title: Quality of type 2 diabetes management in general practice is associated with involvement of general practice nurses.
abstract: OBJECTIVE
  To assess whether involvement of general practice nurses in type 2 diabetes care in Danish general practice is associated with improved adherence to national guidelines on regular type 2 diabetes monitoring, and with lower HbA1c and cholesterol levels in the type 2 diabetes population.
  
  
  METHODS
  The study was an observational study soliciting questionnaire data from 193 Danish general practices and register data on 12,960 patients with type 2 diabetes (age range 40-80 years) from a diabetes database and a laboratory database. Clustering was addressed in the analyses.
  
  
  RESULTS
  Practices with well-implemented nurse-led type 2 diabetes consultations and practices with no nurse(s) employed differed according to the mean proportions of patients whose HbA1c was measured (6.4%-points: 95% CI: 1.5 to 11.4), and the mean proportions of patients whose HbA1c was ≥ 8% (-3.7%-points: 95% CI: -6.7 to -0.6). Small non-significant differences were found in the cholesterol analyses.
  
  
  CONCLUSIONS
  Compared with practices with no nurse(s) employed, the quality of diabetes management was generally higher in terms of that HbA1c was measured according to the guidelines in a larger proportion of the diabetes population and the proportion of patients with an HbA1c level ≥ 8% was lower in practices with well-implemented nurse-led type 2 diabetes consultations.
authors.affiliation: Department of Public Health, Section for General Practice, Aarhus University, Denmark. lise.juul@alm.au.dk
authors.forename: Lise
authors.initials: L
authors.lastname: Juul
authors.forename: Helle Terkildsen
authors.initials: HT
authors.lastname: Maindal
authors.forename: Morten
authors.initials: M
authors.lastname: Frydenberg
authors.forename: Jette Kolding
authors.initials: JK
authors.lastname: Kristensen
authors.forename: Annelli
authors.initials: A
authors.lastname: Sandbaek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000451:nursing* / Q000628:therapy; D005260:Female; D058006:General Practice / Q000592:standards*; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D017410:Practice Guidelines as Topic / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human