Improving glycaemic control of insulin‐treated diabetic patients – a structured audit of specialist nurse intervention

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Abstract
• Insulin‐treated diabetic patients with poor glycaemic control are frequently referred to diabetes specialist nurses, but little data exist as to the effectiveness of this practice. • We therefore analysed the progress of 43 prospectively referred insulin‐treated patients with glycosylated haemoglobin (HbA1c) levels > 7.5%. • Diabetes nurse intervention involved re‐education, dietary advice and insulin dose adjustment. Improvement in control was defined as a final HbA1c < 7.0% or a fall of HbA1c of > 1.0% at 6 months post‐intervention. • Almost two‐thirds (63%) of patients achieved improvement status, with no increase in body weight or hypoglycaemic episodes. Disappointingly, however, the ‘non‐improver’ group (37%) showed a mean deterioration in HbA1c. • In conclusion, diabetes nurse intervention for poorly controlled insulin‐treated diabetic patients is generally effective, but intervention may be best targeted to responsive patients. • The factors which influence diabetic patients' ‘responsiveness to change’ require further investigation.