There were no significant mean reductions for body mass index or serum cholesterol .
Nurse-led interventions produced greater improvements than ' usual care ' for HbA1c , serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management
Implementation of the Chronic Care Model in Small Medical Practices Improves Cardiovascular Risk but Not Glycemic Control
OBJECTIVE To test whether the implementation of elements of the Chronic Care Model ( CCM ) via a specially trained practice nurse leads to an improved cardiovascular risk profile among type 2 diabetes patients . RESEARCH DESIGN AND METHODS This cluster r and omized controlled trial with primary care physicians as the unit of r and omization was conducted in the German part of Switzerl and . Three hundred twenty-six type 2 diabetes patients ( age > 18 years ; at least one glycosylated hemoglobin [ HbA1c ] level of ≥7.0 % [ 53 mmol/mol ] in the preceding year ) from 30 primary care practice s participated . The intervention included implementation of CCM elements and involvement of practice nurses in the care of type 2 diabetes patients . Primary outcome was HbA1c levels . The secondary outcomes were blood pressure ( BP ) , LDL cholesterol , accordance with CCM ( assessed by Patient Assessment of Chronic Illness Care [ PACIC ] question naire ) , and quality of life ( assessed by the 36-item short-form health survey [ SF-36 ] ) . RESULTS After 1 year , HbA1c levels decreased significantly in both groups with no significant difference between groups ( −0.05 % [ −0.60 mmol/mol ] ; P = 0.708 ) . Among intervention group patients , systolic BP ( −3.63 ; P = 0.050 ) , diastolic BP ( −4.01 ; P < 0.001 ) , LDL cholesterol ( −0.21 ; P = 0.033 ) , and PACIC subscores ( P < 0.001 to 0.048 ) significantly improved compared with control group patients . No differences between groups were shown in the SF-36 subscales . CONCLUSIONS A chronic care approach according to the CCM and involving practice nurses in diabetes care improved the cardiovascular risk profile and is experienced by patients as a better structured care . Our study showed that care according to the CCM can be implemented even in small primary care practice s , which still represent the usual structure in most European health care systems
There were no significant mean reductions for body mass index or serum cholesterol .
Nurse-led interventions produced greater improvements than ' usual care ' for HbA1c , serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management