Please select the eligibility criteria that correspond to the clinical trial below.
Title: Impact of Nurse Case Management on Diabetes Co-morbidities
Brief Summary: Although strong clinical evidence exists that patients with diabetes should achieve certain clinical goals (i.e. HbA1C, BP, LDL, etc.), to reduce morbidity and mortality national surveys indicate that only a minority of people with diabetes achieves these goals.

Hypothesis: combination of nurse case management and enhanced behavior change counseling will improve outcomes for glycemic control, blood pressure and cholesterol in high risk patients with Type 2 diabetes when compared to usual care over a 3 year period.

Study design- The study will be a three year randomized control trial that will select patients that have either A1C \>8.5, LDL \>130, or BP \>140/90. Nurse case managers, trained in clinical guidelines and brief behavior change counseling techniques (motivational interviewing), will aim to foster patient adherence in the experimental group patients. Nurse case managers will use standing orders to set an implementation of clinical guidelines (for diabetes, hypertension, hyperlipidemia and depression) with individual follow up.

A total of 820 patients between the all 9 (6 Hershey Medical Center and 3 Reading Hospital affiliated clinics) will be sought. One third of the study patients will be recruited from the underserved Hispanic population in the Reading area. Patients will be randomized by physician i.e. one physician will be randomly assigned to have all their patients co-managed by a nurse case manager; the other will have usual care without any contact with nurse case manager.

Nurses will be trained and then initiate a small pilot study in July thru August. Full recruitment and initiation of study will begin in September 2006.

Clinic Activities - Each nurse will be responsible for 3 clinics. Nurses will work under the supervision of the primary care physicians. A set of clinical guidelines will be developed with physician input that will serve as the over-riding framework for the nurses.

Outcomes - Over a three-year period the investigators will evaluate clinical response (improvements in A1C, BP, LDL, and depression when present) as well as a series of other measures that will be obtained by surveys (patient satisfaction, quality of life, self-management behaviors). Provider satisfaction will be measured using a standardized tool. Finally, cost effectiveness of the intervention and evaluation of the potential barriers to implementation will be studied.


Options:
A: Inclusion Criteria:

* Provision of informed Consent
* Patients suffering from diabetes type II, insulin dependent or not insulin dependent.

Exclusion Criteria:

* Type I diabetes
* Pregnancy diabetes
* Hospitalisation, as this is a primary care study
* Patients who are member of the Belgian Diabetes Convention
B: Inclusion Criteria:

* Prevalent Type 2-diabetes as confirmed by Primary Care Physician.
* Patient alive throughout the intervention period.
* GP actively working throughout the intervention period (not retired).

Exclusion criteria:

* death during intervention
* moved out of geographic area during intervention
* GP retired during intervention
C: Inclusion Criteria:

* African-American
* 65 years of age or older
* no dilated fundus exam in past 2 years

Exclusion Criteria:

* appointment for dilated fundus exam scheduled
* no access to phone
D: Inclusion Criteria:

* Type 2 diabetes
* age \> 18 years old who are at high risk based on any one of the following criteria:

  * HbA1C \> 8.5
  * LDL \> 130
  * BP \> 140/90 within the last 6 months

Exclusion Criteria:

* patients who are pregnant upon entry in the study (however if a patient becomes pregnant in the course of the study, she can continue with the study)
* unable to communicate in either English or Spanish
* in nursing homes (and therefore unable to attend outpatient visits)

Answer: D