A nurse-managed diabetes care programme

To compare diabetes outcomes in patients under endocrinologist-directed diabetes care with those in patients in a nurse-managed diabetes care (NMDC) programme.

NMDC was provided to the diabetic patients referring to a Wednesday diabetes clinic in Shiraz. A total of 159 patients who had received such care were hierarchically matched with 159 diabetic patients receiving usual endocrinologist care in the same clinic during the rest of the week. Outcomes in patients who completed 1 year under NMDC were compared with those of usual endocrinologist care patients and also with those derived from the year before receiving NMDC.

For patients in NMDC programme, the process measures recommended by the American Diabetes Association (ADA) were carried out more frequently than for the appropriate control patients. Under NMDC, HbA(1c) levels fell 3.2% in the 117 patients who were followed for at least 6 months, when compared with a 2.5% fall under usual endocrinologist care (p < 0.001). During the year before the study, in 73 patients mean HbA(1c) levels decreased by 2.6%. At the end of a year under the NMDC programme, the values fell further by 0.65% (p < 0.001). Also, the proportions of patients with TG levels > 150 mg% and LDL levels > 100 mg% decreased from 31% and 36% to 16% and 20%, respectively (p < 0.04 and p < 0.05, respectively).

NMDC programme improves diabetes outcomes more significantly than endocrinologist-directed care.