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Item #4
Nurses Vs. Endos in Diabetes
Management
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.
Diabetes
Care.
2003;26:998-1001, 1058-1063
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