Effective diabetes care by a registered nurse following treatment algorithms in a minority population.

OBJECTIVE

To compare usual care with nurse-directed care for patients with diabetes.

STUDY DESIGN

Randomized before-after trial.

METHODS

Diabetic patients were randomly selected for a diabetes managed care program (DMCP), in which a specially trained registered nurse, supervised by an endocrinologist, followed detailed treatment algorithms. Process and outcome measures during the year before DMCP entry were compared with those during the first year of DMCP enrollment.

RESULTS

A total of 367 patients completed a full year in the DMCP. Data from the prior year were available for 331 patients. Among a subset of Latino patients, 95% earned less than 25,000 US dollars and 73% had an education of 6th grade or less. Process measures recommended by the American Diabetes Association (ADA) were met 98% of the time during the DMCP year compared with 54% of the time during the prior year (P <.001). Mean glycosylated hemoglobin (A1C) levels fell from 9.3% to 8.7% in the year before entry into the DMCP and to 7.0% by the end of the first DMCP year (P < .001). At DMCP entry, 28% met the ADA A1C goal of <7%; 60% did so at the end of the year. Fifty-one percent met the ADA low-density lipoprotein cholesterol goal at entry into the DMCP compared with 82% at the end of the year.

CONCLUSION

A nurse making clinical decisions based on detailed treatment algorithms did a better job of achieving ADA-recommended process and outcome measures than physicians providing usual care.