Fewer than 10% of people with diabetes achieve the desired outcomes from the evidence-based guidelines of the American Diabetes Association (ADA), which stipulate management of glycosylated hemoglobin (HbAIc), low-density lipoprotein (LDL) cholesterol, and blood pressure levels. A study on the effects of nurse-directed diabetes management on patients' use of urgent care and ED services found that RNs have the potential to significantly improve health outcomes for these patients.
For the study, 331 randomly selected patients (84% female, 77% Latino, 99% with type 2 diabetes) who had been treated at an inner-city clinic in California during the preceding year were assigned to managed care by a specially trained RN who used detailed treatment algorithms. After one year, 64% of patients met the ADA goal of HbAIc of less than 7%, compared to 28% of patients before the program. Eighty percent of the patients met the LDL cholesterol goal after one year, in contrast to 37% of patients prior to the program. Hospitalizations and ED and urgent care visits for diabetes-related problems such as diabetic ketoacidosis, hyperglycemia, hypoglycemia, and infections decreased by 45%, from 95 visits in the year before the program to 52.
The authors attribute the success of the nurse-directed diabetes managed care program to "self-management skills taught to the patients by the nurse during their year under her care."
Another study also supports nurses' role in managing diabetes care. The Diabetes Attitudes Wishes and Needs study interviewed diabetes patients, nurses, and physicians in 13 countries to determine ways to improve diabetes care. The interviews focused on the needs, attitudes, and wishes of both the health care providers and the patients. In a report focusing on the views of American physicians and nurses, the authors state that both felt that "nurses provide better education, spend more time with patients, [are] better listeners, and [know] their patients better than physicians." The physicians and nurses surveyed shared the opinion that nurses should have a larger role in managing diabetes.
Linda Epstein, BSN, RN