Quality of type 2 diabetes management in general practice is associated with involvement of general practice nurses

Abstract

Aims: To assess whether involvement of general practice nurses in type 2 diabetes care in Danish general practice is associated with improved adherence to national guidelines on regular type 2 diabetes monitoring, and with lower HbA1c and cholesterol levels in the type 2 diabetes population.

Methods: The study was an observational study soliciting questionnaire data from 193 Danish general practices and register data on 12,960 patients with type 2 diabetes (age range 40-80 years) from a diabetes database and a laboratory database. Clustering was addressed in the analyses.

Result: Practices with well-implemented nurse-led type 2 diabetes consultations and practices with no nurse(s) employed differed according to the mean proportions of patients whose HbA1c was measured (6.4%-points: 95% CI: 1.5 to 11.4), and the mean proportions of patients whose HbA1c was ≥ 8% (-3.7%-points: 95% CI: -6.7 to -0.6). Small non-significant differences were found in the cholesterol analyses.

Conclusion: Compared with practices with no nurse(s) employed, the quality of diabetes management was generally higher in terms of that HbA1c was measured according to the guidelines in a larger proportion of the diabetes population and the proportion of patients with an HbA1c level ≥ 8% was lower in practices with well-implemented nurse-led type 2 diabetes consultations.