title: Management of diabetes by primary health care nurses in Auckland, New Zealand.
abstract: BACKGROUND
  The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management.
  
  
  OBJECTIVE
  To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses.
  
  
  METHODS
  Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day.
  
  
  RESULTS
  Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses.
  
  
  CONCLUSIONS
  Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand. b.daly@auckland.ac.nz.
authors.forename: Barbara
authors.initials: B
authors.lastname: Daly
authors.affiliation: School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.affiliation: School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kenealy
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Sheridan
authors.affiliation: School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Robert
authors.initials: R
authors.lastname: Scragg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D001837:Body Weights and Measures; D002648:Child; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D004032:Diet; D019468:Disease Management; D015444:Exercise; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D024802:Nurse's Role; D009726:Nurses; D010353:Patient Education as Topic; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000458:organization & administration*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents