Use of Disease Registry to Facilitate Nurse Case Management of Diabetics to Achieve Lower Lipid Levels

Purpose:
Cardiovascular risk factors, including elevated lipid levels, are common in patients with diabetes. The purpose of this strategy was to decrease cardiovascular risk through reduction in lipid levels (LDL) in a group of diabetics using nurse case management and data obtained from a disease registry.

Significance:
Improved control of LDL can reduce cardiovascular complications by 20-50% in Type 2 diabetics. Type 2 diabetics typically have a preponderance of smaller,denser LDL particles, which increase the formation of plaques in large and small vessels, and therefore increase the likelihood of cardiac events.

Strategy and Implementation:
A group of 53 diabetic patients pulled from disease registry, with LDL>100, received nurse case management with provider support from June 2010-April 2012. Nurse case management included frequent communication with patients by phone and mail. This communication included education regarding diet and exercise, medication management, and lifestyle changes which contribute to improvement in LDL cholesterol levels. Follow up was provided as needed, including repeat labs, facilitated by collaboration between the nurse and the assigned physican/provider. A comparison group of 64 diabetic patients with LDL>100 during this same time period received usual care only.

Evaluation:
34% in nurse case management group met goal of LDL<100. 60% had decreases in LDL from 2-83 mg/dL during the period of case management. 2% in comparison group met the goal of LDL<100. 25% of patients in the comparison group showed improvement/decreases in LDL from 2-77 mg/dL during the same period.

Implications for Practice:
Nurse case management using data from a clinical disease registry can facilitate improvement in quality of care and outcomes for diabetics with elevated LDLs. These results may be useful for staff in other clinics experiencing challenges managing LDL levels in their Type 2 diabetic patients.