A review of the activity and effects of nurse-led care in diabetes

To identify systematically, summarize and critically appraise the current evidence regarding the activity and effects of nurse-led care in diabetes. A diverse range of nurse-led models of care exist in diabetes. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies has not been undertaken. Systematic searches of CINAHL, MEDLINE and British Nursing Index from 1996 until June 2006. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles. Twenty-two relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are involved in specific areas of care including education, individualized care, patient safety, promotion of self-care, acquisition of physical skills and psychological support. Improved glycemic control, diabetic symptoms, cost-effectiveness and decreased length of hospital stay are the main benefits of nurse-led interventions in diabetes care. Disease management protocols are the main mechanism by which nurses adjust and titrate medicines for patients with diabetes. Patient evaluations of nurse-led care report improved self-care and patient knowledge. Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues e.g. poor descriptions of the nurse interventions, the educational needs of nurses and the prescription of medicines by nurses for patients with diabetes, that point to a need for further rigorous evaluation. Nurse-led care is an integral element of the diabetes service offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in diabetes care.