Using a primary nurse manager to implement DCCT recommendations in a large pediatric program.
This study was conducted to determine whether recommendations from the Diabetes Control and Complications Trial (DCCT) could be implemented in a large pediatric population using a diabetes clinical nurse specialist program coordinator dedicated to intensive management.



Patients' charts were reviewed to examine HbA1c levels from before the results of the DCCT were published and again 1 year after the recommendations were implemented. Patients who met the following criteria (N = 124) were enrolled: type 1 diabetes, less than 18 years old, followed at Yale for 1 year prior to the results of the DCCT and 1 year after, and HbA1c level recorded in the medical chart.



HbA1c levels were significantly lower 1 year after implementing the DCCT protocol; 3 years later these same patients improved even further as evidenced by another decrease in HbA1c levels. The patients were taking more insulin (more Ultralente and regular insulin and less NPH) and had an increased number of injections at both the 1-year and 3-year follow-up points.



The DCCT protocol can be implemented in a large population of pediatric patients with the help of a nurse who is dedicated and available to the patients for ongoing adjustments and provides creative ways to overcome the barriers to achieving normoglycemia.
Ahern
J A
JA
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
Ramchandani
N
N
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
Cooper
J
J
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
Himmel
A
A
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
Silver
D
D
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
Tamborlane
W V
WV
The Department of Pediatrics, the Children's Clinical Research Center, Yale University School of Medicine and Yale New Haven Hospital, New Haven, Connecticut
D000293:Adolescent; D000553:Ambulatory Care / Q000592:standards; D002648:Child; D002985:Clinical Protocols / Q000592:standards*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000451:nursing* / Q000517:prevention & control*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009720:Nurse Clinicians / Q000592:standards*; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000592:standards; D010371:Pediatric Nursing / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015397:Program Evaluation; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin