A comparison of two different team models for treatment of diabetes mellitus in primary care

The importance of the nurse's role in the management of patients with type 2 diabetes has long since been emphasized. The aim of this study was to tes t the hypothesis that a structured organization of type 2 diabetes care, wi th a diabetes nurse working more independently of the general practitioner, has a significant impact on the patient's self-management and quality of c are. The test consisted of 394 registered patients, all with an onset of di abetes mellitus occurring after the age of 34, at two primary health care ( PHC) districts in Blekinge county in South Sweden. During one year all cons ultations for both doctors and nurses were analysed, and a structured telep hone survey was carried out involving 364 patients who were 84 years or you nger. A comparison between the two PHC centres was made regarding quality o f care, frequency of consultation, patients' knowledge of their disease; an d patients' self-management. The results showed that organizing care of typ e 2 diabetes in a structured way encourages better metabolic control in spi te of less use of oral medication, and among the patients a greater knowled ge of their disease and a more active self-management thus favouring implem entation of local guidelines. Also, a difference was found in the patients' choice of contact with doctor or nurse regarding their diabetes and even o ther causes, which shifted the balance from doctor to nurse. This study pro vides support for organizing type 2 diabetes care in a structured way to in crease the quality of care.