Shift in responsibilities in diabetes care: the Nurse-Driven Diabetes In-Hospital Treatment protocol (N-DIABIT).
To investigate the feasibility, safety and efficacy of the Nurse-Driven Diabetes In-Hospital Treatment protocol (N-DIABIT), which consists of nurse-driven correctional therapy, in addition to physician-guided basal therapy, and is carried out by trained ward nurses.



Data on 210 patients with diabetes consecutively admitted in the 5-month period after the introduction of N-DIABIT (intervention group) were compared with the retrospectively collected data on 200 consecutive patients with diabetes admitted in the 5-month period before N-DIABIT was introduced (control group). Additional per-protocol analyses were performed in patients in whom mean patient-based protocol adherence was ≥ 70% (intervention subgroup, n = 173 vs. control subgroup, n = 196).



There was no difference between the intervention and the control group in mean blood glucose levels (8.9 ± 0.1 and 9.1 ± 0.2 mmol/l, respectively; P = 0.38), consecutive hyperglycaemic (blood glucose ≥ 10.0 mmol/l) episodes; P = 0.15), admission duration (P = 0.79), mean number of blood glucose measurements (P = 0.21) and incidence of severe hypoglycaemia (P = 0.29). Per-protocol analyses showed significant reductions in mean blood glucose levels and consecutive hypoglycaemia and hyperglycaemia in the intervention compared with the control group.



Implementation of N-DIABIT by trained ward nurses in non-intensive care unit diabetes care is feasible, safe and non-inferior to physician-driven care alone. High protocol adherence was associated with improved glycaemic control.
Section of Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands.
I G
IG
Manders
Department of Anesthesiology, VU University Medical Centre, Amsterdam, The Netherlands.
K
K
Stoecklein
Diabetes Centre, VU University Medical Centre, Amsterdam, The Netherlands.
C H C
CH
Lubach
Diabetes Centre, VU University Medical Centre, Amsterdam, The Netherlands.
J
J
Bijl-Oeldrich
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
P W B
PW
Nanayakkara
Department of Vascular Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
J A
JA
Rauwerda
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
M H H
MH
Kramer
Section of Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands.
E M W
EM
Eekhoff
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D002985:Clinical Protocols; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000451:nursing*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000451:nursing*; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000451:nursing / Q000517:prevention & control; D007003:Hypoglycemia / Q000451:nursing / Q000517:prevention & control; D008297:Male; D024802:Nurse's Role; D010343:Patient Admission / Q000706:statistics & numerical data; D012941:Social Responsibility
D001786:Blood Glucose