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Diabetes Prevention and Control: Case Management Interventions to Improve Glycemic Control

Case management involves planning, coordinating, and providing healthcare for all people affected by a disease—in this case, diabetes. It is directed to people who are likely to have to use too much of their income to pay for related healthcare services, who are not receiving those services that give them the best chance to stay healthy, or who are receiving services that are not well coordinated with one another.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force  recommends diabetes case management strategies on the basis of strong evidence of effectiveness in improving glycemic control. There also is sufficient evidence of improved provider monitoring of glycated hemoglobin (GHb) when case management was delivered in combination with disease management.

The Task Force finds insufficient evidence to determine the effectiveness of diabetes case management strategies, when implemented alone or in combination with disease management, for improving:

  • Lipid concentrations (based on too few studies with inconsistent results)
  • Weight or body mass index (based on too few studies with inconsistent results)
  • Blood pressure (based on too few studies with inconsistent results)

Task Force Finding

About the Interventions

  • Diabetes case management involves appointing a professional case manager, who does not provide healthcare services directly, but who oversees and coordinates all of the services received by someone with the disease.
  • Case management has five essential features: 1) identifying all those affected by the disease that are eligible for a case manager, 2) assessing current levels of healthcare and needs of eligible participants, 3) developing an individual care plan for each participant, 4) putting the care plan into action, and 5) monitoring of results.
  • Case management can be delivered as a single intervention or as part of a multicomponent intervention (e.g., disease management).

Results from the Systematic Review

Fifteen studies qualified for the review.

  • Glycated hemoglobin (GHb) levels: Median decrease of 0.53 percentage points (interquartile range: –0.65% to –0.46%; 11 studies) when case management was implemented with disease management and of 0.40 percentage points (range: -0.6% to -0.16%; 3 studies) without it.
  • Healthcare providers monitoring of GHb levels: median increase of 33% when implemented with disease management (interquartile interval, -13% to -42%; 5 studies).
  • Additional physiologic outcomes examined in this review include:
    • Lipid concentrations (3 studies)
    • Body mass index (1 study)
    • Weight (4 studies)
    • Blood pressure (2 studies)
  • The reviewed studies showed that case management helped adults with type 2 diabetes who were in managed care systems; whether or not the results apply beyond adults with type 2 diabetes in managed care systems has not been determined.
  • Case management was implemented along with disease management in 11 of the included studies.
  • In four of the reviewed studies, additional interventions were used, including diabetes self-management education, telemedicine support, insulin-adjustment algorithms, group support, visit reminders, and hospital discharge assessment and follow-up. It was not possible to determine the isolated effect of case management in these studies.
  • Economic Efficiency: no studies were found that met the requirements for inclusion in a Community Guide review.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to diabetes prevention and control.

Supporting Materials

Publications

Norris SL, Nichols PJ, Caspersen CJ, et al. The effectiveness of disease and case management for people with diabetes: a systematic review. Adobe PDF File [PDF -784 kB] Am J Prev Med 2002;22(4S):15-38.

Task Force on Community Preventive Services. Recommendations for healthcare system and self-management education interventions to reduce morbidity and mortality from diabetes. Adobe PDF File [PDF -67 kB] Am J Prev Med 2002;22(4S):10-4.

Task Force on Community Preventive Services. Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001 ;50(RR16):1-15. External Web Site Icon

Task Force on Community Preventive Services. Diabetes. Adobe PDF File [PDF -331 kB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:188-222.

Read other Community Guide publications about Diabetes Prevention and Control in our library.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Diabetes prevention and control: case management interventions to improve glycemic control. www.thecommunityguide.org/diabetes/casemgmt.html. Last updated: MM/DD/YYYY.

Review completed: January 2001