Effectiveness and Cost of a Health Promotion Nurse Intervention among Medicare Beneficiaries with Diabetes or are at High Risk of Developing Diabetes

Diabetes is associated with increased prevalence and incidence of physical disability across the lifespan, but the disease burden is particularly pronounced among older adults. We examined the effectiveness and cost of a multi-component health promotion nurse intervention in 383 older adults with diabetes or are at high risk of developing diabetes by rural and urban status using data from a randomized controlled trial. Participants were included if they lived in the community, received Medicare, reported having functional disability, and reported having been told by their physicians that they had diabetes, or had BMI of 25 or greater, or had hypertension, and who completed the 22-month follow-up. We measured self-reported dependencies in activities of daily living (ADL) and instrumental activities of daily living (IADL), and total health care expenditures. We found that the impact of the nurse intervention on ADLs and IADLs were not statistically significant (p=0.229 and p=0.425, respectively). When the interaction between nurse and rural was examined, the effect of the intervention on ADL was borderline significant among rural participants (p=0.063). Average total health care expenditures were 8.5% ($2,463) lower in the nurse group compared to the control group ($26,447 versus $28,911, respectively), but the difference is not statistically significant. We conclude that the health promotion nurse intervention may be able to maintain physical functioning while remaining cost neutral for high risk Medicare beneficiaries with diabetes or at high risk of developing diabetes.