Prompts Aid Doctors' Diabetes Prevention Efforts : When nurses alert physicians, high-risk patients get exercise, diet, and weight-loss plans more often.

SAN DIEGO — A simple nurse-based physician prompt significantly improved the rates of counseling for exercise, diet, and weight control received by primary care patients at high risk for diabetes, results from a multisite study showed.

“Involving nurses in diabetes prevention with simple prompts can lead to improved outcomes,” John M. Boltri, M.D., told this newspaper during a poster session at the annual scientific sessions of the American Diabetes Association.

He and his associates randomized 10 primary care practices to intervention and control groups. Nurses in the intervention group received training on the ADA high-risk criteria for diabetes, how to calculate body mass index, how to use fingerstick glucometers, and how to counsel patients and follow up on glucose results.

Nurses in the control group received no such training.

Patients seen at the practices completed an ADA risk assessment questionnaire in the waiting room. In the intervention group, the nurses scored the questionnaire and if the patient was high risk for diabetes, they prompted the doctor to counsel him or her about exercise, diet, and weight control. The control group received usual care. The investigators then followed patients in both groups for 3 months to determine who received diet, exercise, and weight-reduction plans.

Of the 1,395 patients in the study, 42% had a family history of diabetes and 84% were at high risk for diabetes according to ADA criteria, reported Dr. Boltri, professor of family medicine at Mercer University, Macon, Ga. Their mean age was 50 years and their mean BMI was 30 kg/m2.

At 3 months of follow-up, 15% of patients in the intervention group received exercise plans, compared with only 2% of those in the control group. Patients in the intervention group also received more counseling for diet and weight reduction plans, compared with those in the control group (16% vs. 3%, and 6% vs. 2%, respectively).

When the investigators adjusted for age, gender, ADA risk score, and overweight, patients in the intervention group were eight times more likely than controls to receive a diet plan, six times more likely than controls to receive an exercise plan, and two times more likely than controls to receive a weight-loss plan.

“We were surprised at the magnitude of the difference,” Dr. Boltri said. “The odds ratios were high enough to say that this [prompt] would probably work in most primary care practices.”

The study was funded by the Medcen Community Health Foundation and the Health Resources and Services Administration.

Patients at risk for diabetes were more likely to receive counseling from physicians when nurses prompted them.