title: Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: results from a systematic review.
abstract: OBJECTIVE
  Using the methodology of the Joanna Briggs Institute, a systematic review of current research was performed to determine if the addition of management by nurses had been more effective in improving clinical outcomes of patients with type 2 diabetes attending a general practice compared with standard care.
  
  
  METHODS
  A three-step literature search was conducted for suitable English studies with quantitative clinical outcomes that had been published from January 1990 to May 2014. Randomised controlled trials (RCTs) were particularly sought after; however, other research designs were considered. Articles were assessed by two independent reviewers for methodological validity, prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute. When possible, quantitative data were pooled in statistical meta-analysis.
  
  
  RESULTS
  Seven studies were of suitable quality and relevance for the review: these included three randomised control trials; two cluster- RCTs; a cluster, nonrandomised, controlled before-after study; and a cluster observational cohort study. These studies yield evidence that nurse management in addition to standard general practitioner care leads to modest improvements in blood pressure and total cholesterol levels in adults with type 2 diabetes attending a general practice.
  
  
  CONCLUSIONS
  Meta-analysis identified modest, significant improvements amongst participants in nurse management interventions (NMIs) in the following clinical outcomes: mean SBP, mean DBP and mean total cholesterol. The majority of outcomes studied did not show any advantage to adding NMIs to general practitioner care. Two studies reported significant improvements of participants with poor control in mean haemoglobin A1c. An RCT that investigates the effect of NMIs on patients, with poor control in regard to clinical outcomes and cost effectiveness, is recommended.
authors.affiliation: 1School of Nursing, Midwifery and Social Work, The University of Queensland 2Australian Centre for Evidence Based Community Care: A Collaborating Centre of the Joanna Briggs Institute, The University of Queensland 3School of Medicine, University of Queensland, St Lucia 4Centre for Applied Nursing Research, Western Sydney University and the Ingham Applied Medical Research Institute, Liverpool, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Parker
authors.forename: Diane
authors.initials: D
authors.lastname: Maresco-Pennisi
authors.forename: Karen
authors.initials: K
authors.lastname: Clifton
authors.forename: Ridhwan
authors.initials: R
authors.lastname: Shams
authors.forename: Jacqui
authors.initials: J
authors.lastname: Young
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000451:nursing*; D058006:General Practice / Q000458:organization & administration; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D024802:Nurse's Role; D009726:Nurses; D016896:Treatment Outcome