Nurses Lead the Way to Improved Diabetes Control

A program led by certified diabetes nurse educators helped patients titrate insulin and improve key diabetes parameters….

Jacob Cohen, MD, a resident in internal medicine at the University of California, San Francisco, Fresno Medical Center reported that, compared with baseline, 84 patients in a nurse-led study reduced A1c from 10.6% to 8.9% (P<0.0001) over the course of a year, and lowered their fasting home glucose levels from a baseline of 196 mg/dL to 146 mg/dL (P<0.0001).

Among the 45 patients who also received simultaneous Diabetes Self-Management Training in the diabetes management clinic, HbA1c decreased an additional 1.92% (P<0.0001), but patients who only had diabetes titration instruction were unable to significantly reduce HbA1c the researchers reported.

Cohen wrote, "Our study demonstrated that a nurse-led Diabetes Medication Management Clinic may be an effective resource to help improve glycemic control."

He and colleagues reviewed patients to determine which ones had participated in at least two sessions in the Diabetes Medication Management Clinic, identifying 84 of these individuals. He also identified 45 patients who received additional instruction in home care.

"The Diabetes Medication Management Clinic was set up in a community outpatient clinic historically associated with lengthy delays in obtaining physician appointments," Cohen explained. The clinic was designed to be a resource that could provide timely and improved diabetic care for those with poorly-controlled diabetes mellitus.

In a typical diabetes clinic certified diabetes nurse educators only provide diabetes self-management training. In the specialized clinic, the nurse – under supervision of the internists over a period as long as 3-months – initiates insulin use and also help the patients to titrate insulin to an optimum dose. He reported that the self-management program has previously been validated as a method of improving glycemic control. "However, the impact of a nurse-led medication clinic on glycemic control was previously unknown," he stated.

"Nurse-led medication management clinic significantly improved short-term glycemic control," Cohen stated. "Younger patients and those with higher baseline HbA1c were associated with the higher reduction in HbA1c. The reduction of HbA1c was 2.5 times higher in the patients who received simultaneous diabetes self-management training than those who did not."

"All patients in medication management clinic should therefore undergo simultaneous diabetes self-management training to get the maximum benefit of the clinic," he suggested.

Practice Pearl:

• In this retrospective cohort study, a nurse-led diabetes medication management clinic significantly improved short-term glycemic control in those who simultaneously received simultaneous diabetes self-management training.

Cohen J, et al "Impact of nurse-led diabetes medication management clinic on glycemic control" AACE 2013.