Nurse practitioner management of type 2 diabetes.

Published

Journal Article

CONTEXT: Multifactorial barriers prevent primary care clinicians from helping their adult patients with type 2 diabetes achieve good control of hemoglobin A1c (HbA1c) levels. Patients' depression and low self-efficacy can complicate diabetes management by impairing tasks needed for effective disease self-management. OBJECTIVES: To evaluate whether nurse practitioners in collaborative practices with primary care clinicians are effective in helping improve control of HbA1c, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in adults with uncontrolled hyperglycemia, and to assess whether nurse practitioner-guided care affects depression and self-efficacy in these patients. DESIGN: De-identified preintervention and postintervention data were collected from prospective review of medical charts of patients in a managed care organization's primary care clinics. MAIN OUTCOME MEASURES: Preintervention and postintervention HbA1c values were evaluated as the primary outcome measure. Preintervention and postintervention values for BP, LDL-C, body weight, and depression and self-efficacy scores were secondary outcome measures. RESULTS: After intervention, 50% of 26 patients achieved HbA1c benchmarks, 95.6% achieved systolic and diastolic BP benchmarks, and 57.8% achieved LDL-C benchmarks. Wilcoxon paired samples tests showed significantly increased self-efficacy (z = -3.42, p < 0.001) from preintervention to postintervention. Depression scores decreased slightly from preintervention (mean = 0.44, standard deviation = 1.34, median < 0.001) to postintervention values (mean = 0.18, standard deviation = 0.73, median < 0.001), but this decrease was not significant. CONCLUSION: Integrating nurse practitioners into primary care teams to provide innovative methods of support to adults with uncontrolled hyperglycemia improves clinical outcomes and self-efficacy for patients with type 2 diabetes.

Full Text

Duke Authors

Cited Authors

  • Richardson, GC; Derouin, AL; Vorderstrasse, AA; Hipkens, J; Thompson, JA

Published Date

  • January 2014

Published In

Volume / Issue

  • 18 / 2

Start / End Page

  • e134 - e140

PubMed ID

  • 24867560

Pubmed Central ID

  • 24867560

Electronic International Standard Serial Number (EISSN)

  • 1552-5775

International Standard Serial Number (ISSN)

  • 1552-5767

Digital Object Identifier (DOI)

  • 10.7812/TPP/13-108

Language

  • eng