Real-world comparison of HbA1c reduction at 6-, 12- and 24-months by primary care provider type. Issue 4 (August 2018)

• Record Type: Journal Article
• Authors: Marin, Patricia A.; Bena, James F.; Albert, Nancy M.
• Is Part Of: Primary care diabetes. Volume 12:Issue 4(2018)
• Page Start: 319
• Page End: 324
• Publication Date: 2018-08
• Subjects: Advanced practice nurse -- Diabetes -- Ambulatory care; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2018.01.008
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: 1 advance practice nurse (APN) achieved similar HbA1c levels compared to physicians. APN providers promote optimized HbA1c levels in less-well controlled patients. An APN-internal medicine team model is ideal in managing type 2 diabetes mellitus. Abstract: Aims: To assess differences in hemoglobin A1c (HbA1c ) over time in diabetics treated by internal medicine physicians using the chronic care model (IMP-ancillary) or an advanced practice nurse (APN-IMP). Methods: Retrospective, 2-group comparative design using administrative databases and matching of IMP-ancillary and APN-IMP subjects 2:1 based on patient age (±3 years), gender and race. Subjects were diabetics treated ≥2 times during 2007–2010, had ≥1 follow-up visit 6-months from baseline and ≥2 HbA1c levels. HbA1c levels were assessed longitudinally using linear mixed effect models. Pearson chi-square and two-sample t-tests compared groups on patient characteristics. Results: A total of 774 patients were identified. After matching 93 APN-IMP patients with 176 IMP-ancillary patients (N = 269), there were no differences between groups in demographics; however, baseline mean (SD) HbA1c was higher in APN-IMP group, p < 0.001. Compared to baseline, at follow-up there were no between-group differences in HbA1c levels at 6 and 12 months; at 24 month follow-up, APN-IMP tended to have a large decrease in HbA1c compared to the IMP-ancillary group; mean difference (95% CI), −0.26 (−0.56, 0.05) p = 0.097. Conclusion: Compared to baseline HbA1c, patients treated by APN-IMP and IMP-ancillary provider groups had equivalent reductions in HbA1c .