Using a primary nurse manager to implement DCCT recommendations in a large pediatric program.

Purpose: This study was conducted to determine whether recommendations from the Diabetes Conrol 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 HbA|1c 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 HbA|1c level recorded in the medical chart. Results: HcA|1c 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 HbA|1c levels. The patients were taking more insulin (more Ultralente and regular insulin and less NPH) and had an increased number of injecting 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. [ABSTRACT FROM AUTHOR]