The George Institute for International Health, The University of Sydney, Australia.
Prim Care Diabetes. 2009 Aug;3(3):181-8. doi: 10.1016/j.pcd.2009.08.005. Epub 2009 Sep 11.
To implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.
We set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.
The total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.
Nurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.
在喀麦隆农村和城市实施基于协议的初级护士主导的 2 型糖尿病护理。
我们在雅温得（首都）设立了三个初级保健诊所，并在巴富特农村卫生区设立了两个。参与者是 225 名（17%来自农村）已知或新诊断为 2 型糖尿病、不需要胰岛素的患者，这些患者要么来自基线调查（38 名患者，占 17%），要么是诊所的二级吸引而来。经过培训的护士提供基于协议的血糖和血压控制。主要结果是空腹毛细血管血糖和血压指数的轨迹，以及基线和最后一次就诊时平均水平的差异。
总的随访时间为 1110 个患者月。在随访期间，空腹毛细血管血糖总体呈显著下降趋势（p<0.001），且大多数参与者亚组均如此。与基线相比，空腹毛细血管血糖在最后一次就诊时下降了 1.6mmol/L（95%CI：0.8-2.3；p<或=0.001）。在高血压患者中，收缩压和舒张压也显著下降，而舒张压略有下降。体重没有明显的显著变化。
在没有医生的情况下，护士可能是改善糖尿病护理获取的潜在替代方案。
