Original research| Volume 8, ISSUE 3, P215-223, October 2014

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Diabetes knowledge of nurses providing community care for diabetes patients in Auckland, New Zealand

Published:January 31, 2014DOI:



      To quantify and compare knowledge of diabetes including risk factors for diabetes-related complications among the three main groups of primary health care nurses.


      In a cross-sectional survey of practice, district and specialist nurses (n = 1091) in Auckland, New Zealand, 31% were randomly sampled to complete a self-administered questionnaire and telephone interview, designed to ascertain nurses’ knowledge of diabetes and best practice, in 2006–2008.


      All 287 nurses (response rate 86%) completed the telephone interview and 284 the self-administered questionnaire. Major risk factors identified by nurses were excess body weight for type 2 diabetes (96%) and elevated plasma glucose levels or glycosylated haemoglobin (86%) for diabetes-related complications. In contrast, major cardiovascular risk factors were less well identified, particularly smoking, although by more specialist nurses (43%) than practice (14%) and district (12%) nurses (p = 0.0005). Cardiovascular complications, particularly stroke, were less well known than microvascular complications, and by significantly fewer practice (13%) and district (8%) nurses than specialist nurses (36%, p = 0.002).


      In general, nurses had better knowledge of overweight as a risk factor for type 2 diabetes mellitus and elevated plasma glucose levels as a risk factor for diabetes-related complications compared with knowledge of cardiovascular risk factors, particularly smoking.


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        • Ministry of Health
        Diabetes Surveillance.
        Ministry of Health, Wellington, New Zealand2007
        • PricewaterhouseCoopers
        Type 2 Diabetes: Managing for Better Health Outcomes.
        Diabetes New Zealand Inc., Wellington, New Zealand2001
        • Hemmingsen B.
        • Lund S.S.
        • Gluud C.
        • et al.
        Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials.
        BMJ. 2011; 343: d6898
        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • et al.
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Costa J.
        • Borges M.
        • David C.
        • Vaz Carneiro A.
        Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials.
        BMJ. 2006; 332: 1115-1124
        • Collins R.
        • Armitage J.
        • Parish S.
        • et al.
        MRC/BHF heart protection study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.
        Lancet. 2003; 361: 2005-2016
        • UK Prospective Diabetes Study Group
        Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38): UK prospective diabetes study (UKPDS) group.
        BMJ. 1998; 317: 703-713
        • Conen D.
        • Bamberg F.
        Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: a systematic review and meta-analysis.
        J. Hypertens. 2008; 26: 1290-1299
        • Fagard R.H.
        Smoking amplifies cardiovascular risk in patients with hypertension and diabetes.
        Diabetes Care. 2009; 32: S429-S431
        • Doll R.
        • Peto R.
        • Boreham J.
        • Sutherland I.
        Mortality in relation to smoking: 50 years’ observations on male British doctors.
        BMJ. 2004; 328: 1519
        • Wannamethee S.G.
        • Shaper A.G.
        • Walker M.
        • Ebrahim S.
        Lifestyle and 15-year survival free of heart attack stroke, and diabetes in middle-aged British men.
        Arch. Intern. Med. 1998; 158: 2433-2440
        • Pan X.R.
        • Li G.W.
        • Hu Y.H.
        • et al.
        Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study.
        Diabetes Care. 1997; 20: 537-544
        • Eriksson K.F.
        • Lindgarde F.
        Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study.
        Diabetologia. 1991; 34: 891-898
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N. Engl. J. Med. 2002; 346: 393-403
        • Kosaka K.
        • Noda M.
        • Kuzuya T.
        Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males.
        Diabetes Res. Clin. Pract. 2005; 67: 152-162
        • Stone R.A.
        • Rao R.H.
        • Sevick M.A.
        • et al.
        Active care management supported by home telemonitoring in veterans with type 2 diabetes: the DiaTel randomized controlled trial.
        Diabetes Care. 2010; 33: 478-484
        • Piatt G.A.
        • Orchard T.J.
        • Emerson S.
        • et al.
        Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention.
        Diabetes Care. 2006; 29: 811-817
        • Litaker D.
        • Mion L.
        • Planavsky L.
        • et al.
        Physician–nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care.
        J. Interprof. Care. 2003; 17: 223-237
        • Taylor C.B.
        • Miller N.H.
        • Reilly K.R.
        • et al.
        Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes.
        Diabetes Care. 2003; 26: 1058-1063
        • Aubert R.E.
        • Herman W.H.
        • Waters J.
        • et al.
        Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial.
        Ann. Intern. Med. 1998; 129: 605-612
        • Gary T.L.
        • Bone L.R.
        • Hill M.N.
        • et al.
        Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans.
        Prev. Med. 2003; 37: 23-32
        • Hiss R.G.
        • Armbruster B.A.
        • Gillard M.L.
        • McClure L.A.
        Nurse care manager collaboration with community-based physicians providing diabetes care: a randomized controlled trial.
        Diabetes Educ. 2007; 33: 493-502
        • Canga N.
        • De Irala J.
        • Vara E.
        • et al.
        Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.
        Diabetes Care. 2000; 23: 1455-1460
        • Narayan K.M.
        • Imperatore G.
        • Benjamin S.M.
        • Engelgau M.M.
        Targeting people with pre-diabetes.
        BMJ. 2002; 325: 403-404
        • US Preventive Services Task Force
        Screening for type 2 diabetes mellitus in adults: U.S. preventive services task force recommendation statement.
        Ann. Intern. Med. 2008; 148: 846-854
        • Ministry of Health
        Diabetes and Cardiovascular Disease Quality Improvement Plan.
        Ministry of Health, Wellington, New Zealand2008
        • New Zealand Guidelines Group
        New Zealand Primary Care Handbook.
        3rd ed. New Zealand Guidelines Group & Ministry of Health, Wellington, New Zealand2012
        • Ministry of Health
        A Portrait of Health: Key Results of the 2006/07 New Zealand Health Survey.
        Ministry of Health, Wellington, New Zealand2008
        • Goodman G.R.
        • Zwarenstein M.F.
        • Robinson I.I.
        • Levitt N.S.
        Staff knowledge, attitudes and practices in public sector primary care of diabetes in Cape Town.
        S. Afr. Med. J. 1997; 87: 305-309
        • New Zealand Guidelines Group
        Guidelines for the Management of Core Aspects of Diabetes Care.
        New Zealand Guidelines Group, Wellington, New Zealand2000
        • Ministry of Health
        The New Zealand Health Strategy.
        Ministry of Health, Wellington, New Zealand2000
        • Ministry of Health
        Investing in Health: Whakatohutia Te Oranga Tangata: A Framework for Activating Primary Health Care Nursing in New Zealand.
        Ministry of Health, Wellington, New Zealand2003
        • Daly B.
        • Arroll B.
        • Sheridan N.
        • et al.
        Characteristics of nurses providing diabetes community and outpatient care in Auckland.
        J. Prim. Health Care. 2013; 5: 19-27
        • Statistics New Zealand
        Demographic Trends: 2011.
        Statistics New Zealand, Wellington, New Zealand2012
        • Campbell C.
        • Moffatt R.J.
        • Stamford B.A.
        Smoking and smoking cessation – the relationship between cardiovascular disease and lipoprotein metabolism: a review.
        Atherosclerosis. 2008; 201: 225-235
        • Sowers J.R.
        Treatment of hypertension in patients with diabetes.
        Arch. Intern. Med. 2004; 164: 1850-1857
        • New Zealand Guidelines Group
        Evidence-Based Best Practice Guideline: Management of Type 2 Diabetes.
        New Zealand Guidelines Group, Wellington, New Zealand2003
        • Hoare K.J.
        • Steele J.
        • Ram F.S.
        • Arroll B.
        Evidence-based resource use by practice nurses in the Greater Auckland region of New Zealand.
        N. Z. Med. J. 2008; 121: 51-58
        • Groves R.M.
        Survey Methodology.
        J. Wiley, Hoboken, NJ2004
        • O’Donnell C.A.
        • Jabareen H.
        • Watt G.C.
        Practice nurses’ workload, career intentions and the impact of professional isolation: a cross-sectional survey.
        BMC Nurs. 2010; 9: 2
        • Peyrot M.
        • Rubin R.R.
        • Lauritzen T.
        • et al.
        Patient and provider perceptions of care for diabetes: results of the cross-national DAWN study.
        Diabetologia. 2006; 49: 279-288
        • Peyrot M.
        • Rubin R.R.
        • Siminerio L.M.
        Physician and nurse use of psychosocial strategies in diabetes care: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.
        Diabetes Care. 2006; 29: 1256-1262
        • Gerstein H.C.
        • Miller M.E.
        • Byington R.P.
        • et al.
        Effects of intensive glucose lowering in type 2 diabetes.
        N. Engl. J. Med. 2008; 358: 2545-2559
        • Patel A.
        • MacMahon S.
        • Chalmers J.
        Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
        N. Engl. J. Med. 2008; 358: 2560-2572