Pediatric Diabetes 2006: 7: 254–259 All rights reserved # 2006 The Authors Journal compilation # 2006 Blackwell Munksgaard Pediatric Diabetes Original Article A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes Nunn E, King B, Smart C, Anderson D. A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes. Pediatric Diabetes 2006: 7: 254–259. Objective: To determine if scheduled telephone calls from a pediatric diabetes educator to children who have type 1 diabetes improve hemoglobin A1c (HbA1c) level, hospital admissions, diabetes knowledge, compliance, and psychological well-being. Research design and methods: A randomized controlled trial of 123 young subjects (mean age 11.9 yr, 69 male) with type 1 diabetes (mean duration 3.65 yr). For 7 months, the intervention group held bimonthly 15–30 min scheduled supportive telephone discussions. The primary outcome was change in the HbA1c level. Admission rates and changes in diabetes knowledge, psychological parameters, compliance, and patient perception were measured. Results: There was no significant difference between the treatment and control groups either before or after the intervention. The mean HbA1c level in the control group increased from 8.32 to 8.82% and in the intervention group from 8.15 to 8.85% (p ¼ 0.24). Both groups showed an increase in admissions of 0.2 per yr (p ¼ 0.57). There was no improve- ment in diabetes knowledge (p ¼ 0.34), compliance, or psychological function. The intervention group viewed their contact with the clinic as more helpful (p ¼ 0.003). Analysis of family function did not reveal subgroups with statistically significant differences. A mean of 13 calls was made to each subject at a cost of $A36 per child per month. Conclusions: Scheduled bimonthly phone support does not improve the HbA1c level, admission rates, diabetes knowledge, psychological function, or self-management but is perceived by patients as helpful. Further study into the effects of more frequent but shorter periods of support for patients experiencing specific difficulties is needed. Elizabeth Nunn, Bruce King, Carmel Smart and Donald Anderson John Hunter Children’s Hospital, Newcastle, New South Wales, Australia Key words: adolescent – child – diabetes mellitus – education – telephone – type 1 Corresponding author: Dr Donald Anderson, MB BS, Post Grad Dip Stat, FRACP, John Hunter Children’s Hospital, Locked Bag 1, Hunter Regional Mail Center, Newcastle, NSW 2310, Australia. Tel: 61249855634; Fax: 61249213599; e-mail: donald.anderson@hnehealth.nsw.gov.au Submitted 16 October 2005. Accepted for publication 6 May 2006 The Diabetes Control and Complications Trial (1, 2) (DCCT) clarified the association between poor metabolic control in adolescents and accelerated development of diabetes complications. In the DCCT, the 195 adolescents randomized to Ôintensive therapy’ required more support than the adult patients. Not only did patients receive intensive medical therapy but they also were frequently contacted by telephone. The intensive therapy group achieved a significantly lower mean hemoglobin A1c (HbA1c) level and slower progression of complica- tions. However, the trial did not separate the effects of intense insulin management from those due to increased personal support. It is possible with psychosocial support, but without intensive insulin management, to achieve metabolic control similar to that achieved by the adolescents in the DCCT (3). Insulin omission is a common cause for admission with ketoacidosis (4, 5). Programs that increase education and psychological support and offer frequent advice can improve metabolic control. However, these programs are expensive to implement, and the improvement is not maintained after the intervention has been withdrawn (6). An intervention 254