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

Lisa Schaaf; Sanita Ley; Allen Riegler; Amy Poetker; Stavra Xanthakos; Jennifer Sizemore; Nancy Crimmins; Michael Helmrath; Rebekah Tracy; Ana Catalina Arce-Clachar; Jennifer Crail; Nancy Morwessel; Kelsey Frenck; Fatima Tariq; Amy Sanghavi Shah

doi:10.2147/JMDH.S414849

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

J Multidiscip Healthc. 2023 Sep 20:16:2799-2807. doi: 10.2147/JMDH.S414849. eCollection 2023.

Authors

Affiliations

¹ Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
² Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA.
³ Department of Pediatrics, Division of Gastroenterology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
⁴ Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA.
⁵ Department of Surgery, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA.
⁶ Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

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: adolescent; comorbidities; multidisciplinary; pediatrics; type 2 diabetes.