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Preventing Type 2 Diabetes Before It Starts: Inside Children’s Wisconsin’s Diabetes Prevention Clinic
00:11:54
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- [00:01]
A
Welcome to Advancing Health. When it comes to treating children's diabetes, the old saying that two heads are better than one has been put into practice, with impressive results, as we learn in this podcast. Hi, everyone. I'm Tom Hetterle, senior communication specialist with the American Hospital association, and really glad that you're along with us today. I'm going to start this podcast with a quote. Prevention is always the way to go. If we can equip families with knowledge, support, and community, we change health trajectories for life. So those words are referring to childhood type 2 diabetes, and they come from one of our guests today, Matthew Edwards, a certified diabetes care and education specialist at Children's Wisconsin Diabetes Prevention Clinic. And we're really pleased to also have Matt's colleague, Dr. Elizabeth Dabrowski, who is a pediatric endocrinologist at Children's Wisconsin, with us as well. So thank you again for coming on Advancing Health today. It's really apprec. Appreciate your being here. A couple of years ago, when Children's Wisconsin opened its new diabetes prevention clinic, it seems like it decided to come at the problem a little bit differently than it has in the past. What can you tell us about that, maybe, Matt, if you take a first, first crack at that?
- [01:13]
B
Yeah, I think what we saw was a gap in our care. We had patients who had these comorbidities that were finding their ways to maybe our diabetes clinic or to our New Kids clinic. But we kept getting referrals from patients who maybe just had elevated BMIs and not comorbidities to go along with it. And we just wanted to find a home for these patients before they ended up in those other clinics with the comorbidities.
- [01:40]
A
So what was the treatment approach from the outset that was doing things a little more innovatively, shall we say?
- [01:45]
B
Yeah, we wanted closer contact points. There's several programs that have existed that showed more close contact with these patients leads to. To greater outcomes. And we knew we wanted to pair with our endocrinologist because their insight is just so helpful. We've got these other modalities of care that we can use now that are at our fingertips that we can provide these patients with. And then we knew we also wanted to add some movement component with our physical therapists. That's really the piece that has been a little lacking in our program. And more recently, within the last two years, we've been able to refer a number of our diabetes patients and our prevention patients to physical therapy, and the relationship has been really great working with them.
- [02:26]
A
Dr. Dabrowski Combining treatment for children's type 2 diabetes from endocrinologists and dietitians at the same time seems like a logical thing to do. Why wasn't it standard practice in the first place all along?
- [02:39]
C
I think in part because usually by the time kids would get to the diabetes clinic, they already had type 2 diabetes. The horse was out of the barn. And we've been seeing, especially with the advent of GLP medications and new medications that were previously only FDA approved in adults are now FDA approved in children for some for weight and some for type 2 diabetes management. We were seeing more referrals of kids for pre diabetes or their labs were a little abnormal, but they didn't have diabetes yet. And we did not, in standard practice, have dietitians in our clinic. I think if we're looking at changing lifestyle, they are the most important people to have with us. And then if we're looking at deconditioning and physical activity, that's where our physical therapists are. Wonderful. Coming up with exercise regimens for kids that work for them, meeting them where they're at, teaching them a safe way to start. And I think all of that's more important than what I can do. And so that's really why we tried to bring all these groups together.
- [03:41]
A
So from a young patient's point of view, what is the hospital experience like when they come to children's? If you could maybe walk us through a typical day, the kind of care they get, who they're seeing, what kind of advice they're getting, what would that look like?
- [03:54]
C
So the way our clinic is set up, they'll be seen by endocrinologist first. The hospital is actually very kid friendly. My kids actually really enjoy their visits here. And so we'll see them, we'll get a general idea of history, medical problems, family history, all of the general stuff you talk with your physician about. And then we'll talk a little bit about diet and exercise, what the patient's goals are, what their concerns are and why they're there. I don't like to focus on weight. I don't like to focus on a number. I like to see what are your goals? Is your goal to be able to play like one of my little kids? He wants to be on the football team and they told him he cannot be on the football team where he's at right now. And so, okay, how do we get to that goal? And we'll meet my goal in the background. At the same time, it sounds like.
- [04:40]
A
You'Re really making a point to stay Away from any negative messaging about their condition or like you say weight or anything else like that, correct?
- [04:47]
C
Yes.
- [04:48]
A
What kind of diet advice are kids hearing? And are they hearing it for the first time? Maybe, you know, something that they should have been hearing all along?
- [04:56]
B
Yeah, I think absolutely a lot of times our patients are hearing our message for the first time because I think it goes beyond that typical eat healthy, more fruits, more vegetables kind of messaging. We really individualize our approach for our patients. When the dietitian hops into the visit, they'll do what's called the 24 hour recall, where we'll get a sense of what this patient's day looks like. Are they eating breakfast, lunch, dinner? Where are those meals happening and what are the portions or typical foods look like? And we also do talk a great deal about physical activity. We'll talk about sleep, we'll talk about hydration, we'll talk about stressors or other things that might impact their food choices or food decisions, their health environment. We often cover social determinants of health, access to healthy foods and healthy fruits, vegetables, those kind of things. And so it's, it's much greater than just kind of healthy eating. It's how do you take some knowledge and apply it to a glucose environment or a blood sugar environment to help your body stay in regulation?
- [05:54]
A
Does it ever feel like you're fighting an uphill battle? And I only ask that because, you know, there is so much, I think we all admit this, there's so much sugar and garbage and junk in the typical American diet that it's very difficult, I would think, to wall off, you know, especially a young person from those influences. So how do you handle that part of it?
- [06:12]
B
It's extremely difficult. I think it's important to meet the families where they're at. Maybe not every meal is ideal, but could we have an optimized snack or an optimized meal at certain times of the day? Can we focus more on satiety or filling foods? Maybe not changing the foods that are on their plate, but what does that composition look like? Can we decrease the amount of the less filling foods like grains and increase the filling foods like proteins, fruits and vegetables, or fibrous foods? And it's just really meeting the patients where they're at and individualizing their approach.
- [06:44]
C
I think a big part also is the family approach. And so I'm not asking my patients to do anything that I don't already do in my house. And I'm also, you know, if mom and dad aren't doing it, the Child is not going to do it. And so one of our big things is juice. My personal take. No one needs juice. It is not a healthy option. And so if the kid, you're buying juice and the kids drinking the whole bottle in two days, let's just not buy it anymore. I had one little kid. I must have seen him last October because I told my, the mom my approach to Halloween candy and all of that. And the next visit I saw him, I was like, oh my gosh, you're doing so well. What did you change? And she's like, well, you mentioned how you just limit the snacks in your house to a few days a week. Like the really sugary things, you still get them, but it's limited. And she's like, that's all we did. It's not that simple all the time by any means. That one just stuck out because I was like, oh, I didn't even realize I was helping there. But I think 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. And so just like Matt said, talking about portions, talking about how much carbohydrates versus protein and all of that, or when you're talking about snacks, kids who are having chips three times a day, oh, like maybe replace one with a fruit and one with salted popcorn or something a little better. But maybe not what we all see as great. It still makes a big difference overall.
- [08:09]
A
And I imagine in some cases you're really working not just to change an individual's behavior, but that of their family or their peer group or whoever they're spending time with. In the first two years, the program served approximately 200 children and not one of the program's participants went on to develop a type 2 diabetes diagnosis, which is remarkable. Did you anticipate such a record of success?
- [08:33]
B
I don't think so. It's been really hopeful to see that kind of result. Now the one caveat I can put on that result is that there may be patients that have been lost to follow up that we don't know if they've now experienced a diagnosis of diabetes. So I want to just put that out there. But I would say that we see so much success in this program for those patients that really invest in the long term follow up plan with this kind of clinic because again, the more contact points we have with the patient and with the family, the better the results that we're seeing.
- [09:07]
C
We really created the clinic to fill a need and we Just, I went in with zero expectations. I really wanted to see what would work for families. We have these kids getting referred to a lot of subspecialists, a lot of different places. And when we're looking at causes of excess weight and all of that, there's a lot of social determinants of health that go into that that may limit their ability to come to appointments or to miss that much work to go to appointments. So seeing how much we could bundle in one appointment or add some virtual touch points or things like that where kids weren't missing as much school, parents weren't missing work, we were hoping to get more of those touch points in. So it looks like it's helping.
- [09:45]
A
Yeah. You must be encouraged by the success you've seen so far. It's wonderful. Any final thoughts about maybe what your peers, another health system or hospital could take away from your experience so far, in terms of your patient population, what you've seen work? What would you say to somebody, another hospital say, that's considering doing something similar?
- [10:04]
C
I'd say 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 until you get what you think is best for them and until you get the care from external sources and dietitians, physical therapists. We're talking about getting some other people into our clinic to serve some of those other needs our patients may have. I'd say just keep chipping away until you get the yes.
- [10:31]
A
Great advice. Matt. Any final thoughts? Anything we haven't discussed so far that you want to touch on?
- [10:35]
B
Yeah, I just have one analogy that I do want to really sneak in here and just highlight the benefit of Prevention Clinic. It's something that I. I remember from being an intern during my titic internship, and one of the mentors that I had at the time said, prevention is, is like a bridge over a river, and. And that bridge is broken and people are crossing the bridge and they're falling into the river and they're heading downstream. Now, our diabetes clinic is the river. We're pouring in tons of resources and tons of effort to relieve this metabolic syndrome. But I just think about 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. We're preventing them from going into the river and turning that life trajectory around.
- [11:25]
A
That's a wonderful image to end our discussion on. Thank you so much. I appreciate your time this afternoon and your excellent work on behalf of your patients. It's really inspiring. So thanks again for appearing on Advancing Health and good luck continuing with your great work.
- [11:40]
B
Thank you.
- [11:40]
C
Thank you.
- [11:42]
A
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