Diabetes management in an ageing society: The role of nursing support in primary care

• Nursing Outpatient Clinics improve adherence to diabetes clinical guidelines. • Patients with nursing support show a 9–13% improvement in follow-up testing. • These results provide key insights for policymakers designing diabetes programs. A growing share of the global population is affected by chronic conditions, prompting the development of various organizational models for chronic disease management. These models often emphasize the pivotal role of General Practitioners (GPs) and community health nurses in leading chronic care efforts. Recognizing the significant burden of diabetes as a leading cause of disability and mortality, the Emilia-Romagna Region of Italy introduced clinical guidelines for diabetes management in 2010 to enhance the quality of care for patients with type 2 diabetes. This initiative enables GPs working within Community Health Homes to collaborate with Nursing Outpatient Clinics (NOCs) for more effective chronic disease management. This study evaluates the impact of NOCs on key indicators of patient adherence with clinical guidelines. Using a balanced panel of administrative, individual-level data, we analyse the diabetic population over 65 years old within the largest Local Health Authority in Emilia-Romagna over a seven-year period (2010–2016). To assess the impact of NOCs on patient adherence, we employ alternative difference-in-differences approaches while accounting for heterogeneous treatment effects due to varying patient exposure periods. Our findings indicate that patients enrolled with GPs who integrate NOCs into diabetes management exhibit significantly improved adherence to clinical guidelines. These results offer valuable insights for policymakers designing diabetes management programs that incorporate nursing support to enhance patient engagement and adherence.