Nurse-led diabetes management in remote locations

Introduction: Nurse-led diabetes management has been shown to be effective in urban and regional general practice. We sought to test the feasibility of providing a nurse-led annual cycle of diabetes care in a remote location and to explore the factors that patients indicated were important in diabetes self-management. Methods: We conducted a pilot study in 3 locations: 1 town and 2 small townships in remote Australia. A chronic disease nurse (CDN) visited each patient over the course of a year. We examined patient clinical outcomes and interview data. We estimated the cost per hour of the CDN's time, including travel time, per 1% drop in glycated hemoglobin (HbA_1C). Results: A total of 21 patients participated in the pilot study. Clinical findings showed significant reductions in HbA1C levels after the nurse-led intervention. Patients reported that they trusted the nurse and thought her advice was pitched at their level. Patients were motivated through a process that included emotional response, change identity and acceptance. The estimated cost in CDN hours per 1% drop in HbA_1C level was A$242.95 (Can$237.60). Conclusion: Nurse-led diabetes care motivated patients to manage their diabetes and resulted in a significant improvement in diabetes management in this remote setting