title: A randomized trial of regular standardized telephone contact by a diabetes nurse educator in adolescents with poor diabetes control.
abstract: OBJECTIVE
  The aim of this study was to determine the effect of regular standardized telephone contact by a diabetes nurse educator (DNE) on metabolic control, treatment compliance, and quality of life in adolescents with poorly controlled type 1 diabetes.
  
  
  METHODS
  A single-blinded 6-month randomized controlled trial was used. Participants included 46 of 49 eligible adolescents (13-17 yr) with type 1 diabetes >1-yr duration and hemoglobin A1c (HbA1c) >8.5% for the previous 6 months. Subjects were randomly assigned to 6 months of standard diabetes management or standard care plus weekly telephone contact by a DNE. Telephone conversations included review of events in the adolescents' lives and diabetes education, but the primary focus was on blood glucose results and insulin-dose adjustments. HbA1c, compliance with glucose monitoring, quality of life [Diabetes Quality of Life Scale for Youth (DQOLY)], and family functioning [Family Environment Scale (FES)] were assessed at baseline, and at 3 and 6 months. Posthoc, HbA1c levels were assessed 6 months following study completion.
  
  
  RESULTS
  Six months of regular telephone contact by a DNE had no immediate effect on any of the outcome measures. However, posthoc 6 months, HbA1c levels decreased (1% change compared to baseline) in 6/21 of the study group and 0/18 of the control group, while HbA1c increased in 4/21 of study subjects compared to 8/18 of control subjects (p = 0.015).
  
  
  CONCLUSIONS
  In contrast to adult studies, regular telephone contact did not lead to immediate improvements in metabolic control in adolescents with poorly controlled type 1 diabetes. However, knowledge and skills gained during the intervention may have had a delayed beneficial effect in these high-risk adolescents.
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. lawson@cheo.on.ca
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Lawson
authors.forename: Nini
authors.initials: N
authors.lastname: Cohen
authors.forename: Christine
authors.initials: C
authors.lastname: Richardson
authors.forename: Elaine
authors.initials: E
authors.lastname: Orrbine
authors.forename: Ba'
authors.initials: B
authors.lastname: Pham
mesh_terms: D000293:Adolescent; D003142:Communication; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009726:Nurses; D010349:Patient Compliance; D010353:Patient Education as Topic; D011788:Quality of Life; D016037:Single-Blind Method; D013689:Telephone; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin