Improving glycaemic control of insulin‐treated diabetic patients – a structured audit of specialist nurse intervention

Abstract

Insulin-treated diabetic patients with poor glycaemic control are frequently referred to diabetes specialist nurses, but little data exist as to the effectiveness of this practice. We therefore analysed the progress of 43 prospectively referred insulin-treated patients with glycosylated haemoglobin (HbA1c) levels > 7.5%. Diabetes nurse intervention involved re-education, dietary advice and insulin dose adjustment. Improvement in control was defined as a final HbA1c < 7.0% or a fall of HbA1c of > 1.0% at 6 months post-intervention. Almost two-thirds (63%) of patients achieved improvement status, with no increase in body weight or hypoglycaemic episodes. Disappointingly, however, the 'non-improver' group (37%) showed a mean deterioration in HbA1c. In conclusion, diabetes nurse intervention for poorly controlled insulin-treated diabetic patients is generally effective, but intervention may be best targeted to responsive patients. The factors which influence diabetic patients' 'responsiveness to change' require further investigation.

The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control

“…1998, Thompson et al. 1999, Yong et al. 2002), reduction in cost (Brooten & Naylor 1995) and length of stay during hospitalization (Sadur et al.…”

An employer-based, pharmacist intervention model for patients with type 2 diabetes

“…[11][12][13] Comprehensive diabetes education has also been shown to be effective in improving disease outcomes. 14 The current analysis found a 9% relative change (0.7% absolute change) in HbA 1c levels at the end of one year.…”

Cost Savings and Clinical Effectiveness of an Extension Service Diabetes Program

“…[9][10][11] Insulin resistance precedes the clinical development of type 2 diabetes by 10-20 years and is an underlying component in other diseases. 15 According to the World Health Organization, insulin resistance is a primary symptom of the metabolic syndrome.…”

“…[9][10][11] Patient participation, plus active involvement of the physician and dietitian in patient care, improves long-term adherence to the diabetes care regimen. 12 The purpose of this study was to determine whether participation in the "Diabetes: Stepping Up to the Plate" education program resulted in medical costs savings and significant improvements in anthropometric indices, A1C, written nutrition knowledge test, and food portioning skills.…”

“…[9][10][11]19 A 2% drop in A1C results has been observed in patients who received diabetes follow-up education, whether by mail or in the classroom. 8 Personal instruction with follow-up telephone instruction showed similar positive outcomes; 63% achieved successful improvement in A1C (< 7.0% or a decrease of > 1%).…”