Effectiveness of a specialist nurse-led intervention clinic in the management of cardiovascular risk factors in diabetes
DOI:
https://doi.org/10.1002/edn.89Keywords:
Nurse-led clinic, hypertension, hyperlipidaemia, cardiovascular risk factorsAbstract
AbstractAim: To evaluate the effectiveness of a specialist nurse-led, protocol-driven and doctor-supervised clinic in the management of cardiovascular risk factors, particularly hypertension and hyperlipidaemia.
Methods: Patients with type 2 diabetes attending the diabetes specialist service, who had uncontrolled hypertension or hyperlipidaemia, were recruited to participate in the study. Patients were followed in a specialist nurse-led intervention clinic for effective control of blood pressure (BP), lipid profile and other vascular risk factors. Antihypertensive agents and lipid-lowering drugs were sequentially introduced and dose titrated according to protocols. Patients were discharged once target BP (<140/80 mmHg) and/or target lipid profile were achieved.
Results: Ninety-four patients were managed in the clinic between April 2003 and March 2004. The mean age of the patients was 62±9 years and their duration of diabetes was 18±14 years. Seventy-seven patients were hypertensive at first visit and antihypertensive agents were initiated or altered, resulting in significant reduction in systolic BP (167±12 versus 132±8 mmHg, p<0.001) and diastolic BP (85±9 versus 70±7 mmHg, p<0.001). Seventy-two patients (92%) achieved target BP. Patients required two or more antihypertensive agents to achieve targets. Levels in 59 patients treated for hyperlipidaemia and total cholesterol (6.0±1.2 versus 3.9±0.7 mmol/l, p<0.001) and triglycerides (4.2±0.8 versus 2.4±1.2 mmol/l, p<0.001) significantly improved. Hence, 52 patients (91%) achieved target lipid profile control. Only six patients (10%) required combination drug therapy to achieve target lipid profile. The mean glycosylated haemoglobin (HbA1c) level also improved (8.5±1.5 versus 7.4±1.5 %, p<0.01) and 45% of patients achieved target glycaemic control (HbA1c <7.0%).
Conclusion: Specialist nurse-led clinics can be effective in significantly improving BP and lipid profile, and achieving targets, in people with diabetes.
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