8/8/2019 zev - article1

1/2

Joel Ian D. Espenilla

BSNIII 1N

Nurse Case Management To Improve Glycemic

Control in Diabetic Patients in a HealthMaintenance Organization

Background: Control of hyperglycemia delays or preventscomplications of diabetes, but many persons with diabetes do not achieveoptimal control.

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

Design: Randomized, controlled trial.

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

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

Intervention: The nurse case manager followed written managementalgorithms 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 emergencydepartment and hospital admissions were also assessed.

Results: 72% of patients completed follow-up. Patients in the nursecase management group had mean decreases of 1.7 percentage points inHbA1c 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 HbA1cvalues 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 withstatistically significant changes in medication type or dose, body weight,blood pressure, or lipids or with adverse events.

8/8/2019 zev - article1

2/2

Conclusions: A nurse case manager with considerable managementresponsibility can, in association with primary care physicians and anendocrinologist, help improve glycemic control in diabetic patients in agroup-model HMO.

Reaction:

The study done is about the application of nursing care, along with

other members of the health care team, in the care of diabetic clients. A

study of 138 diabetic clients being taken care of nurses was done to observe

difference or improvement of results between usual treatments and nurse-

involved treatments. Results do show that there is improvement with clients

having the involvement of nurses in the care than taking care of the usual

way. But there is only a little difference in the statistical results, yet a big

importance of improving ones health.

Though the intervention or care done by the nurse involve is not

described, it still gave an advancement in the proper and therapeutic care in

clients with diabetes. The relevant drop of HbA1c values and FBS values really

showed that the intervention is effective enough to be promoted as a

general nursing intervention for clients with diabetes.

Nursing care really has a big relevance and big difference with other

kinds of care. There are possibilities with the aid of nursing care; any illness

that a client has will decrease in severity and health will improve. There isreally a sense of a magic healing with a nurses care rendered.