A randomized trial of regular standardized telephone contact by a diabetes nurse educator in adolescents with poor diabetes control
ABSTRACT 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.
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.
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).
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.
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ABSTRACT: The control of type 1 diabetes requires interaction between pa- tients and the healthcare team. To achieve this, telematic systems may be useful. The aim of this study was to assess the efficacy and safety of the telematic system Medical Guard Diabetes ® (MGD), which was modified for sending glycaemia and other data. In this study, 20 type 1 diabetic patients with poor metabolic control were randomized to either carry out hospital appointments (CP) or to send information (glycaemia, insulin, carbohydrate intake) with the MGD (MG) and monthly contact by SMS. The study period was 6 months evaluating HbA1c, number of hypoglycaemias, patient knowledge on diabetes, quality of life and costs. Both groups were comparable at baseline. One patient in the MG group left the study. On comparing basal and final values only the MG group showed a significant decrease in the number of hypoglycaemias (p= 0.027). During the follow-up, the change in HbA1c was -0.66% (p= 0.102) in the CP group and 0.16% (p= 0.666) in the MG group. Both groups showed an improvement in the knowledge test at the end of study (CP: p= 0.025; MG: p= 0.023). There was no significant difference in the quality of life tests. The length of the visits was shorter in the MG group (p= 0.025) as was the intervention total cost (CP=119.20 Ä vs. MG= 82.70 Ä). In conclusion, the MGD system is effective and safe for sending information and the telematic appointment is less expensive than hospital appoint- ments.
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ABSTRACT: Task and resource scheduling play an important role in improving the performance of virtually any network-based computing environment. A new bottom-up resource scheduling paradigm, call Osculant, was proposed as an innovative facilitating technology. Osculant was developed under contract NAVY 00039-44-C-0163 and is reported under this cover.