Nurse-Led Clinics Help Diabetics
Achieve Blood Pressure and Lipid Goals
New research suggests that regular visits
to clinics staffed by specialist nurses can help
diabetics achieve blood pressures and cholesterol
levels that are in accordance with current guidelines.
The findings, are based on a study of 1407 patients
with diabetes who were randomized to receive usual
care with or without a visit to a nurse-led clinic
every 4 to 6 weeks.
The patients had hypertension or high total cholesterol
levels, or both problems. The goal was to achieve
a blood pressure < 140/80 mmHg and a total
cholesterol level < 5.0 mmol/L. The average
follow-up period was 1.5 years.
The nurses at the clinics were given algorithms
to help manage the patients' blood pressures and
lipid levels. The nurses provided lifestyle advice
to the patients and were able to titrate medication
doses based on treatment response.
Patients who attended the clinic were 37% more
likely to achieve their targets than those who
just received usual care (p = 0.003), lead author
Dr. John P. New, from Hope Hospital in Salford,
UK, and colleagues note. The clinics appeared
to be more beneficial for patients with hyperlipidemia
than for those with hypertension.
Clinic attendance was also associated with a survival
benefit, the authors note. Clinic attendees were
45% less likely to die than controls (p = 0.02).
"This study provides good evidence to support
the use of specialist nurse-led clinics as an
effective adjunct to hospital-based care of patients
with diabetes," the researchers state. In
fact, such clinics were associated with "a
surprising and significant reduction in mortality."
Diabetes Care 2003;26:2250-2255.
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