This Article Full Text Full Text (PDF) All Versions of this Article: 0145721709343677v1 35/5/851    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Curtis, J. Articles by Wilson, C. PubMed PubMed Citation Articles by Curtis, J. Articles by Wilson, C. Social Bookmarking                         What's this?

Effectiveness and Safety of Medication Adjustments by Nurse Case Managers to Control Hyperglycemia

From Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (Dr Curtis), and Division of Centers of Excellence, Phoenix Indian Medical Center (Ms Lipke, Ms Effland, Ms Dickinson, Ms McCabe, Ms Russell, Dr Russell, Dr Bloomquist, Dr Wilson), Phoenix, Arizona.

Correspondence to Jeffrey Curtis, MD, MPH, 1550 East Indian School Road, Phoenix, AZ 85014 (jfcurtis{at}mail.nih.gov).

Purpose

The purpose of this study was to determine the safety and effectiveness of implementing standing orders for nurse case managers to adjust antihyperglycemic medications.

Methods

A retrospective cohort design was used to assess outcomes in American Indian and Alaska Native people who received case management and medication adjustment and those who received only standard primary care. Patients with diabetes and evidence of keeping regular follow-up appointments for diabetes care (N = 2345) who all had baseline A1C 7.0% were divided into 3 mutually exclusive groups for analysis: (1) those seen only by primary care providers (PCP; n = 1574); (2) those seen by nurse case managers (NCM; in addition to primary care) for diabetes education services only (n = 711); and (3) those who, in addition to a PCP and NCM visit, had medications adjusted by the nurse case managers (MA; n = 60). Outcome variables were number of visits with documentation of hypoglycemia (safety) and rate of A1C change (effectiveness).

Results

Documented hypoglycemia occurred more frequently with more intensive treatment. The MA group experienced the greatest rate of hypoglycemic events. The difference in hypoglycemia incidence between the groups was significant, but the number of events was small. Glycemic control improved most rapidly in the MA group, even after adjusting for potentially confounding variables.

Conclusions

In this setting, hypoglycemia occurs infrequently in all groups, but at higher rates with more intensive treatment. Nurse case management, whether with or without medication adjustment, is effective in improving short-term glucose control.

This version was published on September 1, 2009

The Diabetes Educator, Vol. 35, No. 5, 851-856 (2009)
DOI: 10.1177/0145721709343677


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?