Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon.
OBJECTIVE
To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.


METHODS
We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.


RESULTS
The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.


CONCLUSIONS
Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.
Kengne
Andre Pascal
AP
The George Institute for International Health, The University of Sydney, Australia. akengne@george.org.au
Fezeu
Leopold
L
Sobngwi
Eugene
E
Awah
Paschal Kum
PK
Aspray
Terence J
TJ
Unwin
Nigel C
NC
Mbanya
Jean-Claude
JC
D000328:Adult; D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D002163:Cameroon; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000451:nursing*; D004992:Ethics, Medical; D005260:Female; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012424:Rural Population; D014505:Urban Population
D001786:Blood Glucose