Using a primary nurse manager to implement DCCT recommendations in a largepediatric program

PURPOSE This study was conducted to determine whether recommendations from the Diab etes Control and Complications Trial (DCCT) could be implemented in a large pediatric population using a diabetes clinical nurse specialist program co ordinator dedicated to intensive management. METHODS Patients' charts were reviewed to examine HbA(1c) levels from before the re sults of the DCCT were published and again 1 year after the recommendations were implemented. Patients who met the following criteria (N=124) were enr olled: 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 HbA(1c) level recor ded in the medical chart. RESULTS HbA(1c) levels were significantly lower 1 year after implementing the DCCT protocol; 3 years later these same patients improved even further as eviden ced by another decrease in HbA(1c) levels. The patients were taking more in sulin (more Ultralente and regular insulin and less NPH) and had an increas ed 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 pat ients with the help of a nurse who is dedicated and available to the patien ts for ongoing adjustments and provides creative ways to overcome the barri ers to achieving normoglycemia.