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

M Constantine Samaan; Marlie Valencia; Connie Cheung; Boguslaw Wilk; Keith Lau; Lehana Thabane

doi:10.2147/JMDH.S63842

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

J Multidiscip Healthc. 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.

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.