Diabetics Cared for by NPs, PAs Do as Well as Those in Physicians' Care

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Medium-term outcomes in diabetes remain the same under nurse practitioners (NPs) and physician assistants (PAs) as with physicians, suggests a study in the Annals of Internal Medicine.

Researchers compared clinical changes among some 370,000 Veterans Affairs patients with diabetes in almost 600 VA primary care facilities. All were observed for 2 years. Changes in glycated hemoglobin, systolic blood pressure, and low-density lipoprotein among those under the principal care of an NP or PA did not differ when compared to those under physician care.

For example, when compared with physicians' care, average systolic BP in the second year of observation was 0.08 mm Hg lower with NPs and 0.02 mm Hg higher with PAs — differences with no clinical significance. The same held true with hemoglobin and lipoprotein measures.

An editorialist, favoring different approaches to primary care, writes that "it is time to stop calling NPs and PAs 'midlevel' providers."