The American Association of Clinical Endocrinologists (AACE) recently held its meeting in Phoenix. Several abstracts were of particular interest to me. Today’s blog will focus on the essential contributions of nurse educators within a multidisciplinary diabetes care team. The Diabetes team at the University of California, San Francisco, presented “Impact of Nurse-Led Diabetes Medication Management Clinic on Glycemic Control.” The authors, Cohen, Yourseefi, Colon, Mathur, Calderon, and Naing proposed to determine the “effect of a nurse-led Diabetes Medication Management Clinic on glycemic control in diabetes patients.”
How did the authors perform the study?
The study, from 10/2010–9/2011 was retrospective in nature and performed in a community outpatient clinic. The study population included non-pregnant adults who attended the community clinic at least two times per year. Hb A1c and fasting blood sugars were obtained at the visits, as well as evaluation of home blood glucose monitoring.
What were the results of the study?
One hundred thirty-three (133) patients were identified by the authors and 49 patients were excluded due to only one visit to the clinic or incomplete records. The remaining 84 patients were included in the study.
- Mean hb A1c level decreased from 10.6 to 8.9 percent (p<0.0001- highly statistically significant)
- Mean fasting home blood sugar levels decreased from 196 mg/dL to 146 mg/dL (P<0.0001- highly statistically significant)
- Mean All home blood sugar levels decreased from 203 mg/dL to 171 mg/dL (p<0.0084- highly statistically significant)
- There was a positive correlation between age and change in baseline hb A1c (r=+0.337, p=0.0091 – statistically significant)
- There was a negative correlation between baseline hb A1C and change in hb A1c (r=
-0.646, p<0.0001- highly significant)
How do we interpret the results of the study?
The authors note that the Nurse Led Diabetes Medication Management Clinic was set up in the community due to the difficulty and delay in obtaining physician appointments. The clinic was developed to provide diabetes care to those patients with poorly controlled diabetes. Diabetes Nurse Educators, who were Certified Diabetes Educators (CDE’s). According to the authors, these nurse educators had previously only provided diabetes self-management training. In the nurse-led model, the CDEs initiated and adjusted the insulin doses under the supervision of MDs over a maximum period of 3 months. The authors concluded that “nurse-led medication management clinic significantly improved short-term glycemic control.” Younger (adult) patients and those with higher baseline hb A1cs were associated with higher reduction in hb A1c. It should also be noted that those patients who received concurrent Diabetes self-management training along with medication management had 2.5 times reduction of hb A1c.
Real Life Application: This study essentially supports the manner in which we care for our diabetes patients in the pediatric setting. At Children’s National Medical Center, along with most pediatric diabetes healthcare teams, nurse educators (CDEs) play a major role in day-to-day insulin adjustment in our patients. Our families’ work with the nurse educators during all stages of their children’s diabetes diagnosis. Clearly, during the initial self-management training, there is an extraordinarily close relationship between the nurse educator and family as insulin dose adjustments are made on a day by day basis. After the initial diagnosis, our nurse educators work with families for routine insulin adjustments based on normal growth and development, daily activities as well as sick-day management. Our Certified Diabetes Nurse Educators are the backbone of our multidisciplinary diabetes care team and are greatly appreciated by our patients and families. In this way, our team supports our youth with diabetes between each of the physician visits every 3-4 months.