Nurse-based management in patients with gestational diabetes.
OBJECTIVE
To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management.


METHODS
In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse's role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher's exact test.


RESULTS
Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulin treatment and perinatal outcome (hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia, small- and large-for-gestational-age newborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and mortality) were also similar in both groups.


CONCLUSIONS
Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and perinatal outcome. This supports a more active role of nurses in the management of women with GDM.
García-Patterson
Apolonia
A
Endocrinology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain.
Martín
Esther
E
Ubeda
Justa
J
María
Miguel A
MA
Adelantado
Juan M
JM
Ginovart
Gemma
G
de Leiva
Alberto
A
Corcoy
Rosa
R
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D016640:Diabetes, Gestational / Q000188:drug therapy / Q000451:nursing*; D004704:Endocrinology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin