Improving the transitioning of pediatric patients with type 1 diabetes into adult care by initiating a dedicated single session transfer clinic

Background: Young adults with type 1 diabetes face potential health problems and disruptions in accessing care related to their move from pediatrics into adult care. At a medium-sized pediatric hospital with no formal transition support program, we developed and evaluated the use of a single-session transfer clinic as an initial quality improvement intervention to improve patient satisfaction, clinic attendance, and knowledge of transition related issues. Methods: Following a jurisdictional scan of other diabetes programs, the pediatric diabetes program developed a half-day transfer clinic. After the first transfer clinic was held, evaluation surveys were completed by patients, parents, and healthcare providers. Based on the feedback received, we altered the structure and evaluated the revised clinic by surveying patients and parents. Results: All patients and parents who attended reported high levels of satisfaction with the clinic. Providers were also mostly positive regarding their participation. Feedback from the first clinic was used to modify the structure of the second clinic to better meet the needs of participants and to allow the clinic to run more efficiently. The use of group sessions and adapting resources developed by other diabetes programs were viewed favourably by participants and lessened the burden on staff who delivered the clinic. Conclusions: A half-day transfer clinic is a viable step towards improving patient and parent satisfaction during the transition into adult care without requiring additional staff or significant expenditures of new resources. This type of clinic can also be incorporated into a larger program of transition supports or be adopted by programs serving young adults with other chronic diseases

An Evaluation of a Universal Funding Program for Insulin Pumps for Children and Teens with Type 1 Diabetes

Pediatric insulin pump therapy has been broadly adopted despite equivocal evidence about long-term comparative effectiveness. This thesis aimed to elucidate the dynamics underlying observed patterns of pump use and outcomes in the context of a universal funding program for pediatric insulin pump therapy in Ontario, Canada. First we conducted interviews with physicians to understand why pumps have been broadly adopted. We found that physicians recognized that pumps fell short of expectations often because of lack of family or school support. Yet, pumps were valued in a number of ways. Second, we developed a survey and described the distribution of patients and resources amongst all 35 centres in the Ontario Pediatric Diabetes Network. We found differences in availability of diabetes team members and 24 hour support. Finally we performed two population-based cohort studies of youth with type 1 diabetes (Ph.D.2018-02-12 00:00:0

Mental Health Matters: Limited Support Remains a Barrier to Optimal Care for Youth With Diabetes

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The Impact of Telemedicine Interventions Involving Routine Transmission of Blood Glucose Data with Clinician Feedback on Metabolic Control in Youth with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Abstract Our objective was to determine the impact of telemedicine (TM) interventions on the management of type 1 diabetes (T1DM) in youth. We performed a systematic review of randomized trials that evaluated TM interventions involving transmission of blood glucose data followed by unsolicited scheduled clinician feedback. We found no apparent effect of the TM interventions on hemoglobin A1c (HbA1c), severe hypoglycemia, or diabetic ketoacidosis. The limited data available on patient satisfaction, quality of life, and cost also suggested no differences between groups. It is unlikely that TM interventions, as performed in the assessed studies, had a substantial effect on glycemic control or acute complications. However, it remains possible that there are other benefits of TM not adequately reported, that newer TM strategies may be more effective and that interventions may benefit subgroups of youth, such as those with the poor glycemic control, adolescents, or those living in remote areas