The role of a nurse-led vascular risk reduction clinic in diabetes care
MacMahon Tone, Jacqueline (2008) The role of a nurse-led vascular risk reduction clinic in diabetes care. Master of Science thesis, Dublin City University.
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Background and Aims
Type 2 diabetes is characterised by excess vascular morbidity and mortality. Intensive vascular risk reduction in type 2 diabetes patients with microalbuminuria has been shown to significantly reduce future vascular events by 50%. The aim of this research was to determine whether an intensive, nurse-led clinic could achieve recommended vascular risk reduction targets in patients with type 2 diabetes compared with standard diabetes management. In addition, the study aimed to test the hypothesis that diabetes patients attending the vascular intervention clinic would have a clearer understanding of the
relationship between diabetes and heart disease than those randomised to standard diabetic care.
Part 1: Two hundred patients with type 2 diabetes were randomised to receive either intensive nurse-led or standard diabetes care in a one-year study.
Part 2: Following completion of the vascular risk intervention study, a questionnaire examining knowledge of vascular risk targets, was sent to patients who completed the study.
94 patients in each group completed the study. The groups were matched for age and baseline HbA1c, blood pressure and lipid profiles. More patients in the intensive group achieved targets than in the standard group, systolic BP (<130 mmHg) (33.0% vs 12.1%, p 0.001), diastolic BP (<80 mmHg) (75.5% vs 40.2% (p 0.001), cholesterol (< 4.8 mmol/L) (84.8% vs 63.6% (p 0.003), LDL cholesterol (< 2.6 mmol/L) (73.4% vs 54.5% (p 0.007) and HbA1c (<6.5 %) (53.2% vs 32.9% (p 0.005). There was a 75% response rate to the questionnaire. A surprisingly high number of patients did not know what their ideal blood pressure (67.2%), cholesterol (65.1%) or HbA1c (68.1%) should be, with no significant difference between the groups. However,
a high percentage of patients were aware that heart disease (89.2%) and stroke disease (82.8%) were complications associated with diabetes, with no significant difference
between the groups.
Conclusion: An intensive, nurse-led clinic is more successful in achieving vascular risk reduction targets than standard diabetes care. However, education programmes for patients with type 2 diabetes need to include information regarding vascular risk factors and their relationship to diabetes.
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