Care directed by a specialty-trained nurse practioner or physician assistant can overcome clinical inertia in management of inpatient diabetes

Patricia A. Mackey, Mary E. Boyle, Patricia M. Walo, Janna C. Castro, Meng Ru Cheng, Curtiss B. Cook

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: The study's objective was to determine the impact of care directed by a specialty-trained nurse practitioner (NP) or physician assistant (PA) on use of basal-bolus insulin therapy and glycemic control in a population of noncritically ill patients with diabetes.Methods: A retrospective review of diabetes patients evaluated between July 1, 2011 and December 31, 2011 was conducted. 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, and had more frequent hyperglycemia, 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% of patients 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% confidence interval, 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 results in greater use of recommended basal-bolus insulin therapy and is correlated with lower mean glucose levels before discharge. Adapting this model for use outside an endocrinology consult service needs to be explored so that the expertise can be brought to a broader inpatient population with diabetes.

Original languageEnglish (US)
Pages (from-to)112-119
Number of pages8
JournalEndocrine Practice
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2014

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Physician Assistants
Nurse Practitioners
Inpatients
Nurses
Insulin
Hyperglycemia
Adrenal Cortex Hormones
Hospitalization
Point-of-Care Systems
Glucose
Endocrinology
Therapeutics
Population
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Care directed by a specialty-trained nurse practioner or physician assistant can overcome clinical inertia in management of inpatient diabetes. / Mackey, Patricia A.; Boyle, Mary E.; Walo, Patricia M.; Castro, Janna C.; Cheng, Meng Ru; Cook, Curtiss B.

In: Endocrine Practice, Vol. 20, No. 2, 01.02.2014, p. 112-119.

Research output: Contribution to journalArticle

Mackey, Patricia A. ; Boyle, Mary E. ; Walo, Patricia M. ; Castro, Janna C. ; Cheng, Meng Ru ; Cook, Curtiss B. / Care directed by a specialty-trained nurse practioner or physician assistant can overcome clinical inertia in management of inpatient diabetes. In: Endocrine Practice. 2014 ; Vol. 20, No. 2. pp. 112-119.
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