Issue 167 Item 10 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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