Care Directed by a Specialty-Trained Nurse Practitioner or Physician Assistant can Overcome Clinical Inertia in Management of Inpatient Diabetes.
Endocr Pract. 2013 Sep 6;:1-27
Authors: Mackey PA, Boyle ME, Walo PM, Castro JC, Cheng MR, Cook CB
Abstract
Objective: Determine impact of care directed by a specialty-trained nurse practitioner or a physician assistant (NP/PA) on use of basal-bolus insulin therapy and glycemic control in a population of non-critically ill patients with diabetes.Methods: Retrospective review of diabetes patients evaluated between July 1 and December 31, 2011. Patients cotreated by a specialty-trained NP/PA were compared with patients who did not receive such care.Results: In total, 171 patients with 222 hospitalizations were cotreated by an NP/PA and 543 patients with 665 hospitalizations were not. Patients with NP/PA involvement were younger, had more frequent hyperglycemia and hypoglycemia, and had greater corticosteroid use than patients without NP/PA involvement (P<.01 for all). Basal-bolus insulin therapy was administered to 80% of patients with NP/PA involvement and 34% without it (P<.01). After adjustment for age, sex, hyperglycemia measures, and corticosteroid use, the odds of basal-bolus insulin therapy being administered were increased significantly through NP/PA care (odds ratio, 3.66; 95% CI, 2.36-5.67; P<.01). After adjustment for these variables and insulin regimen, NP/PA care was significantly correlated with lower mean point-of-care glucose levels at 24 hours before discharge (P=.042).Conclusion: Diabetes care assisted by an NP/PA trained in inpatient diabetes management resulted in greater use of recommended basal-bolus insulin therapy and correlated with lower mean glucose levels before discharge. Adapting this model for use outside an endocrinology consult service needs to be explored so the expertise can be brought to a broader inpatient population with diabetes.
PMID: 24013999 [PubMed - as supplied by publisher]