Two studies support the role of
nurse-based management of diabetes.
One study shows that
compared with endocrinologist-based management, nurse-based management of women
with gestational diabetes mellitus (GDM) had the same outcomes. In the second
study, patients with complicated diabetes had better glycemic control with
nurse-based care than with usual care.
"Nurse practitioners
today are increasingly furthering their training, developing specialized skills,
and making autonomous diagnoses and treatment decisions, with outcomes that do
not differ from those of physicians," write Apolonia Garcia-Patterson, MD, and
colleagues from Autonomous University Barcelona in Spain.
This retrospective
analysis compared 244 patients with GDM receiving endocrinologist-based care
(delivering between January 1, 1995, and June 30, 1997) with 283 patients with
GDM receiving nurse-based care (delivering between July 1, 1997, and December
31, 1999).
Rates of insulin
treatment and perinatal outcome were similar in both groups, in terms of
hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia,
small- and large-for-gestational-age newborns, obstetric trauma, major
malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory
distress, and mortality.
"Comparison of periods
of endocrinologist-based and diabetes nurse-based metabolic management of women
with GDM showed no differences in the rate of insulin treatment and perinatal
outcome," the authors write. "This supports a more active role of nurses in the
management of women with GDM."
The second study, from
Kaiser Permanente Medical Center in Santa Clara, California, was a randomized
controlled trial of a nurse-care management system designed to improve outcomes
in patients with complicated diabetes.
Of 169 patients with
longstanding diabetes, one or more major medical comorbid conditions, and HbA1c
greater than 10%, 84 received the special nurse-management intervention, and 85
received usual medical care for one year. Patients in the nurse-based group met
with a nurse-care manager to establish individual outcome goals, attended group
sessions once weekly for up to four weeks, and received telephone calls for
medication management and counseling regarding self-care activities.
At one year, mean
reductions in HbA1c,
total cholesterol, and low-density lipoprotein cholesterol were significantly
greater in the nurse-based group than in the usual care group. HbA1c
was less than 7.5% in 42.6% of patients in the intervention group and in 24.6%
of patients in the usual care group (P < .03).
"A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits," the authors write.
Source: Diabetes In Control Dot Com: Diabetes Care. 2003;26:998-1001, 1058-1063.
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