Nurses: at the heart of diabetes care

Abstract

For 2020, World Diabetes Day on Nov 14 is dedicated to promoting the crucial role of nurses in the prevention and management of diabetes. The campaign, Nurses Make the Difference, which is led by the International Diabetes Federation (IDF), highlights that nurses account for almost 60% of the health-care workforce worldwide and play a key part in the care of people with all types of diabetes and in the prevention of type 2 diabetes in those at risk. A central focus of the IDF campaign is on the importance of education and training for nursing staff to equip them with the knowledge and skills necessary to help support people living with diabetes to overcome the challenges they face in managing the disorder and prevent the development of complications. The focus of World Diabetes Day on the role of nursing follows in the footsteps of the World Health Assembly, which designated 2020 as the International Year of the Nurse and the Midwife—an initiative intended to celebrate the work of nurses and midwives, while drawing attention to the challenges they face and advocating for increased investment in the workforce globally. As part of this initiative, in April, WHO released a landmark report on the state of the world's nursing in 2020. The report provides up-to-date information on the global nursing workforce, including on the overall shortage of nurses, estimated at almost 6 million—with the vast majority of shortfalls in low-income and middle-income countries, where the growth in nurse numbers is scarcely keeping pace with population growth. But even in some high-income countries the demand for nurses outpaces their supply: in England, even before the COVID-19 pandemic, in 2019 there were about 40 000 vacancies for nurse roles across health and care settings, described by the Royal College of Nursing as a workforce crisis. Meanwhile, the need for wealthier countries such as the UK and Germany to recruit from abroad can contribute to the workforce shortages in other countries. According to the WHO report, the number of nurse graduates worldwide will need to increase by an average of 8% per year to overcome the global shortage by 2030. As diabetes is a chronic disorder, patients often have substantial contact with the health-care system, and much of their direct contact is with nurses. Across various settings at all levels of the health system, from routine clinic visits to inpatient care, nurses have a central role in caring for people with diabetes. In particular, the IDF emphasises the key contributions of nurses in ensuring the timely diagnosis of diabetes, in helping to prevent type 2 diabetes by addressing risk factors, and in the provision of self-management education and psychological support for patients. To help strengthen these and other important contributions, the IDF is calling on national governments to expand education in diabetes in nursing curricula and ongoing education and professional development throughout nursing careers. Additionally, the campaign is calling for investment in the training and recognition of diabetes specialist nursing. Nurses specialised in diabetes can provide crucial expertise in the multidisciplinary care of people with diabetes, with a central role as an educator and counsellor for patients and families and in the provision of education and support for other nurses and non-specialist health workers who see patients on a regular basis. Nurse-led models of care have been shown to be effective in the management of diabetes. In a meta-analysis of randomised trials of nurse-led clinic approaches and nurse-led prescribing reported in 2019, nurse-led clinics had a beneficial effect on HbA1c, and nurse-led prescription was similar to doctor prescribing with respect to effects on HbA1c. Similarly, the authors of an evidence synthesis of nurse-led adult primary diabetes care, also reported in 2019, concluded that there is “evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care”. Although the evidence is limited and restricted to high-income countries and China, there is clear appeal for piloting such approaches in resource-limited settings—requiring investment in building and sustaining the nursing workforce. With the growing burden of diabetes worldwide, the nurses working at the heart of diabetes care—including both specialists and generalists across all levels of the health and care systems—are more important than ever before. The calls of WHO and the IDF, to invest to expand the nursing workforce and diabetes training both for nurses in general and for those specialising in diabetes care, must be heeded.