention compared to standard care (SC) on glycemic control and diabetes distress in a Canadian tertiary-care setting.


METHODS
We recruited 140 adults with type 2 diabetes and glycated hemoglobin (A1C) levels >8% (64 mmol/mol) from 2 tertiary care facilities and randomized them to: 1) a 6-month NCM intervention in addition to SC or 2) SC by the primary endocrinologists. Assessments were conducted at baseline and at 6 months. Primary outcomes included A1C levels and diabetes distress scores (DDS). Secondary outcomes included body mass index, blood pressure, diabetes-related behaviour measures, depressive symptoms, self-motivation and perception of support.


RESULTS
At the 6-month follow up, the NCM group experienced larger reductions in A1C levels of -0.73% compared to the SC group (p=0.027; n=134). The NCM group also showed an additional reduction of -0.40 (26% reduction) in DDS compared to those in the SC group (p=0.001; n=134). The NCM group had lower blood pressure, ate more fruit and vegetables, exercised more, checked their feet more frequently, were more motivated, were less depressed and perceived more support. There were no changes and no group differences in terms of body mass index, medication compliance or frequency of testing.


CONCLUSIONS
Compared to SC, NCM intervention was more effective in improving glycemic control and reducing diabetes distress. It is, therefore, a viable adjunct to standard diabetes care in the tertiary care setting, particularly for patients at high risk and with poor control.
Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Danni
D
Li
Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Diabetes, Vancouver, British Columbia, Canada.
Tom
T
Elliott
Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Diabetes, Vancouver, British Columbia, Canada.
Gerri
G
Klein
Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Ehud
E
Ur
Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: tricia.tang@vch.ca.
Tricia S
TS
Tang
D000368:Aged; D002170:Canada / Q000453:epidemiology; D019090:Case Management / Q000639:trends*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D063128:Tertiary Health Care / Q000379:methods* / Q000639:trends*
cadre des soins tertiaires; critères de jugement psychosociaux; diabetes distress; diabetes nurse case manager; détresse liée au diabète; essai clinique à répartition aléatoire; infirmière gestionnaire de cas de diabète; psychosocial outcomes; randomized controlled trial; tertiary care setting