Diabetes Centre, Isala Clinics, Langerhans Medical Research Foundation, Zwolle, The Netherlands.
J Clin Nurs. 2011 May;20(9-10):1264-72. doi: 10.1111/j.1365-2702.2010.03562.x. Epub 2011 Mar 15.
To determine whether the management of type 2 diabetes mellitus in a primary care setting can be safely transferred to practice nurses.
Because of the increasing prevalence of type 2 diabetes mellitus and the burden of caring for individual patients, the demand type 2 diabetes mellitus patients place on primary health care resources has become overwhelming.
Randomised controlled trial.
The patients in the intervention group were cared for by practice nurses who treated glucose levels, blood pressure and lipid profile according to a specified protocol. The control group received conventional care from a general practitioner. The primary outcome measure was the mean decrease seen in glycated haemoglobin (HbA1c) levels at the end of the follow-up period (14 months).
A total of 230 patients was randomised with 206 completing the study. The between-group differences with respect to reduction in HbA1c, blood pressure and lipid profile were not significant. Blood pressure decreased significantly in both groups; 7.4/3.2 mm Hg in the intervention group and 5.6/1.0 mm Hg in the control group. In both groups, more patients met the target values goals for lipid profile compared to baseline. In the intervention group, there was some deterioration in the health-related quality of life and an increase in diabetes-related symptoms. Patients being treated by a practice nurse were more satisfied with their treatment than those being treated by a general practitioner.
Practice nurses achieved results, which were comparable to those achieved by a general practitioner with respect to clinical parameters with better patient satisfaction.
This study shows that diabetes management in primary care can be safely transferred to practice nurses.
确定在初级保健环境中管理 2 型糖尿病是否可以安全地转移给执业护士。
由于 2 型糖尿病的患病率不断增加以及照顾个体患者的负担增加，2 型糖尿病患者对初级卫生保健资源的需求已经不堪重负。
随机对照试验。
干预组的患者由执业护士照顾，他们根据特定方案治疗血糖水平、血压和血脂谱。对照组接受全科医生的常规护理。主要观察指标是随访期结束时（14 个月）糖化血红蛋白（HbA1c）水平的平均下降。
共随机分配了 230 名患者，其中 206 名完成了研究。在 HbA1c、血压和血脂谱方面，两组之间的降低差异无统计学意义。两组的血压均显著下降；干预组下降 7.4/3.2mmHg，对照组下降 5.6/1.0mmHg。在两组中，与基线相比，更多的患者达到了血脂谱的目标值。在干预组中，健康相关生活质量有所恶化，糖尿病相关症状有所增加。接受执业护士治疗的患者比接受全科医生治疗的患者对治疗更满意。
执业护士在临床参数方面取得了与全科医生相当的结果，同时患者满意度更高。
本研究表明，初级保健中的糖尿病管理可以安全地转移给执业护士。
