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.