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Care Managers Nudge Diabetes Numbers

Care managers made a difference for people with diabetes and weight problems, but it wasn’t a major change, according to a study in the Journal of Primary Care & Community Health.

The study divided 10 primary care practices into two groups, five that implemented care management programs and five that provided usual care. The care management included a care manager, staff training, and care-management improvements to the electronic medical record. Patients were followed for a year. The analysis included 696 patients in each arm, 443 with diabetes and 253 without diabetes but who were obese.

The results showed a modest (12%) advantage for the care management group in control of blood sugar levels, as measured by the proportion of patients whose HbA1c was under 7%.

Among the obese patients, the care management group had a 16 percentage point edge (26% vs. 10%) over the usual care group in the proportion of those who lost 5% of their body weight.

The before-and-after HbA1c results in the care management group were fairly impressive. Before the intervention, 25% of the patients had a HbA1c under 7%. Afterward, that proportion had increased to 45%.

Many have high hopes for care management, and this study was an attempt to study it in a primary care setting. But the study didn’t include any information about the cost of the care management program, so it is impossible to say whether it adds or subtracts to the evidence for care management being worth the trouble and expense.

Care management is usually provided across a spectrum of providers, including nurses, social workers, pharmacists, and dietitians. It can be delivered by telephone or other means, although a face-to-face meeting is usually included.

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