Advancing Health Podcast Summary

Episode: Preventing Type 2 Diabetes Before It Starts: Inside Children’s Wisconsin’s Diabetes Prevention Clinic
Date: November 10, 2025
Host: Tom Hetterle, American Hospital Association
Guests:

• Matthew Edwards, Certified Diabetes Care & Education Specialist
• Dr. Elizabeth Dabrowski, Pediatric Endocrinologist

Episode Overview

This episode explores how Children’s Wisconsin's Diabetes Prevention Clinic innovatively addresses rising rates of childhood Type 2 diabetes. By bringing together endocrinologists, dietitians, and physical therapists in a coordinated, holistic approach, the clinic aims to intervene before children develop diabetes, equipping families with knowledge and community support to fundamentally alter health outcomes. The conversation focuses on the clinic's multidisciplinary model, individualized family-centered care, real-world challenges, and notable early successes.

Key Discussion Points and Insights

1. The Need for a Different Approach

• Identified Gap: Many children were being referred for elevated BMIs without comorbidities, lacking a dedicated home in existing diabetes clinics.
  • Matthew Edwards (01:13): “We just wanted to find a home for these patients before they ended up in those other clinics with the comorbidities.”

2. Multidisciplinary, Close-Contact Care

• Innovative Model: The clinic pairs endocrinologists with dietitians and recently physical therapists, based on evidence that close, frequent contact yields better outcomes.
  • Edwards (01:45): “There’s several programs…that showed more close contact with these patients leads to greater outcomes.”
• Physical Activity Component: Integration of physical therapy has added value, teaching children safe ways to become more active.

3. Why Wasn’t This Standard Practice?

• Previously, children only arrived at clinics after developing diabetes, missing earlier intervention opportunities.
  • Dr. Dabrowski (02:39): “Usually by the time kids would get to the diabetes clinic, they already had type 2 diabetes. The horse was out of the barn.”
• Importance of including dietitians and physical therapists, not only medical doctors.

4. The Clinic Experience for Children and Families

• Focus on understanding the patient's goals rather than weight-centric messaging.
  • Dr. Dabrowski (03:53): “I don’t like to focus on weight… what are your goals? Is your goal to be able to play like one of my little kids…okay, how do we get to that goal?”
• Each visit typically starts with endocrinology, followed by nutrition and then physical activity guidance.

5. Beyond ‘Eat Better’: Personalized Lifestyle Advice

• Assessment includes a 24-hour dietary recall, reviewing family environment, sleep, hydration, and social determinants.
  • Edwards (04:55): “We really individualize our approach for our patients...cover social determinants of health, access to healthy foods and healthy fruits, vegetables, those kind of things.”
• Messaging goes deeper than standard advice—realistic, personalized, and taking into account barriers families might face.

6. Meeting Families Where They Are

• Acknowledging the challenges posed by ubiquitous “junk” food and busy lives.
• Practical guidance: optimize snacks and meals, focus on satiety and realistic swaps, and encourage gradual, family-wide changes.
  • Edwards (06:11): “Maybe not every meal is ideal, but could we have an optimized snack or...focus more on satiety or filling foods?”
  • Dr. Dabrowski (06:44): “If mom and dad aren’t doing it, the child is not going to do it…one of our big things is juice. My personal take: no one needs juice.”

Memorable Anecdote

• Halloween snack moderation resulted in tangible success for a young patient, demonstrating the impact of small, manageable lifestyle tweaks.
  • Dr. Dabrowski (07:06): “She’s like, that's all we did. It's not that simple all the time…that one just stuck out because I was like, oh, I didn’t even realize I was helping there.”

7. Family and Community Change

• The program’s success also involves modifying the support network around the child—parents, siblings, peers.
• Emphasis on sustainable, not “all or nothing,” changes.

8. Outcomes and Early Success

• First two years: approximately 200 children served; none progressed to Type 2 diabetes (with the caveat of lost-to-follow-up).
  • Host (08:09): “Not one of the program’s participants went on to develop a type 2 diabetes diagnosis, which is remarkable.”
  • Edwards (08:32): “It’s been really hopeful to see that kind of result…”

9. Bundling Care for Accessibility

• Combining appointments and offering virtual touchpoints ease burdens on families (less missed school/work, fewer logistical obstacles).
  • Dr. Dabrowski (09:06): “Seeing how much we could bundle in one appointment or add some virtual touch points…kids weren’t missing as much school, parents weren’t missing work…”

10. Advice to Peers: Perseverance and Advocacy

• Success depended on persistence in building the right team and advocating for necessary resources.
  • Dr. Dabrowski (10:03): “Don't take no for an answer. If you see a need that's there for patients, you just keep asking and asking and asking…”

11. The Prevention Analogy

• Memorable closing metaphor underscoring prevention’s power:
  • Edwards (10:35): “Prevention is like a bridge over a river, and that bridge is broken and people are crossing…and falling into the river. Our diabetes clinic is the river...the benefit of preventing people from going into that river and having to struggle and having to pour all those resources in. To me, that's what our Prevention Clinic is.”

Notable Quotes & Moments

• “Prevention is always the way to go. If we can equip families with knowledge, support, and community, we change health trajectories for life.”
  – Matthew Edwards, quoted by host (00:15)

• “The horse was out of the barn.”
  – Dr. Dabrowski on missed prevention opportunities (02:40)

• “Meeting them where they’re at, trying not to make anything off limits because then you’re going to limit, limit, limit and then overdo it.”
  – Dr. Dabrowski (07:22)

• “Just keep chipping away until you get the yes.”
  – Dr. Dabrowski, on advocating for new clinical programs (10:12)

• “Prevention is like a bridge over a river…we’re preventing them from going into the river and turning that life trajectory around.”
  – Matthew Edwards (10:35)

Timestamps for Key Segments

• 00:01-01:45 – Problem introduction, origins of the Prevention Clinic
• 01:46-03:40 – Multidisciplinary, close-contact care model
• 03:41-04:47 – Patient experience; focus on goals, not weight
• 04:48-06:44 – Personalized, family-centered dietary advice
• 06:45-08:08 – Practical challenges and the need for whole-family change
• 08:09-09:45 – Outcomes, family/community approach, bundling care
• 09:46-10:34 – Advice for replication elsewhere
• 10:35-11:25 – “Bridge over a river” prevention analogy

Takeaway

Children’s Wisconsin’s Diabetes Prevention Clinic demonstrates that with multidisciplinary, patient- and family-focused care, it's possible to prevent type 2 diabetes before it starts—even in the face of daunting dietary and socioeconomic challenges. Key elements include individualized plans, practical support, sustained engagement, and relentless advocacy by providers. Their success offers both a template and inspiration for health systems nationwide.