Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: We appreciate these clarifications from authors of the primary studies included in our analysis. Dr Krein and colleagues clarify that case managers in one1 of their 2 trials1,2 did not make medication changes without approval from primary care physicians. Repeating the random-effects meta-analysis shown in Figure 3 of our article after reclassifying the trial by Krein et al1 increased the pooled reduction in HbA1c levels for the trials in which case managers could make independent medication changes from 0.96% (95% confidence interval, 0.52%-1.41%) to 1.09% (95% confidence interval, 0.71%-1.47%). This relatively small change is because this study contributed only 16% weight to the estimate associated with trials in which case managers could make independent medication changes.
Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Rushakoff RJ, Owens DK. Quality Improvement Strategies for Type 2 Diabetes—Reply. JAMA. 2006;296(22):2680-2681. doi:10.1001/jama.296.22.2681-a