TY - JOUR
T1 - Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes
T2 - A randomized controlled trial
AU - Ishani, Areef
AU - Greer, Nancy
AU - Taylor, Brent C.
AU - Kubes, Laurie
AU - Cole, Paula
AU - Atwood, Melissa
AU - Clothier, Barbara
AU - Ercan-Fang, Nacide
PY - 2011/8
Y1 - 2011/8
N2 - 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. RESEARCH DESIGN AND 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.
AB - 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. RESEARCH DESIGN AND 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.
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U2 - 10.2337/dc10-2121
DO - 10.2337/dc10-2121
M3 - Article
C2 - 21636796
AN - SCOPUS:84855983764
SN - 0149-5992
VL - 34
SP - 1689
EP - 1694
JO - Diabetes care
JF - Diabetes care
IS - 8
ER -