| ObjectiveDiabetes is the third leading killer in the world. The current situation of this disease in China: the explosion of obesity has placed heavy burdens on our society; complications crop up frequently while the attainment rate of treatment is rather low; the level of our nursing, education and management of diabetic patients lags far behind that of those advanced countries, and the long-term follow-up for observing the effectiveness of the diabetes education and management is insufficient. But diabetes is a chronic desease, the diabetes and its complication should be provented by diabetes patient education. It is very important that how to teach the diabetis deal with diabetes and manage its complication; enhance the compliableness of diabetes treatment and nursing; decrease consultation rate and medical fee. This research project tries to explore how to enhand the diabetes specialist nursing and an effective working system for Diabetes Specialist Nurse-led Clinic, based on case management to provide an individualized assessing as well as make great efforts to normalize the treatment of diabetes; make regular follow-up visits; take precautions against complications and try to discover them as early as possible; reinforce the prevention of the Type 2 diabetes in order to take effective control of diabetes,offering patients personalized evaluation, treatment and instruction so as to enhance the ability of self-management in clinical diabetics. This research project tries to suggest an effective working system for Diabetes Specialist Nurse-led Clinics, which could provide a basis for assessing and licensing diabetes nurse specialists in the future.MethodsThe research would apply the case contrast study for convenience sampling and include the patients who received medical treatment in the Diabetes Nurse Specialist Clinics of Jinan University First Affiliate Hospital from January to June 2007. The case management is carried out by spliting 109 diebetes patients into two groups, the experimental group which consists of 49 patients and control group of 60 patients. The patients was hospitalized in the nurse-led clinic either on their own or under recommendation of the specialist doctors. Inclusion criteria of the cases: The one, aging from 30 to 70, should have the T2MD which is in accordance with the Diabetes diagnostic standard of WHO in 1997. Exclusion criteria of the cases: IGT and type 1 Diabetes, other cases may have an effect on the education result, the patients who have serious Diabetic complications, the patients who can't and/or are impossible to understand and comply with this plan. Control Group: The 60 T2MD patients, aging from 30 to 70, who weren't diagnosed in the Specialty Nurse Nurse-led Clinic but in the diabetes doctor-clinic and received the general diabetes patient education in the First Affliliated Hospital.The Diabetes Specialist Nurse-led Clinic was established with the approval of Medical Affairs Dept. Department of Endocrinology and Nursing Dept.in Jan 2006. The work scope of this clinic is pre-designed and invistigated, including the evaluation sheet and the medical procedure by diabetes specialist nurses.The Diabetes Specialist Nurses provided diabetes specialist nursing assessment for 49 patients in the experimental group, analyzed individualized problem, performed one-to-one personalized diabetes education, followed up the patients three months in the nursing way of case management and evaluated the effect of education and management.The 60 patients of the control group were assessed by the general nurse assessed for the first time when they were waiting to meet the medical doctor (using the same assessment sheet). The patients of the control group took part in the genetal diabetes patient education that organized by Department of Endocrinology of the First Affiliated Hosptial of Jinan University. The indicators such as FBG and PBG of the control group as well as the compliance to the monitoring were compared respectively three month in advance or later of the intervention. The data of FBG and PBG of control group after intervention was studied simultaneously with the survey on the control of metabolism in Guangzhou that conducted by Guangzhou T2DM cooperation Team, the blood samples were collected at the same day.SPSS 13.0 software package was adopted to process and analyse the data. The statistical methods included Independent T test, Peareson test and Mann-Whitney U Test, Normalit plots with tests.Results1. There are 49 cases in the experimental group,with an average age(53.306±9.607),60 cases in the control group with the average age (55.617±7.975), P=0.173.The average BMI of experimental group(24.096±2.960) kg/m~2 compared with the average BMI of the control group(23.731±4.385) kg/m~2,P=0.621.The x~2 valid of diabetes history of two groups was 3.261 , P =0.353. There were no significant differences between the age, the diabetes history as well as BMI of the patients of two groups, which indicates the influence of social feature on the results and ensures the comparativity of these two groups. Before intervention, the rank test was conducted to FBG and PBG of the patients to get P > 0.05, revealing no statistical difference and demonstrating no significant difference in the source of the samples.2. The compliableness of screen of the HbA1c, Macroalbuminuria(mALB), blood lipit, eyes, foot and Self-monitoring blood glucose(SMBG),self-monitoring blood presser,diet control and exercise therapy after intervention between two groups. That is significance difference between two groups, P< 0.05, which reveals that the patients under the care of clinical specialists nurse have much more effective self-management than those in the control group. Some risk of diabetes complication should be found by the DSN in the CSNLC, thus the problems underlied could be solved with the help of timely instruction3. Comparing the attainment rate of FBG and PBG of two groups after intervention,it was found that there is no significant difference in the classified PBG between two groups, P > 0.05. The attainment rate of classified FBG of two groups shows the significant difference (P < 0.05),the attainment rate of FBG of the experimental group is apparently much higher than the control group.4.To conduct the self contrast method between the average FBG and PBG before and after intervention. The result shows the FBG and PBG of the experimental group after intervention is lower than that before intervention, which result in some difference(P < 0.05).After the individualized education and case management by the diabetes specialist nurses in the experimental group, the average FBG of patients (6.582±2.144)mmol/L is apparently lower than that before intervention, that is, FBG(8.549±3.090)mmol/L ,P < 0.05. Comparing the experimental group and control group, the average FBG of patients in the control group is (8.842±3.380)mmol/L, P =0.000. FBG in the control group is much higher than that of the experimental group after intervention. PBG (8.560±2.333)mmol/L of patients in the experimental group after intervention is obviously lower than that(12.222±5.350)mmol/L before intervention, P=0.000.Comparing the PBG (9.67±3.554)mmol/L of the experimental group and control group after the intervention, P=0.04,revealing the statistical difference. 5. The working model of the DSNLC were promoted through the special report in the newspaper, the academic article contributed in the journals,more academic meetings participated. Besides that, the visit to the clinics is welcome, future study in this area is encouraged,more education-led classes organized,in this way, this working model would be further extended.ConclusionsTo open the Diabetes Specialist Nurse-led Clinic and implement the case management as well as the individualized assessment, working shelf of the DSNLC and follow-up regularly could effectively enhance the self-management capability of patients with diabetes, reinforce the patients' treatment compliance, and control the FBG., take precautions against complications and try to discover them as early as possible; in order to take effective control of diabetes. Moreover, it is enabled to detect high risk factors that induce the diabetes complications and resolve the individual problems. As the most pertinent diabetes education method, it wins the widest popularity among the patients. The result showed that the effective working model of the DSNLC and the case management are better than the general diabetes patient education. In near future, domestic management of diabetes patients should be geared for the nurse-led clinic and the working mode of case management.
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