Specialist Nurse-Led Intervention to Treat and Control Hypertension and Hyperlipidemia in Diabetes (SPLINT)

A randomized controlled trial

  1. John P. New, FRCP1,
  2. James M. Mason, PHD2,
  3. Nick Freemantle, PHD3,
  4. Sue Teasdale, MA1,
  5. Louise M. Wong, BSC1,
  6. Nick J. Bruce, MSC4,
  7. John A. Burns, BSC1 and
  8. John M. Gibson, PHD1
  1. 1Department of Diabetes, Hope Hospital, Salford, U.K.
  2. 2Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, U.K.
  3. 3Department of Primary Care and General Practice, University of Birmingham, Birmingham, U.K.
  4. 4Department of Outcomes Research and Evidence Based Medicine, Pfizer, Kent, U.K.
  1. Address correspondence and reprint requests to Dr. J.P. New, Department of Diabetes, Hope Hospital, Stott Lane, Salford, M6 8HD, U.K. E-mail: john.new{at}man.ac.uk

Abstract

OBJECTIVE—To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care.

RESEARCH DESIGN AND METHODS—This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure (≥140/80 mmHg), raised total cholesterol (≥5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4–6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention.

RESULTS—Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11–1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25–2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86–1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32–0.92], P = 0.02).

CONCLUSIONS—This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

Footnotes

  • J.P.N. and J.M.G. have received honoraria from Pfizer for speaking engagements. J.M.M. has received an unrestricted research grant from Pfizer. N.F. has received consulting fees from Aventis Pharmaceuticals and research funding from Pfizer. S.T. and L.W. have received funding from an educational grant from Pfizer and honoraria from Pfizer for speaking engagements.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted April 28, 2003.
    • Received February 21, 2003.
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