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Journal of General Internal Medicine

, Volume 10, Issue 2, pp 59–66 | Cite as

A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus

Impact on glycemic control and health-related quality of life
  • Morris Weinberger
  • M. Sue Kirkman
  • Gregory P. Samsa
  • E. Anne Shortliffe
  • Pamela B. Landsman
  • Patricia A. Cowper
  • David L. Simel
  • John R. Feussner
Original Articles

Abstract

OBJECTIVE: To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians.

DESIGN: Randomized, controlled trial.

SETTING: Veterans Affairs general medical clinic.

PATIENTS: 275 veterans who had NIDDM and were receiving primary care from general internists.

INTERVENTION: Nurse-initiated contacts were made by telephone at least monthly to provide patient education (with special emphasis on regimens and significant signs and symptoms of hyperglycemia and hypoglycemia), reinforce compliance with regimens, monitor patients’ health status, facilitate resolution of identified problems, and facilitate access to primary care.

MEASUREMENTS: Glycemic control was assessed using glycosylated hemoglobin (GHb) and fasting blood sugar (FBS) levels. Health-related quality of life (HRQOL) was measured with the Medical Outcomes Study SF-36, and diabetes-related symptoms were assessed using patients’ self-reports of signs and symptoms of hyper- and hypoglycemia during the previous month.

MAIN RESULTS: At one year, between-group differences favored intervention patients for FBS (174.1 mg/dL vs 193.1 mg/dL, p=0.011) and GHb (10.5% vs 11.1%, p=0.046). Statistically significant differences were not observed for either SF-36 scores (p=0.66) or diabetes-related symptoms (p=0.23).

CONCLUSIONS: The intervention, designed to be a pragmatic, low-intensity adjunct to care delivered by physicians, modestly improved glycemic control but not HRQOL or diabetes-related symptoms.

Key Words

ambulatory care diabetes mellitus health services randomized controlled trial nurses 

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References

  1. 1.
    Carter Center of Emory University. Closing the gap: the problem of diabetes mellitus in the United States. Diabetes Care. 1985;8:391–406.CrossRefGoogle Scholar
  2. 2.
    Westerhall SF, Olson DR, DeStefano F. et al. Trends in diabetes and diabetic complications. 1980–1987. Diabetes Care. 1992;15:960–7.CrossRefGoogle Scholar
  3. 3.
    Weinberger M, Cowper PA, Kirkman MS, Vinicor F. The economic impact of diabetes mellitus in the elderly. Clin Geriatr Med. 1990;6:959–70.PubMedGoogle Scholar
  4. 4.
    Huse DM, Oster G, Killen AR, Lacey MJ, Colditz GA. The economic costs of non-insulin dependent diabetes mellitus. JAMA. 1989;262:2708–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Krosnick A. Economic impact of type Il diabetes mellitus. Prim Care. 1988;15:423–32.PubMedGoogle Scholar
  6. 6.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRefGoogle Scholar
  7. 7.
    Lasker RD. The diabetes control and complications trial: implications for policy and practice. N Engl J Med. 1993;329:1035–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Mazzuca SA. Does patient education in chronic disease have therapeutic value? J Chron Dis. 1982;35:521–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Mulrow C, Bailey S, Sonksen PH, Slavin B. Evaluation of an audiovisual diabetes education program: negative results of a randomized trial of patients with non-insulin-dependent diabetes mellitus. J Gen Intern Med. 1987;2:215–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Bloomgarden ZT, Karmally W, Metzger MJ. et al. Randomized. controlled trial of diabetic patient education: improved knowledge without improved metabolic status. Diabetes Care. 1987;10:263–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Rettig BA, Shrauger DG, Recker RR, Gallagher TF, Wiltse H. A randomized study of the effect of a home diabetes education program. Diabetes Care. 1986;9:173–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith DM, Weinberger M, Katz BP. A controlled trial to increase office visits and reduce hospitalizations of diabetic patients. J Gen Intern Med. 1987;2:232–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Mazzuca SA, Moorman NH, Wheeler ML. et al. The diabetes education study: a controlled trial of the effects of diabetes patient education. Diabetes Care. 1986;9:1–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Rubin RR, Peyrot M, Saudek CD. Effect of diabetes education on self-care. metabolic control. and emotional well-being. Diabetes Care. 1989;12:673–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Greenfield S, Kaplan SH, Ware JE Jr. Yano EM, Frank HJL. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRefGoogle Scholar
  16. 16.
    Kaplan RM, Hartwell SL, Wilson DK, Wallace JP. Effects of diet and exercise interventions on control and quality of life in non-insulindependent diabetes mellitus. J Gen Intern Med. 1987;2:220–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Safran C, Phillips RS. Interventions to prevent readmission: the constraints of cost and efficacy. Med Care. 1989;27:204–11.PubMedCrossRefGoogle Scholar
  18. 18.
    Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Weinberger M, Tierney WM, Booher P, Katz BP. Can the provision of information to patients with osteoarthritis improve functional status?: a randomized controlled trial. Arthritis Rheum. 1989;32:1577–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Weinberger M, Tierney WM, Cowpar PA, Katz BP, Booher P. Cost-effectiveness of increased telephone contact for patients with osteoarthritis: a randomized, controlled trial. Arthritis Rheum. 1993;26:243–6.Google Scholar
  21. 21.
    Kaplan MH, Feinstein AR. The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. J Clin Epidemiol. 1974;27:387–404.Google Scholar
  22. 22.
    Ware JE Jr. Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Stewart AL, Greenfield S, Hays RD. et al. Functional status and wellbeing of patients with chronic medical conditions: results from the Medical Outcomes Study. JAMA. 1989;262:907–13.PubMedCrossRefGoogle Scholar
  24. 24.
    McHorney CA, Ware JE Jr. Raczel AE. The MOS 36-item health survey (SF-36): psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–63.PubMedCrossRefGoogle Scholar
  25. 25.
    Weinberger M, Samsa GP, Hanlon JT. et al. An evaluation of a brief health status measure. J Am Geriatr Soc. 1991;39:691–4.PubMedGoogle Scholar
  26. 26.
    Smith DM, Norton JA, Weinberger M, McDonald CJ, Katz BP. Increasing prescribed office visits: a controlled trial in patients with diabetes mellitus. Med Care. 1986;24:189–99.PubMedCrossRefGoogle Scholar
  27. 27.
    Weinberger M, Kirkman MS, Samsa GP. et al. Relationship between glycemic control and quality of life in patients with non-insulin dependent diabetes mellitus [abstract]. Clin Res. 1992;40:594A.Google Scholar
  28. 28.
    Allen BT, DeLong ER, Feussner JR. Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Diabetes Care. 1990;10:1044–50.CrossRefGoogle Scholar
  29. 29.
    Weinberger M. A randomized trial to improve glycemic control of elderly diabetics. Final Report IIR #89-079. Washington, DC: Department of Veterans Affairs. Health Services Research and Development Service. 1994.Google Scholar
  30. 30.
    Ware JE Jr. Snyder ML, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann. 1983;6:247–63.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1995

Authors and Affiliations

  • Morris Weinberger
    • 1
    • 2
  • M. Sue Kirkman
    • 1
    • 2
  • Gregory P. Samsa
    • 1
    • 2
    • 3
  • E. Anne Shortliffe
    • 1
  • Pamela B. Landsman
    • 1
  • Patricia A. Cowper
    • 1
    • 2
  • David L. Simel
    • 1
    • 2
  • John R. Feussner
    • 1
    • 2
  1. 1.the Center for Health Services Research in Primary Care, Durham VAMCDuke University Medical CenterDurham
  2. 2.the Division of General Internal Medicine, Department of MedicineDuke University Medical CenterDurham
  3. 3.the Department of Community and Family MedicineDuke University Medical CenterDurham

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