1. 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.
Task Force Recommendations & Findings
The Task Force on Community Preventive Services recommends diabetes case management strategies on the
basis of strong evidence of effectiveness in improving glycemic control. There also was sufficient evidence of
improved provider monitoring of glycated hemoglobin (GHb) when case management was delivered in combination
with disease management.
There was 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 findings
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 Reviews
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).

2.  Additional physiologic outcomes examined in this review include:
o Lipid concentrations (3 studies)
o Body mass index (1 study)
o Weight (4 studies)
o 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
 Analytic framework - See Figure 1 on page 17
 Summary evidence table – See Appendix A on pages 31-38
 Research gaps
 Included studies
Publications
Norris SL, Nichols PJ, Caspersen CJ, et al. The effectiveness of disease and case management for people with
diabetes: a systematic review. 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. 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.
Task Force on Community Preventive Services. Diabetes. 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.