Effectiveness of diabetes nurse-led clinic in treating people with type 2 diabetes mellitus

Abstract

Diabetes Mellitus (DM) has become a global epidemic. It is estimated that DM prevalence in China would be increased from 98.4 million people in 2013 to 142.7 million by2035.This rapidly growing prevalence will inevitably put heavy burden to the health care system. Current DM management is sub-optimal due to patient treatment non-adherence and the lack of timely treatment intensification. There is an urgent need in developing effective and affordable health care delivery approaches for DM patients. Nurse-led DM management programs have been proven effective in Western countries. However, inadequate studies were conducted to evaluate nurse-led DM intervention on Chinese. Awareness for the need of cultural sensitivity when applying those effective nurse-led programs to Chinese is important. Therefore, I aimed to evaluate the effectiveness of Diabetes Nurse Clinic (DMNC)in improving glycaemic control of Chinese patients with type 2 DM. I designed and conducted a 24-week, randomised controlled study. One hundred and fifty Chinese type 2 DM patients with sub-optimal glycaemic control, i.e. atHbA1c level between 7.5% and9.5%, were recruited. Patients in the intervention group received Diabetes Self-Management Education (DSME) and protocol driven medication intensification, which were arranged in 3 bimonthly DMNC visits and a telephone call one month following each DMNC. Patients in the control group received usual group DM education and medical care. The primary outcome was Haemoglobin A1c (HbA1c), while the secondary outcomes were lipid profiles, body mass index, waist hip ratio, body fat analysis, blood pressure and the Chinese version of the Diabetes Empowerment Scale-20 items (C-DES-20). All these measurements were taken before and at 24 weeks after randomisation. The 150 patients had mean age 63.6 years (SD = 9.7, range = 37 to 79), with duration of DM at a mean of 13.7 +8.5 years and 88(59 %) of them were male. Five patients (7%) in the intervention group, 4 patients (5%) in the control group withdrew before 24 weeks. At baseline, the 75 patients in the intervention group and 75 patients in the control group had no significant differences in all clinical characteristics. At 24 weeks, patients under the management in the DMNC had HbA1c significantly reduced by 0.7% (95% CI = 0.4%to 1.0%, p< 0.001) more than those under the usual care. The corresponding reductions in the intervention and control groups were 1.0% (95% CI=0.8 to 1.2, p < 0.001) and 0.3%(95% CI=0.1 to 0.6, p=0.002), respectively. For other outcomes, there were no significant differences between the in intervention and the control groups. In conclusion, this study provided evidence to support that DMNC could improve glycaemic control of Chinese type 2 DM patients with sub-optimal glycemic control. The effectiveness of DMNC is deemed to be due to the more effective delivery of DSME resulting in better treatment adherence, and protocol driven medication intensification. Including DMNC as a routine medical care for Chinese with type 2 DM is therefore recommended. Further study to evaluate the sustainability of glycaemic improvement by DMNC is needed.