Background
Clalit Health Services (CHS) established structured follow-up for diabetic patients that are carried out by the primary care nurses, as a supplement to the follow-up performed by the family physician.

Aims
To compare follow-up and outcomes of adult diabetic patients by physicians alone and with additional structured nursing follow-up.

Methods
A cohort of 2,024 diabetic patients aged 40- 76 years were randomly selected from the data base of CHS. Patients who had been under physician follow-up only were compared to those who received additional structured nursing follow-up. Outcome measurements included percentage of patients undergoing the recommended annual follow-up tests, as well as HbA1C, LDL and blood pressure levels.

Results
1,044(51.6%) of the patients were female. The average age was 60.7 years. 760 (37.5%) patients were exempt from payments by the national insurance.
In 2005, 801diabetic patients (39.5%) received structured nursing follow-up for diabetes. In 2006, this rose to 852 diabetic patients (42.1%) and in 2007 1,005 diabetic patients (49.6%) received structured nursing follow-up.
Patients receiving structured nursing follow-up were older, had more chronic diseases and a greater proportion from low socioeconomic class.
The proportion of patients undergoing each individual follow-up test was higher with supplemental nursing follow-up as was the proportion that performed all the recommended follow-up tests. There were no differences in HbA1c and blood pressure levels between the groups. LDL cholesterol levels were lower in the structured nursing follow-up group.

Discussion
Although the patients receiving supplemental nursing follow up were older, with more chronic diseases and from a poorer socio-economic background their HbA1C levels and blood pressure were similar to the control group, while their LDL was lower.
These findings indicate an advantage in the work of a doctor- nurse team in treating diabetic patients with complicated medical and social backgrounds.
With the effectiveness of supplemental nursing follow-up shown in this study it is likely that with more time to perform follow-up on diabetic patients nurses could reach more patients improving their diabetic follow-up and control.

(1) Family Medicine Department, Central District, Clalit Health Service Rehovot
(2) Central District Clalit Health Service Rishon Lezion
(3) Meir Medical Center, Kfar Saba
(4) Family Medicine Department, Hadassa Medical Center, Jerusalem

Research number: R/119/2007