DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Compared to non-diabetes specialist nurses, there are no studies to support that diabetes education provided by
certified diabetes educators improves outcomes.
Community Health Workers
Community health worker (CHW) characteristics are often poorly reported (CHWs included in studies all were
members of the local community and of the same ethnicity/race as the study subjects). Diabetes programs include
community health workers as team members in a variety of roles. There are some preliminary data demonstrating
improvements in participant knowledge and behavior as well as participant satisfaction with CHW contacts. Effects
on physiological measures and health behaviors were mixed. Data on health related quality of life, healthcare
utilization and economic efficiency were sparse. Some of the successful interventions were multi-component and
some were limited primarily or exclusively to the CHW (Norris et al., 2006).
EVIDENCE TABLE
Recommendation Sources LE QE SR
1 Education provided in either Rickheim et al., 2002 I Fair B
individual or group settings.
2 Telehealth/electronic interventions Austin Boren S et al., 2006 I Fair B
Barlow et al., 2007
Balas et al., 2004
3 Group visits Deakin et al., 2005
I Fair B
Jaber et al., 2006
Sadur et al.,1999
Wagner et al., 2001
Trento et al., 2001
Kirsh et al., 2007
van Dam et al., 2005 §
4 Nurse interventions Loveman et al., 2003 §
I Fair B
Marrero et al., 1995
Piette et al., 2000
Thompson et al., 1999
5 Pharmacist interventions Machado et al., 2007
I Fair B
Wubben & Vivian, 2008
LE-Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation §=Systematic Review (see Appendix A)
Module M: Self-management Page 117