Results Summary

What was the research about?

Diabetes is a long-term illness that causes blood sugar levels to rise. It can cause health problems that affect the heart, brain, eyes, limbs, and kidneys. American Indian and Alaska Native, or AI/AN, peoples are more likely to have diabetes than people from other ethnic groups.

The Indian Health Service and Tribal health programs offer health care to members of AI/AN Tribes. In addition to usual care, some people with diabetes receive education, case management, and pharmacy, or ECP, services. Nurses, case managers, and advanced practice pharmacists deliver these services, which include:

  • Information about diet, exercise, and regularly checking blood sugar
  • Support getting the healthcare services people need
  • Help managing medicines

In this study, the research team wanted to learn if ECP services helped people with diabetes improve their health. Using health data, the team compared a group of people who used ECP services with a group who didn’t.

What were the results?

Compared with the people who didn’t use ECP services, those who did:

  • Were less likely to have high blood pressure or high cholesterol
  • Were less likely to be admitted to the hospital or have one or more avoidable hospital stays
  • Spent fewer days in the hospital and had fewer emergency room visits

The two groups didn’t differ in blood sugar levels.

Also, compared with people who had one or two ECP visits, those with three or more visits:

  • Were less likely to have high blood pressure or high cholesterol
  • Spent fewer days in the hospital
  • Were less likely to have avoidable hospital stays

Who was in the study?

The research team looked at health data from 28,578 AI/AN people with diabetes who lived throughout the United States. Of these, 57 percent were women. During the study, 41 percent went to at least one ECP visit. People who used any ECP services averaged about three visits in one year.

What did the research team do?

The research team looked at health data for three fiscal years. The team looked at health outcomes in fiscal year 2013. The team looked at use of ECP services in fiscal year 2012. The team used data from fiscal year 2011 to account for differences between the two groups, such as age or gender.

AI/AN people, caregivers, and staff from the Indian Health Service, Tribal health programs, Tribal Councils, and Tribal Authorities gave input on the study.

What were the limits of the study?

The study didn’t assign people to each group by chance. The team can’t be sure that the results were entirely because of ECP services.

Future studies could look at whether the benefits of ECP services last more than one year.

How can people use the results?

Clinics can use the results to support AI/AN people with diabetes.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked the researchers to add information regarding treatment costs, one of the study goals, or to add an explanation for why costs were not explicitly addressed. The researchers explained that their stakeholder network requested many additional analyses that used up available resources, so they were not able to complete the original cost analyses. With supplemental funding from other sources, the researchers said they are planning to review their treatment cost findings and publish those results separately.
  • The reviewers asked for more explanation for how missing data were handled for participants who had some missing data in sites that were included in the analyses. The researchers provided more detail in the text and in an appendix on how they handled missing data. In general, their analyses included participants missing baseline data but with outcome data. However, the researchers excluded participants missing data on a particular outcome from analyses of that outcome.

Conflict of Interest Disclosures

Project Information

Joan O'Connell, PhD
University of Colorado Denver
Improving Health Outcomes among Native Americans with Diabetes and Cardiovascular Disease

Key Dates

September 2013
May 2020

Study Registration Information


Has Results
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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: March 14, 2024