Does case management improve physiologic outcomes for patients with poorly controlled diabetes?

Objective. To determine if a collaborative case management program improves diabetes and cardiovascular care in patients with poorly controlled diabetes mellitus. Design. Randomized controlled trial. Setting and participants. 246 patients with poorly controlled type 2 diabetes (ie, hemoglobin A_1C levels > 7.5%) who were receiving care at 1 of 2 Veterans Affairs hospitals in Michigan. Participants randomized to the intervention group were monitored by active nurse case management through use of telephone contacts, collaborative goal setting, and treatment algorithms. Control patients received educational materials and usual care from their primary care physician. Main outcome measures. Glycemic control, cholesterol level, blood pressure, and patient satisfaction. Main results. Average follow-up between the 2 groups was 19 months, with a complete follow-up of 209 patients. There was no difference in level of glycemic control between the intervention and control groups (9.3% versus 9.2% [95% confidence interval, -0.49%-0.79%]; P = 0.65). Similarly, there was no difference in level of low-density lipoprotein cholesterol or blood pressure. Patients in the intervention arm were much more likely to report being satisfied with their care than those in the control group. 82% of intervention group patients rated their providers as above average versus 64% in the control group (P = 0.04). Conclusion. Collaborative case management of diabetes patients did not lead to improved glycemic, cholesterol, or blood pressure control. The benefits of case management in improving care for patients with chronic diseases may be limited.