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.

More to Explore...


In the Navajo Nation, a Focus on Health Data
Native Americans have disproportionately high rates of diabetes. Two PCORI studies, including this study, are searching for answers in the Navajo Nation and its health data. Challenges abound—including far-flung geography, low health resources, and language barriers—but together Navajo researchers and community health workers are meeting them. This blog was co-authored by Joan O'Connell, PhD, this study's principal investigator.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

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


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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: December 8, 2022