The strengths of our study include the large sample size,
the representative nature of the cohort, the detailed
clinical assessment plus the ability to access data from
an organisation that provides the majority of local
community nursing services. The limitations of the study
include the lack of patient-level data on the reasons,
content and outcomes of the nurse intervention. We also
lacked data on important co-morbid disabling conditions
including cognitive impairment and arthritis, which means
that our community nursing costs might over-estimate the
direct costs of diabetes. The lack of non-diabetic controls also
means that we are unable to estimate the excess costs due to
diabetes. We were only able to study a sub-sample of the
original FDS cohort for technical reasons related to when
Silver Chain commenced their updated data collection and
the study sample was younger and had fewer complications
than the original cohort indicating that these data
provide underestimates of the need for community
nursing.