Nurse-Based Management in Patients With Gestational Diabetes
- Apolonia García-Patterson, MD1,
- Esther Martín, RN1,
- Justa Ubeda, RN1,
- Miguel A. María, RN1,
- Juan M. Adelantado, MD, PHD2,
- Gemma Ginovart, MD3,
- Alberto de Leiva, MD, PHD1 and
- Rosa Corcoy, MD, PHD1
- 1Endocrinology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain
- 2Obstetric Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain
- 3Pediatric Department, Hospital de la Santa Creu i Sant Pau, Autonomous University Barcelona, Barcelona, Spain
Abstract
OBJECTIVE—To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management.
RESEARCH DESIGN AND METHODS—In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse’s role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher’s exact test.
RESULTS—Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulin treatment and perinatal outcome (hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia, small- and large-for-gestational-age newborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and mortality) were also similar in both groups.
CONCLUSIONS—Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and perinatal outcome. This supports a more active role of nurses in the management of women with GDM.
Footnotes
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Address correspondence and reprint requests to Dr. Rosa Corcoy, Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni Ma Claret, 167, Barcelona 08025, Spain. E-mail: rcorcoy{at}hsp.santpau.es.
Received for publication 29 May 2002 and accepted in revised form 18 December 2002.
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