Development and Implementation of a Multidisciplinary Clinic Focused on the Care of Adolescents with Youth-Onset Type 2 Diabetes

Abstract

Introduction

Diabetes self-management education and lifestyle interventions are the cornerstones of type 2 diabetes (T2D) care; however, the higher risk of comorbidities among youth with T2D requires a comprehensive care model. Traditionally, sub-specialty care relies on a referral model placing the burden on patients/families. In response, we developed a pediatric T2D multidisciplinary clinic (MDC)-A single physical location where patients can access various sub-specialists. The goals of the MDC are to aid with lifestyle modifications and provide referral/access to sub-specialists within the MDC, as determined through screening labs and assessment tools.

Methods

We conducted a retrospective chart review of youth seen in the T2D MDC clinic at Cincinnati Children’s Hospital from 1/2020 to 12/2021. We evaluated the frequency that youth met with each specialist and completion rates of annual screening labs.

Results

The cohort consisted of 227 youth with T2D (mean age 17.6 years, mean BMI 40.9kg/m2, 64% female, 50% Black or African American, 65% public insurance). All patients met with a diabetes provider and 81.2% met with a registered dietitian/certified diabetes education specialist. Exercise physiology met with 51.5% of patients, gastroenterology met with 34.8% of patients, social work met with 44.1% of patients, clinical psychology met with 27.3% of patients, and bariatric surgery met with 9.7% of patients. Percent completion of annual labs were: 98.2% for HbA1c, 84.6% for urine microalbumin, 83.7% for lipids, 90% for liver function, 59.5% for retinopathy, and 45.4% for the Patient Health Questionnaire-9.

Conclusion

The majority of patients received diabetes and nutrition education and annual screening labs. Exercise counseling and sub-specialty care remain below 60% in part due to services not being available at every MDC. Our goals are to increase access to subspecialty care within the MDC’s and consider additional care delivery methods to provide comprehensive care to youth with T2D.

Keywords:

• pediatrics
• type 2 diabetes
• multidisciplinary
• adolescent
• comorbidities

Abbreviations

T2D, Type 2 diabetes; MDC, multidisciplinary clinic; CDC, Center for Disease Control and Prevention; TODAY, Treatment Options for Type 2 Diabetes in Adolescents and Youth; RISE, Restoring Insulin Secretion; SEARCH, The Search for Diabetes in Youth; T1D, type 1 diabetes; CCHMC, Cincinnati Children’s Hospital Medical Center; MD, medical doctor; CNP, certified nurse practitioner; RD, registered dietitian; CDCES, certified diabetes care and education specialist; GI, gastroenterologist; PHQ-9, patient health questionnaire-9; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PEDS-QL, Pediatric Quality of Life Inventory; PSQ, University of Michigan Pediatric Sleep Questionnaire; EDDS-5, Eating Disorder Diagnostic Scale; T2-DDAS, Type 2 Diabetes Distress Assessment System.

Acknowledgments

We would like to thank the patients and families who have allowed us to care for them in the T2D MDC at CCHMC. We would also like to thank the Junior Cooperative Society at CCHMC for providing funding to purchase the retinal camera for the clinic. Finally, we would like to thank CCHMC for supporting the development of this program.

Disclosure

The authors report no conflicts of interest in this work.