The purpose of this study was to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve the metabolic control and quality of life in adolescents who are implementing intensive therapy. A total of 77 youths (age range, 12.5-20 years) who were beginning intensive insulin therapy were randomly assigned to one of two groups: intensive management with CST or without CST. CST consists of a series of small group efforts designed to teach problem solving skills and communication. Data were collected preintervention and at 3 and 6 months post-intervention by using established clinical and psychosocial indicators. Randomization produced equivalent groups. After 6 months, subjects who received CST had better metabolic control (F = 3.89, p = .02) and better general self-efficacy (F = 4.54, p = 0.01). They reported less negative impact of diabetes on their quality of life (F = 4.55, p = .01) and had fewer worries about diabetes (F = 3.82, p = .02). Thus, nurses may find CST useful in assisting youths with diabetes to achieve metabolic and quality of life goals.