title: Nurse practitioner-mediated intervention for preoperative control of diabetes in elective surgery patients.
abstract: OBJECTIVE
  This study evaluated the effect of nurse practitioner (NP) mediated interventions on diabetes control before elective surgery.
  
  
  METHODS
  A program was initiated to improve preoperative diabetes control in patients with HbA1c > 8%. The intervention was initially mediated by a physician alone and subsequently changed to involve NPs. The goal of intervention was fasting blood glucose (BG) <200 mg/dL on the day of surgery (DOS). Data were collected before the program (control group), during physician-mediated intervention (phase 1), and during NP-mediated intervention (phase 2).
  
  
  CONCLUSIONS
  There were 222 patients in the control group, 226 in phase 1, and 160 in phase 2. Mean BG (mg/dL) on DOS was 171.4 ± 66.5 in control group, 162.6 ± 58.1 in phase 1, and 153.4 ± 46.6 in phase 2 (p = NS for control vs. phase 1 and <0.01 for control vs. phase 2). More patients received an intervention in phase 2 (93%) than in phase 1 (75%). Among those receiving intervention, 87% achieved target BG in phase 2 and 82% in phase 1 (p = NS). Duration of diabetes, baseline HbA1c, time available before surgery, and diabetes intervention were independent predictors of achieving target BG.
  
  
  CONCLUSIONS
  NP-mediated interventions increased access to care and resulted in lower BG levels and may be a good strategy for preoperative diabetes control.
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. rgarg@partners.org.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Garg
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Cheyenne
authors.initials: C
authors.lastname: Metzger
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Raquel
authors.initials: R
authors.lastname: Rein
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Meghan
authors.initials: M
authors.lastname: Lortie
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Center for Nursing Excellence, Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Patricia
authors.initials: P
authors.lastname: Underwood
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Department of Anesthesia, Pain, and Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Angela
authors.initials: A
authors.lastname: Bader
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kyle
authors.initials: K
authors.lastname: Carbone
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Brooke
authors.initials: B
authors.lastname: Schuman
mesh_terms: D000368:Aged; D003376:Counseling / Q000379:methods* / Q000592:standards; D003920:Diabetes Mellitus / Q000628:therapy*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D011300:Preoperative Care / Q000379:methods*
keywords: Nurse practitioner; glycemic control; preoperative hyperglycemia; surgical outcomes