Advanced practice nurse outreach may improve HbA1c in patients with type 2 diabetes

American Association of Diabetes Educators 36th Annual Meeting

Intensive, one–on–one diabetes management between advanced practice nurses and patients with poorly controlled type 2 diabetes led to improvements in HbA1c, according to data presented here.

With the initial goal of reducing HbA1c levels toward acceptable levels, researchers at San Francisco General Hospital Medical Center followed 196 patients with diabetes included in an intensive diabetes management outreach program for up to 12 months. The patient population was culturally and linguistically diverse; a significant percentage had low functional health literacy and approximately two-thirds were not meeting diabetes care treatment goals.

The percentage of patients with HbA1c levels >9% prior to an advanced practice nurses targeted intervention decreased from 33.2% in 2006 to 28.1% in 2008 — a 5.1% improvement.

The researchers used a proactive approach to target these patients based on the Chronic Care Model; advanced practice nurses provided intensive diabetes management in an outpatient clinic setting.

During the summer of 2008, 19 patients with HbA1c levels >9% attended the advanced practice nurse diabetes clinic; 10 patients were on insulin. Of the nine patients not on insulin, two refused insulin, three were insulin naïve and four achieved HbA1c levels <7.2%.

Among the 13 patients who received intervention, the baseline average HbA1c was 10.7%. Although HbA1c levels improved from 11.2% to 8.3% among patients who were insulin naïve at four months, HbA1c increased to 9.5% at eight months. Of the 10 patients already on insulin at baseline, HbA1c decreased from 10.5% to 9.6% at four months and to 8.8% at eight months.

The researchers concluded that advanced practice nurse outreach to improve glycemic control may be beneficial; however, barriers to further support patient involvement, such as language, must be evaluated. – by Jennifer Southall

For more information:

Fyles A. #152613. Presented at: The American Association of Diabetes Educators 36th Annual Meeting; August 5-8, 2009; Atlanta.