Background
The creation of advanced nursing roles in diabetes management, with specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. Thus, we aimed to examine the effectiveness of nurse-led clinics, in which nurses were involved in prescribing, on haemoglobin A1c (HbA1c) among people with type 2 diabetes. Nurse prescribers can be split into two types based on their role in prescribing: independent prescribers and supplementary prescribers who work in a team in collaboration with doctors (1).
Methods
We systematically searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Allied Health Literature database guide (CINAHL) databases to identify randomised controlled trials (RCTs) assessing the effect of nurse prescribers on HbA1c. We performed a random effects model meta-analysis to assess the pooled effect size of the intervention.
Results
Nine RCTs were identified, seven of which could be included in the meta-analysis. All studies were from developed countries, with a medium risk of bias and a moderate heterogeneity between studies. In the five RCTs in which nurse prescribers supplemented a team, there was a trend towards improving HbA1c compared to usual care (-0.34 percentage points; 95% CI: -0.71, 0.02). In the four RCTs in which nurses replaced doctors, the outcomes of nurse prescribers were comparable to those of doctors (-0.31 percentage points; 95% CI: -0.77, 0.15).
Conclusions
There was no clear evidence of benefit on glycaemic control when nurse prescribers work alongside a doctor and other practitioners. However, in those studies in which nurses replaced physicians, glycaemic control was comparable between nurses and doctors. Therefore, there may be value in providing nurse-led prescribing services where there is limited access to doctor-led services.