Specialist nurses in diabetes mellitus
Abstract
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Background
The
patient with diabetes has many different learning needs relating to
diet, monitoring, and treatments. In many health care systems specialist
nurses provide much of these needs, usually aiming to empower patients
to self-manage their diabetes
. The present review aims to assess the effects of the involvement of specialist nurse care on outcomes for people with diabetes, compared to usual care in hospital clinics or primary care with no input from specialist nurses.
. The present review aims to assess the effects of the involvement of specialist nurse care on outcomes for people with diabetes, compared to usual care in hospital clinics or primary care with no input from specialist nurses.
Objectives
To
assess the effects of diabetes specialist nurses / nurse case manager
in diabetes on the metabolic control of patients with type 1 and type 2
diabetes mellitus.
Search strategy
We carried out
a comprehensive search of databases including the Cochrane Library,
MEDLINE and EMBASE to identify trials. Bibliographies of relevant papers
were searched, and hand searching of relevant publications was
undertaken to identify additional trials.
Selection criteria
Randomised
controlled trials and controlled clinical trials of the effects of a
specialist nurse practitioner on short and long term diabetic outcomes
were included in the review.
Data collection and analysis
Three investigators performed data extraction and quality scoring independently; any discrepancies were resolved by consensus.
Main results
Six
trials including 1382 participants followed for six to 12 months were
included. Two trials were in adolescents. Due to substantial
heterogeneity between trials a meta-analysis was not performed. Glycated
haemoglobin (HbA1c) in the intervention groups was not found to be
significantly different from the control groups over a 12 month follow
up period. One study demonstrated a significant reduction in HbA1c in
the presence of the diabetes specialist nurse/nurse case manager at 6
months. Significant differences in episodes of hypoglycaemia and
hyperglycaemia between intervention and control groups were found in one
trial. Where reported, emergency admissions and quality of life were
not found to be significantly different between groups. No information
was found regarding BMI, mortality, long term diabetic complications,
adverse effects, or costs.
Authors' conclusions
The
presence of a diabetes specialist nurse / nurse case manager may
improve patients' diabetic control over short time periods, but from
currently available trials the effects over longer periods of time are
not evident. There were no significant differences overall in
hypoglycaemic episodes, hyperglycaemic incidents, or hospital
admissions. Quality of life was not shown to be affected by input from a
diabetes specialist nurse/nurse case manager.
Plain language summary
Specialist nurses in diabetes mellitus
Specialist
diabetes nurses provide education and support services to people with
diabetes in many health care systems. A key goal is helping enable
people to self-manage their diabetes. However, this review of trials
found no strong evidence of benefit of care from specialist diabetes
nurses for adolescents and adults with diabetes. Although short-term
benefits may be possible, this has not been shown to result in long-term
improvements. People receiving care from diabetes nurses do not appear
to have improved health when compared with usual care in hospital
clinics or primary care with no specialist nursing input. No data were
shown on quality of life measures.
NAMA : YUDHO RAHMAT NUGROHO
KELAS: 1A
N.I.M : 2120101750
Emma Loveman1, Pamela Royle2, Norman Waugh3
1Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK. 2Department of Public Health, University of Aberdeen, School of Medicine, Aberdeen, UK. 3Department of Public Health, University of Aberdeen, Aberdeen, UK
Contact address: Hubertus JM Vrijhoef, Health Care Studies, University Maastricht, Universiteitssingel 40, Maastricht, 6200 MD, Netherlands. b.vrijhoef@zw.unimaas.nl.
Editorial group: Cochrane Metabolic and Endocrine Disorders Group.
Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009.
Review content assessed as up-to-date: 29 November 2002.
Citation: Loveman E, Royle P, Waugh N. Specialist nurses in diabetes mellitus. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003286. DOI: 10.1002/14651858.CD003286.
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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