title: Nurse-led cardiovascular risk factor intervention leads to improvements in cardiovascular risk targets and glycaemic control in people with Type 1 diabetes when compared with routine diabetes clinic attendance.
abstract: OBJECTIVE
  To compare the effects of a dedicated cardiovascular risk factor clinic run by a nurse consultant with routine diabetes clinic attendance in achieving glycaemic and cardiovascular risk targets in patients with Type 1 diabetes.
  
  
  METHODS
  Eighty-one patients (45 male, mean age 34.6 years, mean duration of diabetes 15 years) with an HbA(1c) ≥ 8% (64 mmol/mol) and at least one other risk factor for the development of cardiovascular disease were randomized to receive either routine care or intensive nurse-led cardiovascular risk factor intervention. HbA(1c) , non-fasting lipid profile, blood pressure, weight, BMI and insulin dose were recorded at baseline, 6, 12 and 24 months.
  
  
  RESULTS
  At baseline there were no differences between the groups. At 12 months, there were significant improvements in the nurse-led cardiovascular risk factor group: HbA(1c) [10.1% (87 mmol/mol) vs. 9.3% (78 mmol/mol), P < 0.001], total cholesterol (5.8 vs. 4.3 mmol/l, P < 0.001), systolic blood pressure (127 vs. 115 mmHg, P < 0.001) and diastolic blood pressure (71 vs. 65 mmHg, P < 0.05). Improvements were maintained in all variables at 24 months except diastolic blood pressure. In the routine group, only total cholesterol improved significantly (5.8 vs. 5.2 mmol/l, P < 0.01) after 12 months and this was maintained at 24 months.
  
  
  CONCLUSIONS
  A nurse consultant cardiovascular risk factor clinic has a beneficial effect on cardiovascular risk targets in Type 1 diabetes, probably attributable to the increased use of lipid-lowering and anti-hypertensive agents and this was maintained at 24 months. Glycaemic control also improved.
authors.affiliation: University Department of Diabetes and Endocrinology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK. Hermione.Price@dtu.ox.ac.uk
authors.forename: M E
authors.initials: ME
authors.lastname: Wallymahmed
authors.forename: C
authors.initials: C
authors.lastname: Morgan
authors.forename: G V
authors.initials: GV
authors.lastname: Gill
authors.forename: I A
authors.initials: IA
authors.lastname: Macfarlane
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000451:nursing / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000451:nursing; D003925:Diabetic Angiopathies / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D040242:Risk Reduction Behavior
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents