Houweling S T, Kleefstra N, van Hateren K J J, Kooy A, Groenier K H, Ten Vergert E, Meyboom-de Jong B, Bilo H J G
Langerhans Medical Research Group, the Netherlands.
Neth J Med. 2009 Jul-Aug;67(7):279-84.
The objective of this study was to determine whether the management of type 2 diabetes (DM2) can be transferred from an internist to a nurse specialised in diabetes (NSD).
Ninety-three patients with DM2 referred by their general practitioner were randomised; 84 patients completed the study. The intervention group received care from an NSD who treated glycaemia, blood pressure and lipid profile by protocol. The control group received care from an internist. The primary endpoint was the main decrease in HbA1c. Secondary endpoints included blood pressure, lipid profile, healthcare costs, QOL , and patient satisfaction.
HbA1c, total cholesterol, LDL cholesterol and cholesterol/HDL ratio decreased significantly in both study populations after a follow-up time of 12 months. Cholesterol/HDL ratio decreased by 0.4 and 0.9 in the NSD and control group respectively (p=0.034 for the difference between groups). The decreases (95% confidence interval) in systolic blood pressure were 8.6 mmHg (2.6, 14.7) in the NSD group and 4.0 mmHg (-0.9, 8.9) in the control group, without a significant difference between groups. After one year, 33.3% of the patients in the NSD group achieved an HbA1c level. <7% compared with 2.2%at baseline (p=0.002). Healthcare costs were less and patient satisfaction with the NSD s was significantly better(p<0.001), while maintaining the same QOL .
NSD s using treatment protocols are able to provide effective care for patients with DM 2, comparable with the care provided by an internist, with respect to clinical parameters, and superior with respect to healthcare costs and patient satisfaction.
本研究的目的是确定2型糖尿病（DM2）的管理是否可以从内科医生转移至糖尿病专科护士（NSD）。
将93例由全科医生转诊的DM2患者随机分组；84例患者完成了研究。干预组接受NSD的护理，NSD按照方案治疗血糖、血压和血脂水平。对照组接受内科医生的护理。主要终点是糖化血红蛋白（HbA1c）的主要降低情况。次要终点包括血压、血脂水平、医疗费用、生活质量（QOL）和患者满意度。
在12个月的随访期后，两个研究人群的HbA1c、总胆固醇、低密度脂蛋白胆固醇和胆固醇/高密度脂蛋白比值均显著下降。NSD组和对照组的胆固醇/高密度脂蛋白比值分别下降了0.4和0.9（组间差异p = 0.034）。NSD组收缩压的下降幅度（95%置信区间）为8.6 mmHg（2.6，14.7），对照组为4.0 mmHg（-0.9，8.9），组间无显著差异。一年后，NSD组33.3%的患者HbA1c水平<7%，而基线时为2.2%（p = 0.002）。医疗费用更低，患者对NSD的满意度显著更高（p<0.001），同时维持相同的生活质量。
使用治疗方案的NSD能够为DM2患者提供有效的护理，在临床参数方面与内科医生提供的护理相当，在医疗费用和患者满意度方面更优。
