A pilot study comparing a type 1 nurse-led diabetes clinic with a conventional doctor-led diabetes clinic
DOI:
https://doi.org/10.1002/edn.4Keywords:
type 1 diabetes, glycaemic control, quality of life, nurse-led clinics, patient-centred, lifestyle-based careAbstract
AbstractA prospective comparative pilot study was designed to assess and compare care delivered by a diabetes specialist nurse (DSN) and standard doctor-led care for patients with type 1 diabetes. The philosophy was to provide an individualised, patient-centred, lifestyle-based approach.
In all, 60 patients with type 1 diabetes were randomised to either the nurse-led clinic (NLC) or a conventional clinic. NLC patients received medical input during their annual screening appointment.
In the nurse-led system patients prioritised relevant issues with the aid of a ‘Waiting Area Menu’. The menu consisted of pertinent topics relevant to living with diabetes. Care interventions were then agreed and targets discussed.
To date the results of DSN intervention include: 60% of patients changing to a more appropriate insulin regimen; 36% changing equipment following update from the DSN; 20% needing initiation of cardiovascular medication; and 26% being referred to other health care professionals. The mean HbA1c changed by -0.25% in the NLC group and by -0.06% in the control group (ns).
During the pilot there were several barriers which we had not anticipated. These included staffing resources, and organisational and time management issues. However, feedback from patient questionnaires demonstrated that the majority of patients preferred the NLC.
Downloads
References
Nathan D. The epidemiology of cardiovascular disease in type 2 diabetes mellitus: how sweet it is � or is it J Lancet 1997; 350(Supp 1): 4–9.
Department of Health. National Service Framework for Diabetes: Standards. London: DoH, 2001.
Scottish Executive. Scottish Diabetes Framework Edinburgh. Edinburgh: HMSO, 2000.
Diabetes care and research in Europe: The St Vincent declara-tion. Diabetic Med 1995; 7: 360.
Scottish Intercollegiate Guidelines Network. SIGN 55. Royal College of Physicians Edinburgh, 2001.
DiabetesControlandComplications Trial Research Group. The effect of intensive treatment of diabetes on the devel-opment and progression of long-term complications in insulin-dependant diabetes mellitus. N Engl J Med 1993; 329(14): 977–985.
UK Prospective Diabetes Study (UKPDS). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998; 317: 703–713.
ADA Position Statement. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2001; 24(Suppl 1): 533–543.
Audit Commission. Testing times: a review of diabetes services in England and Wales. Briefing paper 12th April. London: Audit Commission, 2000.
Anderson RM. Patient empower-ment and the traditional medical model. A case for irreconcilable differences? Diabetes Care 1995; 18(3): 412–415.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2004 Copyright © 2004 FEND
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
