Objectives: The purpose of this observational cohort study was to observe outcomes in geriatric (aged > or =65 years) and nongeriatric (<65 years) patients after employing a diabetes resource nurse (DRN) case manager in a suburban 12-physician family practice.
Study design: Data were collected by retrospective chart review of 106 patients enrolled in the diabetes care project who completed at least 6 months of the project between March 1999 and January 2001.
Population: Patients were recruited by either referral from their primary physician or invitation from the DRN.
Outcomes measured: Utilizing measures from the American Diabetes Association and the Diabetes Quality Improvement Project, comprehensive protocols were developed for implementation of process measures and management of glucose by the DRN. Active management protocols were not put in place for hypertension, lipids, or depression, but appropriate clinical measures were taken during patient visits. Data were collected at baseline, 6 months, and 12 months.
Results: Improvements in process measures were seen for geriatric and nongeriatric patients: 77% of patients had foot exams, 100% had > or =2 blood pressure measurements, 92% had eye exams, and 99% had lipid profiles. Both groups had improvement in hemoglobin A1c levels (means 7.2% to 6.6% for geriatric patients and 8.9% to 6.8% for nongeriatric patients). The number of hypoglycemia incidents decreased in both groups. Depression scores improved in the nongeriatric group.
Conclusions: Results appear to corroborate a growing body of evidence supporting nurse intervention protocols as a way to improve diabetes care. A randomized controlled trial is planned to examine the effectiveness of the DRN.