Abstract
A nurse-led diabetic clinic to manage type 2 diabetes, which emphasizes medication adherence, titration of hypoglycemic agents, behavior modification, and motivation for lifestyle changes, is widely recommended and practiced in western countries.This review aims to examine the impact of a nurse-led diabetic clinic versus a standard physician-led diabetic clinic on glycaemic control of type 2 diabetes patients.Studies were obtained using a comprehensive search in the electronic databases of PubMed, Embase, SCOPUS, Cochrane Library, and gray literature through March 2021. We calculated the pooled effect estimate with 95% confidence intervals (CIs) comparing subjects with and without nurse-led titration of hypoglycemic agents using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes.Four trials comprising 470 participants (241 intervention group and 229 control group) met the inclusion criteria. Glycated hemoglobin (HbA1c levels and BMI were lower in participants with a nurse-led diabetic clinic (SMD = -0.54, 95% CI -0.89 to -0.20, I2 = 67%, p = 0.002) and (SMD = -0.26 (95% CI -0.45 to -0.07, I2 = 0%, p = .008), respectively, than in those attending a standard physician-led diabetic clinic. Similarly, the pooled result shown that patients attending the nurse-led diabetic clinic had a 31% higher satisfaction level (RR 0.69; 95% CI, 0.51 to 0.92, I2 = 0%, p= 0.01). On the other hand, there was no significant association of the nurse-led diabetic clinics on patients’ blood pressure and intensification of hypoglycemic agents. The certainty of the evidence assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was moderate for outcomes like HbA1c level, intensification of hypoglycemic agents, and patients' satisfaction and low for other secondary outcomes.Our meta-analysis allows for the conclusion that nurse-led titration of hypoglycemic agents is associated with better glycemic control and enhances patients' satisfaction. Therefore, it is recommended to establish and strengthen nurses-led diabetic clinics for better HbA1c control where physician-led diabetic services are limited. Further research is needed to enhance the quality of the evidence.
Highlights
BackgroundDiabetes mellitus (DM) is a chronic metabolic illness with a rising prevalence and increased mortality rate
Glycated hemoglobin (HbA1c levels and body mass index (BMI) were lower in participants with a nurse-led diabetic clinic (SMD = -0.54, 95% confidence intervals (CIs) -0.89 to -0.20, I2 = 67%, p = 0.002) and
What is the impact of a nurse-led diabetic clinic versus a standard physician-led diabetic clinic on glycaemic control in type 2 diabetes patients? This investigation may reveal the potential effectiveness of intervention in diabetes management
Summary
Diabetes mellitus (DM) is a chronic metabolic illness with a rising prevalence and increased mortality rate. Type 2 diabetes mellitus, where body cells could not utilize or produce insulin, is considered the most typical type as around 90% of the globally identified diabetic population. [1] Around 3.4 million globally and 1 million in South-East Asia die due to diabetes as reported in the 2012 WHO Diabetes fact sheet [2]. According to the International Diabetes Federation, 'India is the second-largest hub for diabetes with 77 million patients with diabetes, after China; this number is further expected to reach till 134 million by 2045' [4]. Diabetes increases the risk of severe health issues, and over time, it may damage blood vessels, eyes, kidneys, heart, and nerves. The economic cost of living with diabetes poses a significant challenge to developing countries like India, where 5% to 25% of individuals' earning is spent on diabetes treatment expenditure [5,6] Overall, diabetes has a debilitating impact on the country's economy and health status
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