<--GAT-->
Clinical Topics

NPs, PAs Have as Good Diabetes Outcomes as Physicians

by U.S. Medicine

March 14, 2019

DURHAM, NC—So-called physician extenders do as good a job as physicians at the VA in helping to achieve good outcomes in diabetes patients, according to a new study.

The report in Annals of Internal Medicine focused on primary care provided by nurse practitioners and physician assistants; greater use of those professionals has been proposed as a solution to expected workforce shortages.1

Researchers from the Durham, NC, VA Healthcare System and Duke University sought to determine any differences in intermediate diabetes outcomes among patients of physician, NP and PA primary care providers.

To perform the cohort study, they used data from 568 VA primary care facilities, analyzing information on 368,481 adult diabetes patients treated pharmaceutically. With 74.9% of the patients seeing 3,487 physicians, 18.2% were treated by 1,445 NPs and 6.9% were treated by 443 PAs.

The study team examined the relationship between the profession of the PCP—i.e., the provider the patient visited most often in 2012—and both continuous and dichotomous control of hemoglobin A1c, systolic blood pressure and low-density lipoprotein cholesterol, using measurements gathered in 2013.

Results indicated that the difference in HbA1c values compared with physicians was -0.05% (95% CI, -0.07% to -0.02%) for NPs and 0.01% (CI, -0.02% to 0.04%) for PAs.

Researchers reported that the difference for SBP was -0.08 mm Hg (CI, -0.34 to 0.18 mm Hg) for NPs and 0.02 mm Hg (CI, -0.42 to 0.38 mm Hg) for PAs.

For LDL-C, meanwhile, the difference was 0.01 mmol/L (CI, 0.00 to 0.03 mmol/L) (0.57 mg/dL [CI, 0.03 to 1.11 mg/dL]) for NPs and 0.03 mmol/L (CI, 0.01 to 0.05 mmol/L) (1.08 mg/dL [CI, 0.25 to 1.91 mg/dL]) for PAs.

The authors emphasized that none of the differences were clinically significant, adding, “No clinically significant variation was found among the 3 PCP types with regard to diabetes outcomes, suggesting that similar chronic illness outcomes may be achieved by physicians, NPs, and PAs.”

Jackson GL, Smith VA, Edelman D, Woolson SL, Hendrix CC, Everett CM, Berkowitz TS, White BS, Morgan PA. Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study. Ann Intern Med. 2018 Dec 18;169(12):825-835. doi: 10.7326/M17-1987. Epub 2018 Nov 20. PubMed PMID: 30458506.



Related Articles

Technology Experts Question MISSION Act Electronic Systems

WASHINGTON—VA is working under a tight deadline to implement the community care provisions of the MISSION Act, the new law that goes into effect this summer and revises and codifies access standards for veterans receiving... View Article

VA Study Raises Questions About Value of Readmission Metrics

SAN FRANCISCO—While the VA performs well overall on key 30-day readmission rates, a study by researchers at the San Francisco VAMC questioned the utility of the measures for most of the health system’s hospitals. The... View Article


U.S. Medicine Recommends


More From diabetes

Diabetes

Greatest VA Weight Gains in Women Veterans Without Diabetes

WASHINGTON—High turnover among leadership, gaps in accountability, and long-standing problems in cybersecurity represent significant challenges for VA in its ongoing efforts to improve its IT infrastructure, oversight officials told legislators last month. These challenges will... View Article

Diabetes

Diabetes Patients Do Well in Military Healthcare-to-VA Transition

WASHINGTON—High turnover among leadership, gaps in accountability, and long-standing problems in cybersecurity represent significant challenges for VA in its ongoing efforts to improve its IT infrastructure, oversight officials told legislators last month. These challenges will... View Article

Diabetes

Veterans on Standard Diabetes Care Face Dangers from Hypoglycemia Subhead: Post-hoc VADT Analysis Links Low Blood Sugar to CV Events

WASHINGTON—High turnover among leadership, gaps in accountability, and long-standing problems in cybersecurity represent significant challenges for VA in its ongoing efforts to improve its IT infrastructure, oversight officials told legislators last month. These challenges will... View Article

Diabetes

Is Prandial Insulin or Noninsulin Agent Better for T2D Treatment Intensification?

Some veterans with type 2 diabetes patients can't reach their hemoglobin A1c goal despite using metformin, basal insulin and a sulfonylurea. What should come next?

Diabetes

Caution Urged in Use of Sulfonylureas in Some T2 Diabetes Patients with CAD

VA clinicians should exercise caution with use of sulfonylurea in some patients with co-morbid type 2 diabetes and cardiovascular disease, according to new research.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up