Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center

doi:10.2147/JMDH.S63842

. 2014 Jul 31:7:321-31.

doi: 10.2147/JMDH.S63842. eCollection 2014.

Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center

M Constantine Samaan¹, Marlie Valencia², Connie Cheung², Boguslaw Wilk³, Keith Lau⁴, Lehana Thabane⁵

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
² Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
³ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
⁵ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Population Health Research Institute, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicines, Hamilton, ON, Canada.

PMID: 25114539
PMCID: PMC4124128
DOI: 10.2147/JMDH.S63842

Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center

M Constantine Samaan et al. J Multidiscip Healthc. 2014.

. 2014 Jul 31:7:321-31.

doi: 10.2147/JMDH.S63842. eCollection 2014.

Authors

M Constantine Samaan¹, Marlie Valencia², Connie Cheung², Boguslaw Wilk³, Keith Lau⁴, Lehana Thabane⁵

Affiliations

¹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
² Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
³ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
⁵ Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Population Health Research Institute, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicines, Hamilton, ON, Canada.

PMID: 25114539
PMCID: PMC4124128
DOI: 10.2147/JMDH.S63842

Abstract

Global rates of type 2 diabetes in children and adolescents have increased significantly over the past three decades. Type 2 diabetes is a relatively new disease in this age group, and there is a dearth of information about how to structure treatment programs to manage its comorbidities and complications. In this paper, we describe the design and implementation of a personalized multidisciplinary, family-centered, pediatric and adolescent type 2 diabetes program at a tertiary pediatric center in Hamilton, Ontario, Canada. We report the process of designing and implementing such a program, and show that this multidisciplinary program led to improvement in glycated hemoglobin (n=17, 8% at baseline versus 6.4% at 1 year, 95% confidence interval (0.1-0.28), P-value <0.0001) and stabilized body mass index, with lowered C-peptide and no change in fitness or metabolic biomarkers of lipid metabolism and liver function. As type 2 diabetes becomes more prevalent in youth, the need for programs that successfully address the complex nature of this disease is central to its management and to mitigate its long-term adverse outcomes.

Keywords: adolescents; multidisciplinary; pediatric; program design; type 2 diabetes.

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Figures

**Figure 1**
Results of staff survey to determine the need to develop a type 2 diabetes program (n=12).

**Figure 2**
Type 2 diabetes program clinic structure and patient evaluation plans. **Note:** Social work and behavioral therapy referrals were initiated at diagnosis and continued to be offered throughout the duration of the program as needed. The visits for months 2 and 3 aimed to have two of the team members listed above see the patient as much as possible. **Abbreviations:** C-peptide, endogenous insulin; GAD, glutamic acid decarboxylase autoantibodies; ICA, islet cell autoantibodies; IAA, insulin autoantibodies; HbA1c, glycated hemoglobin; ALT, alanine aminotransferase; ACR, albumin to creatinine ratio; US, ultrasound; PCOS, polycystic ovarian syndrome; OSA, obstructive sleep apnea; MD, physician; RD, registered dietitian; RN, registered nurse OGTT, oral glucose tolerance test.

**Figure 3**
Type 2 diabetes program treatment pathway. **Abbreviations:** MD, physician; RD, registered dietitian; RN, registered nurse; SW, social worker; BT, behavioral therapist; HbA1c, glycated hemoglobin; LSI, lifestyle intervention.

**Figure 4**
Percent overweight change at 1 year compared with baseline (n=16).

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[1] Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260. - PMC - PubMed

[2] Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260. - PMC - PubMed

[3] Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128. - PMC - PubMed

[4] Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–2128. - PMC - PubMed

[5] Whiting DR, Guariguala L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–321. - PubMed

[6] Whiting DR, Guariguala L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–321. - PubMed

[7] Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700. - PubMed

[8] Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700. - PubMed

[9] Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22(2):345–354. - PubMed

[10] Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22(2):345–354. - PubMed

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Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center

Affiliations

Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center

Authors

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Abstract

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References

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