title: Insulin adjustment by a diabetes nurse educator improves glucose control in insulin-requiring diabetic patients: a randomized trial.
abstract: BACKGROUND
  Diabetic patients taking insulin often have suboptimal glucose control, and standard methods of health care delivery are ineffective in improving such control. This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control, as indicated by level of glycated hemoglobin (HbA1c).
  
  
  METHODS
  The authors conducted a prospective randomized trial involving 46 insulin-requiring diabetic patients who had poor glucose control (HbA1c of 0.085 or more). Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher. The patients were randomly assigned to receive standard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy.
  
  
  RESULTS
  At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level (mean [and standard deviation] for standard-care group 0.094 [0.008] and for intervention group 0.096 [0.010]), age, sex, type or duration of diabetes, duration of insulin therapy or complications. After 6 months, the mean HbA1c level in the standard-care group was 0.089 (0.010), which was not significantly different from the mean level at baseline. However, the mean HbA1c level in the intervention group had fallen to 0.078 (0.008), which was significantly lower than both the level at baseline for that group (p < 0.001) and the level for the standard-care group at 6 months (p < 0.01).
  
  
  CONCLUSIONS
  Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver.
authors.forename: D M
authors.initials: DM
authors.lastname: Thompson
authors.forename: S E
authors.initials: SE
authors.lastname: Kozak
authors.forename: S
authors.initials: S
authors.lastname: Sheps
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001955:British Columbia; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000451:nursing*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital; D010349:Patient Compliance; D010353:Patient Education as Topic; D011446:Prospective Studies; D019114:Remote Consultation; D013689:Telephone
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin