Do Nurse Practitioners in a managed care center adhere to the American Diabetes Association Guidelines?

Edmond, Pamela



Type 2 Diabetes Mellitus (DM) is a chronic progressive disease.  Its impact results in severe morbidity, in addition to premature mortality due to micro-vascular and macro-vascular damage.  This disease has increased to epidemic proportions in the United States and has become a major cost burden. Adherence to the American Diabetes Association (ADA) guidelines and algorithms by Nurse Practitioners (NPs) can improve glycemic control and decrease or minimize the progression of diabetic related complications.

Specific Aims


1) To evaluate the degree of success in the diagnosis and management of Type 2 DM

2) To determine the adherence to the ADA Standards of Medical Care in Diabetes-2009 guidelines by Nurse Practitioners (NP) in a Nurse Managed Care Clinic, in Michigan


A retrospective electronic medical record review (n= 30) was performed at a Nurse Managed Clinic.  Twenty three medical records met the inclusion criteria: patient was seen at least three times during 2007 and 2009, had a NP as the primary care provider at their respective visits and had a primary diagnosis of Type II DM. 


Of the 23 electronic medical records reviewed 63% demonstrated symptoms of diabetes as their chief compliant on their initial visit to the clinic.  Ninety percent demonstrated elevated fasting plasma glucose levels >126.  These review findings indicated adherence to the 2009 ADA diagnostics guidelines for diabetes at the following levels: 96% had a hemoglobin A1C level obtained every 3-6 months, 100% had an annual fasting lipid panel and 56% had an annual urine micro-albumin level obtained annually. The record review demonstrated adherence to the ADA management guidelines at the following levels: 96% had pharmacologic treatment of DM with insulin, a hypoglycemic agent or both initiated when glycemic goals were not met, 100 % had documented lifestyle counseling initially and ongoing, and 61% had pharmacologic therapy with an ACE Inhibitor or and Angiotensin Receptor Blocker (ARB) initiated for patients with the diagnosis of DM and hypertension.


These findings indicated that the patients were accurately diagnosed with Type 2 DM based on diagnostics. The data suggest that NPs in this study do adhere overall to the ADA guidelines for the medical management of Type II DM. Recommendations would include follow-up with NPs to enhance adherence for annual urine micro-albumin level and use of ACE and ARBs for DM patient who are also hypertensive.