Additional nurse management leads to moderate improvements on some outcomes for patients with type 2 diabetes

Parker D, Maresco-Pennisi D, Clifton K, et al.  Practice nurse involvement in the management of adults with type 2 diabetes mellitus attending a general practice: Results from a systematic review International Journal of Evidence-Based Healthcare. 2016;14:000-000.

Review question

Does additional management by non-specialist nurses lead to better clinical outcomes (e.g. blood pressure, cholesterol levels, body mass index, etc.) in patients with type 2 diabetes mellitus in a general care setting?

Background

Diabetes management is complex and places a tremendous financial burden on individuals, and patients often lack the resources to properly manage the disease.

Diabetic cases are typically managed by general practitioners, which may be inefficient since nurses could help share the workload, particularly with diabetes management.

Having this additional help in the management of diabetic cases by non-specialist nurses may be an effective means of improving patient outcomes. 

How the review was done

A detailed search of a number of electronic databases for studies published from 1990 until 2014 was conducted. Studies that focused on nurse-management interventions with type 2 diabetic patients in a general practice were included in the review.

A total of 805 studies were identified in searches, and seven were included in the review after assessments for eligibility.

This review was funded by a University of Queensland Summer Research Scholarship.

What the researchers found

The review found that nurse-management interventions led to improvements in blood pressure and total cholesterol. However, improvements were not found in the majority of outcomes.

In particular, there were no improvements in a protein strongly linked to type 2 diabetes complications. However, some individual studies suggest that nurse-management interventions could help control these protein levels in people with poorer control over their diabetes.

Conclusion

The review found that nurse-management interventions led to moderate improvements for a minority of clinical outcomes in patients with type 2 diabetes. There is a lack of high-quality studies that look specifically at individuals with poor control over their diabetes, a population that could particularly benefit from nurse-management interventions.