Can diabetes management be safely transferred to practice nurses in a primary care setting? A randomised controlled trial

Authors

  • Sebastiaan T Houweling,

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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  • Nanne Kleefstra,

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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  • Kornelis JJ van Hateren,

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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  • Klaas H Groenier,

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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  • Betty Meyboom-de Jong,

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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  • Henk JG Bilo

    1. Authors:Sebastiaan T Houweling, MD, PhD, Assistant Professor and General Practitioner, Diabetes Centre, Isala Clinics; Langerhans Medical Research Foundation, Zwolle and General Practice Sleeuwijk, Sleeuwijk; Nanne Kleefstra, MD, PhD, Assistant Professor, Diabetes Centre, Isala Clinics, Zwolle and Langerhans Medical Research Foundation, Zwolle; Kornelis JJ van Hateren, MD, General Practitioner in Training, Diabetes Centre, Isala Clinics, Zwolle; Klaas H Groenier, MSc, PhD, Statistician, Department of General Practice, University Medical Center Groningen, Groningen; Betty Meyboom-de Jong, MD, PhD, Professor, Department of General Practice, University Medical Center Groningen, Groningen; Henk JG Bilo, MD, PhD, FRCP, Professor and Internist, Diabetes Centre, Isala Clinics, Department of Internal Medicine, Isala Clinics, Zwolle and Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Kornelis JJ van Hateren, General Practitioner in Training, Diabetes Centre, Isala Clinics, PO Box 10400, 8000 GK Zwolle, The Netherlands. Telephone: +31 38 4242518.
E-mail:k.j.j.van.hateren@isala.nl

Abstract

Aims and objectives.  To determine whether the management of type 2 diabetes mellitus in a primary care setting can be safely transferred to practice nurses.

Background.  Because of the increasing prevalence of type 2 diabetes mellitus and the burden of caring for individual patients, the demand type 2 diabetes mellitus patients place on primary health care resources has become overwhelming.

Design.  Randomised controlled trial.

Methods.  The patients in the intervention group were cared for by practice nurses who treated glucose levels, blood pressure and lipid profile according to a specified protocol. The control group received conventional care from a general practitioner. The primary outcome measure was the mean decrease seen in glycated haemoglobin (HbA1c) levels at the end of the follow-up period (14 months).

Results.  A total of 230 patients was randomised with 206 completing the study. The between-group differences with respect to reduction in HbA1c, blood pressure and lipid profile were not significant. Blood pressure decreased significantly in both groups; 7·4/3·2 mm Hg in the intervention group and 5·6/1·0 mm Hg in the control group. In both groups, more patients met the target values goals for lipid profile compared to baseline. In the intervention group, there was some deterioration in the health-related quality of life and an increase in diabetes-related symptoms. Patients being treated by a practice nurse were more satisfied with their treatment than those being treated by a general practitioner.

Conclusion.  Practice nurses achieved results, which were comparable to those achieved by a general practitioner with respect to clinical parameters with better patient satisfaction.

Relevance to clinical practice.  This study shows that diabetes management in primary care can be safely transferred to practice nurses.

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