Effect of Nurse-Directed Diabetes Care in a Minority Population
Article Figures & Tables
Figures
- Figure 1—
HbA1c levels at the beginning of nurse-directed diabetes care and 1 year later.
Tables
- Table 1—
Patient demographics and diabetes treatment*
Clinic A Clinic B Clinic C No. of patients 252 252 209 Type 2 diabetes 252 (100) 252 (100) 207 (99) Female 189 (76) 181 (72) 152 (66) Age (years) 52.0 (26–79) 52.6 (27–79) 53.8 (19–84) Duration of diabetes (years) 7.7 (0–32) 7.2 (1–26) NA African American 4 (2) 49 (19) 29 (14) Hispanic 230 (92) 198 (79) 178 (85) Other 15 (6) 4 (2) 2 (1) Diet only 2 (1) 0 (0) NA One oral drug 52 (21) 54 (21) NA ≥2 oral drugs 94 (37) 94 (37) NA Insulin plus oral drug(s) 67 (27) 67 (27) NA Insulin only (≥2 injections) 34 (13) 33 (13) NA Insulin only (1 injection) 2 (1) 4 (2) NA -
Data are n (%) or mean (range) for age and duration.
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↵* Race/ethnicity data missing in 3 patients in clinic A and 1 patient in clinic B.
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- Table 2—
Process measures
Measure ADA guidelines Nurse-directed care Usual care P HbA1c Goal-yes, 1 per 6 months; Goal-no, 1 per 3 months 227/252 (90) 66/252 (26) <0.001 Lipid profile At least yearly 244/252 (97) 148/252 (59) <0.001 Eye exam At least yearly 240/252 (95) 200/252 (79) <0.001 Renal profile* Yearly 215/252 (85) 148/209 (71)† <0.001 If dipstick negative/trace, measure albumin-to-creatinine ratio 54/183 (30) 76/174 (44) <0.01 If dipstick negative/trace, or albumin-to-creatinine ratio >30 mg/g, ACE treatment 19/28 (68) 59/93 (63) NS Foot exam At least biannually 245/252 (97) 202/252 (80)† <0.001 ≥2 visits At least biannually 248/252 (98) 241/252 (96) NS Diabetes education No frequency stated 239/252 (98) 122/252 (48) <0.001 Nutritional counseling No frequency stated 224/252 (89) 14/252 (6) <0.001 - Table 3—
HbA1c (% ± SD) outcome measure
Nurse-directed care Usual care P All patients Percent of patients 249/252 (99) 201/252 (80) <0.001 Initial 13.5 ± 3.7 12.1 ± 3.1 <0.001 ≥2 tests Percent of patients 201/249 (81)* 145/201 (72) <0.05 Initial 13.3 ± 3.5 12.3 ± 3.4 <0.02 Final 10.3 ± 6.0 10.8 ± 3.2 NS Change −3.0 ± 6.6 −1.5 ± 2.9 <0.01 Followed ≥6 months Number of patients 120 145 Initial 13.3 ± 3.4 12.3 ± 3.4 <0.02 Final 9.8 ± 3.0 10.8 ± 3.2 <0.01 Change −3.5 ± 3.8 −1.5 ± 2.9 <0.001 -
Data are n (%) or means ± SD.
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↵* Some of these patients were followed for <3 months.
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- Table 4—
Medications and process measures during the DMCP and the year prior
Medications/measures Nurse-directed care Year prior P n 114 80 Diet only 2 (2) 0 (0) NS One oral drug 16 (14) 28 (35) <0.001 ≥2 oral drugs 81 (71) 36 (45) <0.001 Insulin plus oral drug(s) 13 (12) 12 (15) NS ≥2 injections of insulin per day (no oral drugs) 2 (2) 4 (5) NS Diabetes education 114 (100) 20 (25) <0.001 Nutritional counseling 113 (99) 1 (1) <0.001 ≥2 visits per year 113 (99) 65 (81) <0.01 ≥2 HbA1c measurements per year 111 (97) 46 (58) <0.001 ≥1 lipid profile per year 113 (99) 41 (51) <0.001 ≥1 test for albuminuria per year 107 (94) 77 (96)* NS Eye exam referral 113 (99) 63 (79) <0.001 Eye exam documented 99 (87) 37 (46) <0.001 ≥2 foot exams per year 111 (97) 58 (72)* <0.001 -
Data are n (%).
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↵* Check box on diabetes-specific progress note.
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In this Issue
August 2003, 26(8)
Effect of Nurse-Directed Diabetes Care in a Minority Population
