title: Nurse practitioner management of type 2 diabetes.
abstract: BACKGROUND
  Multifactorial barriers prevent primary care clinicians from helping their adult patients with type 2 diabetes achieve good control of hemoglobin A1c (HbA1c) levels. Patients' depression and low self-efficacy can complicate diabetes management by impairing tasks needed for effective disease self-management.
  
  
  OBJECTIVE
  To evaluate whether nurse practitioners in collaborative practices with primary care clinicians are effective in helping improve control of HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in adults with uncontrolled hyperglycemia, and to assess whether nurse practitioner-guided care affects depression and self-efficacy in these patients.
  
  
  METHODS
  De-identified preintervention and postintervention data were collected from prospective review of medical charts of patients in a managed care organization's primary care clinics.
  
  
  METHODS
  Preintervention and postintervention HbA1c values were evaluated as the primary outcome measure. Preintervention and postintervention values for BP, LDL-C, body weight, and depression and self-efficacy scores were secondary outcome measures.
  
  
  RESULTS
  After intervention, 50% of 26 patients achieved HbA1c benchmarks, 95.6% achieved systolic and diastolic BP benchmarks, and 57.8% achieved LDL-C benchmarks. Wilcoxon paired samples tests showed significantly increased self-efficacy (z = -3.42, p < 0.001) from preintervention to postintervention. Depression scores decreased slightly from preintervention (mean = 0.44, standard deviation = 1.34, median < 0.001) to postintervention values (mean = 0.18, standard deviation = 0.73, median < 0.001), but this decrease was not significant.
  
  
  CONCLUSIONS
  Integrating nurse practitioners into primary care teams to provide innovative methods of support to adults with uncontrolled hyperglycemia improves clinical outcomes and self-efficacy for patients with type 2 diabetes.
authors.affiliation: Nurse Practitioner in Ambulatory Care Medicine at the Panda Medical Center in Atlanta, GA. gail.richardson@kp.org.
authors.forename: Gail Carr
authors.initials: GC
authors.lastname: Richardson
authors.affiliation: Professor of Nursing at the School of Nursing at Duke University in Durham, NC. anne.derouin@duke.edu.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Derouin
authors.affiliation: Professor of Nursing at the School of Nursing at Duke University in Durham, NC. allison.vorderstrasse@duke.edu.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Vorderstrasse
authors.affiliation: Internist in Ambulatory Care Medicine at the Gwinnett Medical Center in Atlanta, GA. james.hipkens@kp.org.
authors.forename: James
authors.initials: J
authors.lastname: Hipkens
authors.affiliation: Research Associate and Statistical Consultant in the School of Nursing at Duke University in Durham, NC. julie.thompson@duke.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Thompson
mesh_terms: D001794:Blood Pressure; D001835:Body Weight; D008078:Cholesterol, LDL / Q000097:blood*; D003299:Cooperative Behavior; D003863:Depression; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000592:standards; D011446:Prospective Studies; D012648:Self Care; D020377:Self Efficacy; D018709:Statistics, Nonparametric
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin