"Care Ambassadors" Aid Juvenile Diabetic Patients

Children with type 1 diabetes and their families are benefiting from the help of "care ambassadors" in managing the disease. Care ambassadors (case managers) help young diabetics keep their scheduled follow-up appointments with the diabetes health care team and can provide support and educational material to the family, according to Lori M. Laffel, MD, of the Joslin Diabetes Center (Boston, Mass). In a randomized trial of 299 type 1 diabetes patients between the ages of 7 and 16, Dr. Laffel and her colleagues looked at the value of care ambassadors. For the study, they assigned the children to 1 of 3 treatment programs: a care ambassador alone, a care ambassador plus a psychoeducational component, or standard diabetes care. The results showed that patients and families who received care ambassador support and educational materials experienced significantly fewer severe adverse complications of diabetes, such as hypoglycemia, and fewer hospital and emergency room visits. For example, the occurrence of hypoglycemia was reduced by 25% to 60%, and hospitalization and emergency room use were lowered by 40%. Furthermore, patients who started the study with uncontrolled diabetes were 3.4 times more apt to improve their diabetes control if they received both a care ambassador and education, compared with the other groups. (The results of the study were published in Pediatrics, October 2003.)