Improving glycaemic control of insulin-treated diabetic patients--a structured audit of specialist nurse intervention.
Insulin-treated diabetic patients with poor glycaemic control are frequently referred to diabetes specialist nurses, but little data exist as to the effectiveness of this practice. We therefore analysed the progress of 43 prospectively referred insulin-treated patients with glycosylated haemoglobin (HbA1c) levels > 7.5%. Diabetes nurse intervention involved re-education, dietary advice and insulin dose adjustment. Improvement in control was defined as a final HbA1c < 7.0% or a fall of HbA1c of > 1.0% at 6 months post-intervention. Almost two-thirds (63%) of patients achieved improvement status, with no increase in body weight or hypoglycaemic episodes. Disappointingly, however, the 'non-improver' group (37%) showed a mean deterioration in HbA1c. In conclusion, diabetes nurse intervention for poorly controlled insulin-treated diabetic patients is generally effective, but intervention may be best targeted to responsive patients. The factors which influence diabetic patients' 'responsiveness to change' require further investigation.
Yong
Alice
A
Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, UK.
Power
Eileen
E
Gill
Geoffrey
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism* / Q000451:nursing; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism* / Q000451:nursing; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000592:standards*; D009731:Nursing Audit; D015402:Nursing Education Research; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin