Glycemic Control in Adult Patients With Type 2 Diabetes Mellitus Receiving Care Through a Nurse-Led Diabetic Follow-Up Clinic Versus Conventional Care: A Randomized Controlled Trial.

Background Strengthening the role of diabetes nurse specialists, by expanding their knowledge and clinical expertise, can significantly contribute to managing diabetes mellitus and its complications. Objectives To assess and compare the impact of nurse-led diabetic follow-up clinics compared to conventional care on glycated hemoglobin (HbA1c) levels and diabetes treatment satisfaction among adult patients with type 2 diabetes mellitus (T2DM) seeking treatment in tertiary care settings. Material and methods A prospective, single-center, parallel-group randomized trial was conducted in a routine Diabetic Outpatient Department (OPD) at a tertiary care setting. After accounting for the loss to follow-up, 106 participants completed the trial. Diagnosed cases of T2DM with more than two records of HbA1c outside of the recommended range (>7%) and receiving insulin therapy for treatment were the inclusion criteria. The intervention included insulin titration and regular follow-up with the trained diabetes nurse for diabetes care and management. Endpoint measurements of HbA1c levels and diabetes treatment satisfaction were taken after three to six months of treatment to analyze the impact of the intervention. Results Participants receiving care through a nurse-led diabetic follow-up clinic had a decrease in HbA1c levels after the intervention, with an average paired difference of 1.75 (1.12 to 2.38), statistically significant at the 0.05 level of significance. Although HbA1c levels in the Control Group also decreased after the standard intervention, with a mean paired difference of 0.64 (0.03 to 1.25), it did not reach statistical significance, with a p-value of 0.05 at the 0.05 level of significance. However, patients' HbA1c levels between the Intervention and Control Groups at baseline (p = 0.101) and post-intervention (p = 0.369) were not statistically significant at the 0.05 level of significance. Furthermore, participants in the Intervention Group achieved better glycemic control, as measured by self-reported satisfaction with regards to hyperglycemia (-0.95 ± 1.43 vs. 0.39 ± 1.88, p = 0.001) and hypoglycemia (-0.35 ± 1.02 vs. 0.71 ± 1.1, p < 0.001) levels. Conclusion The nurse-led diabetes follow-up clinic was found to be an invaluable service, and the addition of a diabetes specialist nurse as part of the treatment team can alter the conventional pathway for diabetes treatment.