Despite strong evidence that achieving recommended HbA1c, LDL cholesterol and blood pressure (BP) goals can substantially reduce morbidity, mortality, and costs in patients with diabetes, the majority of patients do not achieve these targets. The broad goal of our research program is to successfully translate empirical knowledge regarding diabetes treatment and management into sustainable and effective clinical practice. Current barriers include lack of physician contact time, insufficient education on self-management skills, inadequate strategies to foster behavior change and patient adherence, and the difficulty of translating evidence-based clinical guidelines into practice. Nurse case management (NCM) may offer the opportunity for better outcomes at lower cost. Previous studies have targeted a single clinical parameter (glycemic control) and have not, for the most part, addressed the well-known co-morbidities associated with diabetes such as hypertension, hyperlipidemia, and depression. We propose a three-year, randomized clinical trial examining the impact of enhanced nurse case management added to usual primary care given to high-risk patients with diabetes (HbA1c > 8.5, LDL cholesterol >130, or BP >140/90) and will include a significant minority population. Nurse case mangers will meet at regular clinic visits with the experimental group and engage in a more structured approach to improving patient self-management and behavior change through the use of motivational interviewing techniques. The NCM intervention will also include the provision of basic diabetes self-management education, tracking of patient outcomes, and implementation of standing orders for process . measures. Clinical guidelines will be used to prompt physician action and nurses will provide individualized patient follow-up . Our study is unique in addressing several shortcomings in the NCM literature- cost effectiveness, durability of effect, impact on quality of life and adherence of patients ; and satisfaction of both patients and providers. A structured training program will be used and specifics of the intervention will be well documented. Finally, we will examine the barriers encountered and means for overcoming them, as well as the organizational elements that are necessary to successfully implement this multiple risk factor intervention in high-risk populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18DK067495-02
Application #
7121979
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (M1))
Program Officer
Staten, Myrlene A
Project Start
2005-09-15
Project End
2010-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
2
Fiscal Year
2006
Total Cost
$585,826
Indirect Cost
Name
Pennsylvania State University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
129348186
City
Hershey
State
PA
Country
United States
Zip Code
17033
Gabbay, Robert A; AƱel-Tiangco, Raquel M; Dellasega, Cheryl et al. (2013) Diabetes nurse case management and motivational interviewing for change (DYNAMIC): results of a 2-year randomized controlled pragmatic trial. J Diabetes 5:349-57
Bassett, Jon; Adelman, Alan; Gabbay, Robert et al. (2012) Relationship between Depression and Treatment Satisfaction among Patients with Type 2 Diabetes. J Diabetes Metab 3:
Dellasega, Cheryl; Anel-Tiangco, Raquel M; Gabbay, Robert A (2012) How patients with type 2 diabetes mellitus respond to motivational interviewing. Diabetes Res Clin Pract 95:37-41
Bojadzievski, Trajko; Gabbay, Robert A (2011) Patient-centered medical home and diabetes. Diabetes Care 34:1047-53
Gabbay, Robert A; Durdock, Kendra (2010) Strategies to increase adherence through diabetes technology. J Diabetes Sci Technol 4:661-5
Dellasega, Cheryl; Gabbay, Robert; Durdock, Kendra et al. (2010) Motivational Interviewing (MI) to Change Type 2DM Self Care Behaviors: A Nursing Intervention. J Diabetes Nurs 14:112-118
Dellasega, Cheryl; Gabbay, Robert; Durdock, Kendra et al. (2009) An exploratory study of the orientation needs of experienced nurses. J Contin Educ Nurs 40:311-6
Stuckey, Heather L; Dellasega, Cheryl; Graber, Nora J et al. (2009) Diabetes nurse case management and motivational interviewing for change (DYNAMIC): study design and baseline characteristics in the Chronic Care Model for type 2 diabetes. Contemp Clin Trials 30:366-74
Gardner, Thomas W; Gabbay, Robert A (2009) Diabetes and obesity: a challenge for every ophthalmologist. Arch Ophthalmol 127:328-9