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

Abstract

M Constantine Samaan,1–3 Marlie Valencia,1 Connie Cheung,1 Boguslaw Wilk,1,3 Keith Lau,1,4 Lehana Thabane1,5–8 1Department of Pediatrics, McMaster University, 2Division of Pediatric Endocrinology, 3Children's Exercise and Nutrition Center, 4Division of Pediatric Nephrology, McMaster Children's Hospital, 5Population Health Research Institute, 6Department of Clinical Epidemiology and Biostatistics, 7Department of Anesthesia, McMaster University, 8Centre 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: type 2 diabetes, pediatric, adolescents, program design, multidisciplinary