Yet another study has confirmed that diabetes nurse specialists and physicians provide comparable care to patients with diabetes.

This latest, a two-year study from the Netherlands, found that, compared with physicians, diabetes nurse specialists spent more time with patients, and fewer of their patients were hospitalized or experienced diabetes-related complications.

In addition, the nurses provided that care at lower cost-a factor that other studies comparing physicians with diabetes nurse specialists or similar types of advanced practice nurses (APNs) have neglected.

Documenting that nurses save money is an important result of the Dutch study, according to Jane Jeffrie Seley, a diabetes NP on the diabetes team at New York Presbyterian-Weill Cornell Medical Center.

According to Seley, "nurse diabetes programs are the first to go when administrators cut costs," despite evidence that diabetes APNs improve clinical end points and quality of life. In fact, diabetes APNs are often compared with retail "loss leaders"-items sold at a steep discount to draw customers into a store. The Dutch study verifies that "diabetes educators aren't loss leaders," Seley says. "In fact, they're cost-effective."

Previous studies show that nurses and physicians provide equivalent care, and nurses even excel in some areas. For example, a 2002 study by Lenz and colleagues showed that NPs were twice as likely as physicians to teach patients with diabetes about nutrition, weight, exercise, and medications. And an international survey conducted in 2001 identified "diabetes attitudes, wishes, and needs" among patients and care providers, including physicians and nurse specialists. The Diabetes Attitudes, Wishes, and Needs (DAWN) study found that nurses, more than physicians, recognize that psychosocial issues affect self-management, and patients reported better self-management when cared for by a nurse. Moreover, physicians expressed a need for better access to nurses trained in diabetes care.

Over the next 20 years, 336 million people worldwide will develop diabetes, largely in Western countries, yet there's a shortage of physicians to treat them. And the new Dutch study finally "provides the much needed evidence on costs," says DAWN study author Linda Siminerio, a nurse and the executive director of the University of Pittsburgh Diabetes Institute.

Says Seley, "We need creative ways to care for patients, and diabetes nurse educators provide equivalent care while saving money." Siminerio concurs, adding that with the rates of diabetes and other chronic illnesses burgeoning, "health care delivery models that integrate nurses are critically important."

Nurses give family support, provide a sense of security and hope, and serve as liaisons between patients and physicians. "These are essential elements for appropriate chronic disease management," Siminerio says.-Carol Potera

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