Effect of Nurse CaseManagement ComparedWith Usual Care on Controlling Cardiovascular Risk Factors in PatientsWith Diabetes

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 A1c (HbA1c).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,130/80mmHg,HbA1c,8.0%, and LDL,100 mg/dL) at 1 year. Secondary outcomes included improvements within each individ-ual component of the composite primary outcome. Differences between groups were analyzed using t tests, Pearson x2 tests, and linear and logistic regression. RESULTS—A greater number of individuals assigned to case management achieved the pri-mary 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 HbA1c,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 algo-rithm can effectively improve the number of individuals with control of multiple cardiovascular risk factors at 1 year