No significant differences in intermediate diabetes outcomes were reported among patients managed by physician assistants (PAs), nurse practitioners (NPs), or physicians, according to a study published in Annals of Internal Medicine.1

A team of researchers from Duke University and the Durham Veterans Affairs Health Care System in North Carolina conducted a cohort study using data from the US Department of Veteran Affairs (VA) electronic health record to analyze intermediate diabetes outcomes among patients who were managed by PAs, NPs, and physician primary care providers (PCPs).

The investigators collected data from 368,481 adults with medication-treated diabetes managed at 568 VA primary care facilities and measured the association between the PCP profession and continuous and dichotomous control of glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C).

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A total of 3487 physicians, 1445 NPs, and 434 PAs treated 74.9%, 18.2%, and 6.9% of patients, respectively. Compared with measurements in patients managed by physicians, the differences in HbA1c values were -0.05% for NPs and 0.01% for PAs; the differences for SBP were -0.08 mm Hg for NPs and 0.02 mm Hg for PAs; and the differences in LDL-C were 0.01 mmol/L for NPs and 0.03mol/L for PAs.

“In conclusion, we found no clinically significant differences in intermediate diabetes outcomes,” the authors wrote. “As a result, this study provides further evidence that using NPs and PAs as PCPs may represent a mechanism for expanding access to primary care while maintaining quality standards.”

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In a corresponding editorial2 published in Annals of Internal Medicine, Anne L. Peters, MD, of Keck School of Medicine of the University of Southern California, wrote that “although the results validate that NPs and PAs can provide primary care, they are hardly surprising,” adding that “the time has come to embrace many different approaches to providing primary care, particularly for persons with a chronic disease, such as diabetes.”


  1. Jackson GL, Smith VA, Edelman D, et al. Intermediate diabetes outcomes in patients managed by physicians, nurse practitioners, or physician assistants: a cohort study [published online November 20, 2018]. Ann Intern Med. doi: 10.7326/m17-1987
  2. Peters AL. The changing definition of a primary care provider [published online November 20, 2018]. Ann Intern Med. doi: 10.7326/m18-2941