Effectiveness of a Primary Care Nurse Delivered Educational Intervention for Patients with Type 2 Diabetes Mellitus in Promoting Metabolic Control and Compliance with Long-Term Therapeutic Targets: Randomized Controlled Trial

BACKGROUND:

Systematic reviews and meta-analyses have shown very different values for the effectiveness of education in type 2 diabetes mellitus. However, the achievement of therapeutic targets after educational programs has been poorly evaluated.

OBJECTIVE:

Evaluate the effectiveness of a structured and individualised education program for type 2 diabetes, provided by a primary care nurse, which featured educational reinforcements and family support to achieve metabolic control, and long-term therapeutic targets.

METHODS:

Randomised controlled clinical trial with two arms: Intervention and control group. The intervention consisted of six face-to-face sessions of 30 min and follow-ups after 12 and 24 months for 236 participants with type 2 diabetes mellitus in a primary care setting in Andalusia (Spain). The primary outcome variables were the values and achievement of the type 2 diabetes mellitus control targets established by the American Diabetes Association: Glycated haemoglobin, fasting blood glucose, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, systolic and diastolic blood pressure. The secondary outcome variable was body mass index.

RESULTS:

From an overall total of 236 participants, 54.2% were male and the average age was 65.1 ± 9.5. After 12 months, the glycated haemoglobin level and systolic blood pressure decreased in the intervention group. After 24 months, the following variables significantly improved among the intervention group participants: basal glycemia, glycated haemoglobin, total cholesterol low-density lipoprotein cholesterol, and diastolic blood pressure. The glycated haemoglobin target (<7%) was better achieved in the intervention group than in the control group (35.2% vs 24.7%, p < 0.003). The rest of the targets were not met.

CONCLUSION:

Continual diabetes education with reinforcement sessions provided by a nurse achieved reductions in glycated haemoglobin, basal glycaemia, total cholesterol, low-density lipoprotein-cholesterol and systolic blood pressure in both the medium and long term. It also increased the proportion of participants who achieved the therapeutic target of glycated haemoglobin.