Nurse follow-up of patients with diabetes: randomized controlled trial

Abstract

Aim: This paper reports a study comparing the outcomes of diabetic patients undergoing either early discharge or routine care.

Background: The hospital is not the best place to monitor the glycaemic control of patients with diabetes with no other morbidity or complications. It is an unnatural environment in which diet is planned and the activity level is low. The hospital is also an expensive place in which to treat patients.

Methods: This randomized controlled trial was conducted in the medical department of a regional hospital in Hong Kong. A total of 101 patients who needed glycaemic monitoring, but who were otherwise fit for discharge, were recruited. The control group continued to receive routine hospital care. The study group was discharged early and received a follow-up programme which included a weekly or biweekly telephone call from a nurse.

Findings: When compared with the control group, the study group had a greater decrease in HbA1c at 24 weeks, although the statistical difference was marginal (7.6 vs. 8.1, P = 0.06), a higher blood monitoring adherence score at both 12 weeks (5.4 vs. 3.6, P < 0.001) and 24 weeks (5.3 vs. 3.5, P < 0.001), and a higher exercise adherence score at 12 weeks (5.3 vs. 3.4, P = 0.001) and 24 weeks (5.5 vs. 3.2, P < 0.001). The study group had a shorter hospital stay (2.2 vs. 5.9, P < 0.001), and the net savings were HK$11,888 per patient.

Conclusion: It is feasible to integrate treatment into the real life environments of patients with diabetes, and nurse-led transitional care is a practical and cost-effective model. Nurse follow-up is effective in maintaining optimal glycaemic control and enhancing adherence to health behaviours. Management of glycaemic control is better done in the community than in the hospital.