Doctors Prompted by Trained Nurses Improves Rates of Counseling for Diabetes Pre

Doctors Prompted by Trained Nurses Improves Rates of Counseling for Diabetes Prevention
Involving nurses in diabetes prevention with simple prompts can lead to improved outcomes.

Dr. John M. Boltri and his associates randomized 10 primary care practices to intervention and control groups. Nurses in the intervention group received training on the ADA high-risk criteria for diabetes, how to calculate body mass index, how to use fingerstick glucometers, and how to counsel patients and follow up on glucose results.

Nurses in the control group received no such training.

Patients seen at the practices completed an ADA risk assessment questionnaire in the waiting room. In the intervention group, the nurses scored the questionnaire and if the patient was high risk for diabetes, they prompted the doctor to counsel him or her about exercise, diet, and weight control. The control group received usual care. The investigators then followed patients in both groups for 3 months to determine who received diet, exercise, and weight-reduction plans.

Of the 1,395 patients in the study, 42% had a family history of diabetes and 84% were at high risk for diabetes according to ADA criteria, reported Dr. Boltri, professor of family medicine at Mercer University, Macon, Ga. Their mean age was 50 years and their mean BMI was 30 kg/m2.

At 3 months of follow-up, 15% of patients in the intervention group received exercise plans, compared with only 2% of those in the control group. Patients in the intervention group also received more counseling for diet and weight reduction plans, compared with those in the control group (16% vs. 3%, and 6% vs. 2%, respectively).

When the investigators adjusted for age, gender, ADA risk score, and overweight, patients in the intervention group were eight times more likely than controls to receive a diet plan, six times more likely than controls to receive an exercise plan, and two times more likely than controls to receive a weight-loss plan.

“We were surprised at the magnitude of the difference,” Dr. Boltri said. “The odds ratios were high enough to say that this [prompt] would probably work in most primary care practices.”

Family practice News Volume 35, Issue 15, Page 23 (1 August 2005)

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FACT:
Low cardiorespiratory fitness is a strong and independent predictor of incident metabolic syndrome in women and men: Clinicians should consider the potential benefits of greater cardiorespiratory fitness in the primary prevention of metabolic syndrome, particularly among patients who have already begun to cluster metabolic syndrome components.”
Circulation. 2005;112:505-512. July 26, 2005.