title: Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon.
abstract: 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.
authors.affiliation: The George Institute for International Health, The University of Sydney, Australia. akengne@george.org.au
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
authors.forename: Leopold
authors.initials: L
authors.lastname: Fezeu
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
authors.forename: Paschal Kum
authors.initials: PK
authors.lastname: Awah
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Aspray
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Unwin
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Mbanya
mesh_terms: 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
chemical_list: D001786:Blood Glucose