Using a Primary Nurse Manager to Implement DCCT Recommendations in a Large Pediatric Program

Abstract

PURPOSE 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. METHODS Patients' charts were reviewed to examine HbAic 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. RESULTS 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 HbAlC 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. CONCLUSIONS 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.