Medical and economic evaluation of disease management program for poorly-controlled elderly diabetes patients

[Purpose] To evaluate the medical and economic effectiveness of disease management program by nurses on poorly controlled diabetic patients, an intervention trial was conducted. [Methods] This study was originally designed as a RCT but had to be conducted as an uncontrolled trial due to the small number of eligible patients. Twenty one elderly diabetic patients (average age: 65.3, SD 6.38, M/F=5/16) being treated at a rural community hospital but in a poorly controlled condition (HbA1c>=6.5%) were recruited and nutritional health guidance supplemented with blood sugar self-monitoring (SMBG) kit was provided by professionally trained nurses for two months. Evaluation was done using laboratory data from medical records of the participating hospital and health insurance claims from all providers for the patients were disclosed by the insuring municipal government with written consent. Comparison was made between before/after the health guidance on an individual basis. [Results] A satisfactory medical effect was obtained: the average HbA1c of five exams before/after the intervention was 6.69%/7.1% or 0.4% reduction (p=0.001). However the economic effect was inconclusive: the overall health care cost per consultation of the patients for all providers increased after the intervention. If the data were limited to the participating community hospital, the average cost per consultation and per-diem drug cost were slightly lower after the intervention but failed to reach significance due to small sample size. [Conclusion] Disease management incorporating health guidance by nurses provides a better control of diabetes but its cost reduction in the short term was plausible but remained uncertain.