Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial

Ann Intern Med. 1998 Oct 15;129(8):605-12. doi: 10.7326/0003-4819-129-8-199810150-00004.


Background: Control of hyperglycemia delays or prevents complications of diabetes, but many persons with diabetes do not achieve optimal control.

Objective: To compare diabetes control in patients receiving nurse case management and patients receiving usual care.

Design: Randomized, controlled trial.

Setting: Primary care clinics in a group-model health maintenance organization (HMO).

Patients: 17 patients with type 1 diabetes mellitus and 121 patients with type 2 diabetes mellitus.

Intervention: The nurse case manager followed written management algorithms under the direction of a family physician and an endocrinologist. Changes in therapy were communicated to primary care physicians. All patients received ongoing care through their primary care physicians.

Measurements: The primary outcome, hemoglobin A1c (HbA1c) value, was measured at baseline and at 12 months. Fasting blood glucose levels, medication type and dose, body weight, blood pressure, lipid levels, patient-perceived health status, episodes of severe hypoglycemia, and emergency department and hospital admissions were also assessed.

Results: 72% of patients completed follow-up. Patients in the nurse case management group had mean decreases of 1.7 percentage points in HbA1c values and 43 mg/dL (2.38 mmol/L) in fasting glucose levels; patients in the usual care group had decreases of 0.6 percentage points in HbA1c values and 15 mg/dL (0.83 mmol/L) in fasting glucose levels (P < 0.01). Self-reported health status improved in the nurse case management group (P = 0.02). The nurse case management intervention was not associated with statistically significant changes in medication type or dose, body weight, blood pressure, or lipids or with adverse events.

Conclusions: A nurse case manager with considerable management responsibility can, in association with primary care physicians and an endocrinologist, help improve glycemic control in diabetic patients in a group-model HMO.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Algorithms
  • Blood Glucose / metabolism*
  • Case Management*
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / nursing*
  • Diabetes Mellitus, Type 1 / therapy
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / nursing*
  • Diabetes Mellitus, Type 2 / therapy
  • Glycated Hemoglobin / metabolism
  • Health Maintenance Organizations*
  • Humans
  • Middle Aged


  • Blood Glucose
  • Glycated Hemoglobin A