Abstract

OBJECTIVE—This study evaluated the efficacy of a nurse-care management system designed to improve outcomes in patients with complicated diabetes.

RESEARCH DESIGN AND METHODS—In this randomized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara, CA, 169 patients with longstanding diabetes, one or more major medical comorbid conditions, and HbA_lc >10% received a special intervention (n = 84) or usual medical care (n = 85) for 1 year. Patients met with a nurse-care manager to establish individual outcome goals, attended group sessions once a week for up to 4 weeks, and received telephone calls to manage medications and self-care activities. HbA_lc, LDL, HDL, and total cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure, BMI, and psychosocial factors were measured at baseline and 1 year later. Annualized physician visits were determined for the year before and during the study.

RESULTS—At 1 year, the mean reductions in HbA_lc, total cholesterol, and LDL cholesterol were significantly greater for the intervention group compared with the usual care group. Significantly more patients in the intervention group met the goals for HbA_1c (<7.5%) than patients in usual care (42.6 vs. 24.6%, P < 0.03, χ²). There were no significant differences in any of the psychosocial variables or in physician visits.

CONCLUSIONS—A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits.