Diabetes nurse case management and motivational interviewing for change (DYNAMIC): Results of a 2-year randomized controlled pragmatic trial (糖尿病护士病例管理以及促进改变的动机性会谈（DYNAMIC）：一项为期2年的实用随机对照研究)
Article first published online: 28 MAY 2013
© 2013 Wiley Publishing Asia Pty Ltd and Ruijin Hospital, Shanghai Jiaotong University School of Medicine
Journal of Diabetes
Volume 5, Issue 3, pages 349–357, September 2013
How to Cite
Gabbay, R. A., Añel-Tiangco, R. M., Dellasega, C., Mauger, D. T., Adelman, A. and Van Horn, D. H.A. (2013), Diabetes nurse case management and motivational interviewing for change (DYNAMIC): Results of a 2-year randomized controlled pragmatic trial (糖尿病护士病例管理以及促进改变的动机性会谈（DYNAMIC）：一项为期2年的实用随机对照研究). Journal of Diabetes, 5: 349–357. doi: 10.1111/1753-0407.12030
- Issue published online: 5 AUG 2013
- Article first published online: 28 MAY 2013
- Accepted manuscript online: 1 FEB 2013 01:44AM EST
- Manuscript Accepted: 29 JAN 2013
- Manuscript Revised: 21 JAN 2013
- Manuscript Received: 16 JUL 2012
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: R18-DK067495
- behavior change;
- motivational interviewing;
- nurse case management
The aim of the present study was to determine whether the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high-risk type 2 diabetes patients.
A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n = 313) or those who received the intervention (n = 232) with additional practice-embedded NCM care, including MI-guided behavior change counseling. The NCMs received intensive MI training with ongoing fidelity assessment.
Systolic blood pressure (SBP) was better in the intervention than usual care group (131 ± 15 vs. 135 ± 18 mmHg, respectively; P < 0.05). Improvements were seen in both the control and intervention groups in terms of HbA1c (from 9.1% to 8.0% and from 8.8% to 7.8%, respectively), low-density lipoprotein (LDL; from 127 to 100 mg/dL and from 128 to 102 mg/dL, respectively), and diastolic blood pressure (from 78 to 74 mmHg and from 80 to 74 mmHg, respectively). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance.
The NCMs and MI improved SBP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia may also be needed.
本研究的目的是评估在常规护理中加入接受过动机性会谈（MI）训练的护士病例管理经理（nurse case managers NCMs）后是否能够改善高风险2型糖尿病患者的预后。
干预组的收缩压（SBP）控制比常规护理组好（131±15 vs 135±18mmHg；P < 0.05）。在对照组与干预组中都可以看到HbA1C（分别从9.1%降至8.0%以及从8.8%降至7.8%）、低密度脂蛋白（分别从127降至100 mg/dL以及从128降至102mg/dL）以及舒张压（分别从78降至74mmHg以及从80降至74mmHg）有所改善。干预组的抑郁症状评分更好。糖尿病相关痛苦的减少接近达到统计学意义。