Nurse Practitioners, Physician Assistants Deliver Diabetes Care Comparable with Physicians

Nurse practitioners’ (NPs) and physician assistants’ (PAs) impact on diabetes management is comparable to management by physicians, according to a study published in theAmerican Journal of Medicine.

Several previous studies have indicated that patient outcomes when managed by NPs and PAs were similar with those managed by physicians. The latest findings continue to underscore that patients can benefit highly from the care of NPs and PAs, and increasing their involvement in patient management could help meet the demand for primary care providers in the United States.

The researchers examined whether patients in the Veterans Health Administration managed by either primary care NPs, PAs, or physicians had similar hemoglobin A1c levels at comparable times. The study included 19,238 veterans with newly diagnosed diabetes in 2008, continuous primary care from 2008 to 2012, and more than 75% of primary care visits with NPs, PAs, or physicians. Annual hemoglobin A1c levels were documented through 2012 and all patients had 4 years of consistent primary care follow-up.

Of those included in the study, 2,821 were managed by NPs, 1,367 were managed by PAs, and 15,050 were managed by physicians. Patients managed by NPs and PAs had 14.5% and 15% of primary care visits with physicians, respectively.

A total of 15,841 patients were prescribed glucose-lowering medications. Of these, 96% had at least 1 oral medication, 37% had at least 2 oral medications, and 17% were prescribed insulin. According to the results, median hemoglobin A1c at initiation of the first and second oral drug was significantly lower in patients of NPs (7% and 7.5%, respectively) compared with that of physicians (7.1% and 7.7%). However, NPs and physicians started patients on insulin at similar hemoglobin A1c levels (9.5% and 9.7%).

The findings indicate no difference in hemoglobin A1c levels at diagnosis, initiation of medication, or after first 4 years of follow-up. NPs started patients on insulin at slightly lower hemoglobin A1c levels than physicians, but these differences were not statistically significant.

Overall, the researchers concluded that expanding the roles of NPs and PAs in patient management could significantly benefit patients in health care, both within and outside the Veterans Affairs system.

Reference

Yang Y, Long Q, Jackson SL, et al. Nurse practitioners, physician assistants, and physicians are comparable in managing the first five years of diabetes.Am J Med. 2018. 131:3:276-283. Doi: https://doi.org/10.1016/j.amjmed.2017.08.026