At the completion of the year in the DMCP, significantly more (P 0.001) patients were on a combination of oral drugs compared with a single oral agent at enrollment. Because the eye exams took place on site at clinic B (as opposed to clinic A), it was possible to ascertain whether patients referred for the examination actually received it. Except for evaluation of albuminuria (a reminder of which was indicated in a check box on a diabetesspecific progress note), every process measure in Table 4 was met significantly more (P 0.001) often under nurse directed care than in the year prior. There was no difference between the two groups in the number of patients with negative or trace dipstick results receiving an evaluation for microalbuminura. However, in those who had a dipstick result of 1 or an albumin-to-creatinine ratio 30 mg/g, 95% (40 of 42) received an ACE inhibitor under nurse-directed care