A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life.
OBJECTIVE
To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians.


METHODS
Randomized, controlled trial.


METHODS
Veterans Affairs general medical clinic.


METHODS
275 veterans who had NIDDM and were receiving primary care from general internists.


METHODS
Nurse-initiated contacts were made by telephone at least monthly to provide patient education (with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia), reinforce compliance with regimens, monitor patients' health status, facilitate resolution of identified problems, and facilitate access to primary care.


METHODS
Glycemic control was assessed using glycosylated hemoglobin (GHb) and fasting blood sugar (FBS) levels. Health-related quality of life (HRQOL) was measured with the Medical Outcomes Study SF-36, and diabetes-related symptoms were assessed using patients' self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month.


RESULTS
At one year, between-group differences favored intervention patients for FBS (174.1 mg/dL vs 193.1 mg/dL, p = 0.011) and GHb (10.5% vs 11.1%, p = 0.046). Statistically significant differences were not observed for either SF-36 scores (p = 0.66) or diabetes-related symptoms (p = 0.23).


CONCLUSIONS
The intervention, designed to be a pragmatic, low-intensity adjunct to care delivered by physicians, modestly improved glycemic control but not HRQOL or diabetes-related symptoms.
Weinberger
M
M
Center for Health Services Research in Primary Care, Durham VAMC, NC, USA.
Kirkman
M S
MS
Samsa
G P
GP
Shortliffe
E A
EA
Landsman
P B
PB
Cowper
P A
PA
Simel
D L
DL
Feussner
J R
JR
D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing* / Q000523:psychology / Q000628:therapy; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010353:Patient Education as Topic; D011321:Primary Nursing; D011788:Quality of Life; D013689:Telephone
D001786:Blood Glucose