NURSE-LED primary care can reduce cardiovascular risk factors in patients with type 2 diabetes, researchers say.

A fifth of patients who received care from an allocated nurse care manager were able to reduce a trio of cardiovascular risk factors: blood pressure (BP), HbA_1c levels and lipids.

A total of 21.9% of patients in the nurse-led care group were able to bring all three outcome measures under control, compared with 10.1% in the usual care group at one year.

The biggest difference was seen in BP management, with 45% in the nurse-led group achieving a BP of <130/80 mmHg, compared with 25.4% of patients receiving usual care over one year.

The goal of achieving a HbA_1c of <8.0% was reached by 73.7% of patients in the intervention group, compared to 65.8% in the usual care group.

“The observed differences were likely mediated both by enhanced lifestyle changes and a greater intensity of pharmacological treatment among those in the intervention group,” the US researchers said.

Modest improvements were observed in LDL, with just over half of patients in both groups achieving <2.6 mmol/L. This might have been because 16% of study participants had previously had an adverse reaction to statin therapy and refused the reintroduction of a statin, the researchers commented.

After an initial visit, patients in the intervention group were provided with a home BP monitor and contacted by the nurse every two weeks initially until improvements were seen. A median of 10 phone calls had been successfully made to each patient at one year.

For the study, 556 patients with diabetes, mean age 65 years, were randomised to either the intervention or control group.

Diabetes Care 2011; online 2 June