title: Nurse-based management in patients with gestational diabetes.
abstract: 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.
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain.
authors.forename: Apolonia
authors.initials: A
authors.lastname: García-Patterson
authors.forename: Esther
authors.initials: E
authors.lastname: Martín
authors.forename: Justa
authors.initials: J
authors.lastname: Ubeda
authors.forename: Miguel A
authors.initials: MA
authors.lastname: María
authors.forename: Juan M
authors.initials: JM
authors.lastname: Adelantado
authors.forename: Gemma
authors.initials: G
authors.lastname: Ginovart
authors.forename: Alberto
authors.initials: A
authors.lastname: de Leiva
authors.forename: Rosa
authors.initials: R
authors.lastname: Corcoy
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007328:Insulin