Diabetes specialist nurse as main care provider for patients with type 2 diabetes.
BACKGROUND
The objective of this study was to determine whether the management of type 2 diabetes (DM2) can be transferred from an internist to a nurse specialised in diabetes (NSD).


METHODS
Ninety-three patients with DM2 referred by their general practitioner were randomised; 84 patients completed the study. The intervention group received care from an NSD who treated glycaemia, blood pressure and lipid profile by protocol. The control group received care from an internist. The primary endpoint was the main decrease in HbA1c. Secondary endpoints included blood pressure, lipid profile, healthcare costs, QOL , and patient satisfaction.


RESULTS
HbA1c, total cholesterol, LDL cholesterol and cholesterol/HDL ratio decreased significantly in both study populations after a follow-up time of 12 months. Cholesterol/HDL ratio decreased by 0.4 and 0.9 in the NSD and control group respectively (p=0.034 for the difference between groups). The decreases (95% confidence interval) in systolic blood pressure were 8.6 mmHg (2.6, 14.7) in the NSD group and 4.0 mmHg (-0.9, 8.9) in the control group, without a significant difference between groups. After one year, 33.3% of the patients in the NSD group achieved an HbA1c level. <7% compared with 2.2%at baseline (p=0.002). Healthcare costs were less and patient satisfaction with the NSD s was significantly better(p<0.001), while maintaining the same QOL .


CONCLUSIONS
NSD s using treatment protocols are able to provide effective care for patients with DM 2, comparable with the care provided by an internist, with respect to clinical parameters, and superior with respect to healthcare costs and patient satisfaction.
Houweling
S T
ST
Langerhans Medical Research Group, the Netherlands.
Kleefstra
N
N
van Hateren
K J J
KJ
Kooy
A
A
Groenier
K H
KH
Ten Vergert
E
E
Meyboom-de Jong
B
B
Bilo
H J G
HJ
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000451:nursing* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009720:Nurse Clinicians; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000191:economics / Q000458:organization & administration*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care; D018434:Sickness Impact Profile; D000078329:Workforce