By: Dr. Mary Lauren Scott
In the recent past, children who were newly diagnosed with diabetes immediately faced a hospitalization that lasted five days. Most of that time was spent teaching parents and their child about the disease and essential care. Over the past decade, Children’s of Alabama has shortened that stay to about two days, while providing better targeted education and follow up.
For instance, I was diagnosed with Type 1 diabetes in the 1990s, at age 12. I was admitted to a general hospital where I stayed for five days in a children’s wing. I wasn’t sick enough to actually need a hospitalization, and I spent my time going to classes with adults who had been recently diagnosed with Type 2 diabetes. So the diabetes education I received wasn’t specific to my condition or my age. Educators at the hospital did teach my parents how to give me insulin injections—the key to treatment of Type 1 diabetes. However, my father was a doctor, and the injections weren’t a big issue for our family.
These days, a newly diagnosed patient is usually hospitalized at Children’s for two days. We have been able to shorten the length of hospitalization for most of our patients by personalizing care and education.
We can focus our efforts on Type 1, Type 2 or even steroid-induced diabetes. In addition to one-on-one attention, our educators supply families with a plethora of education materials in a folder so they have everything in writing when they go home. Families are plugged into our FAX and email systems so they can easily contact a doctor or educator, and respond appropriately to emergencies.
We follow up with a phone call one to two days after discharge to ensure that everything is OK. We have the families provide us with blood sugar levels three or four days after the child goes home. And the family returns for a follow-up visit and refresher class about one month after discharge.
There are plenty of reasons for this drive for efficiency. First of all, we hope our system is delivering better care for patients. But we are also facing rising rates of Type 1 and Type 2 diabetes in children, particularly in the South. That means we have to care for more patients. In addition, there are not nearly enough pediatric endocrinologists, particularly in the South.
We are also working on ways to improve the transition of patients from pediatric to adult care. The adult medical care system requires that patients take more responsibility for their care. For example, adult patients must understand insurance coverage, how to get prescriptions filled and how to find a primary care doctor.
Our educators have created a program for patients who appear to be ready to move out of pediatric care and into adult care. This often happens when our patients go away to college. In preparation to this move, an educator will meet with a patient at least twice, and a social worker will meet with them at least once. A physician will meet with the patient once or twice to ensure the patient knows how to take their medications and has lined up a physician who treats adults. If the patient is a young lady, we explain to her how a pregnancy could affect their diabetic care.
Recently, the Alabama Department of Motor Vehicle Division/Registration Section approved a license plate to help raise funds for our transitional program. The Hope for Kids with Diabetes tag costs $50, with $41.25 of every purchase benefitting Pediatric Endocrinology at Children’s of Alabama. In addition to the transitional program, the money will be used for other patient care, physician training and research.
Here are some good sources for more information about diabetes and children:
--National Diabetes Education Program at www.YouDiabetesInfo.org.
--American Association of Diabetes Educators at www.diabeteseducator.org.
--American Diabetes Association at www.diabetes.org/planetD.
--American Dietetic Association at www.eatright.org.
--Bam! Body and Mind at www.bam.gov.
--Children With Diabetes at www.childrenwithdiabetes.com.
--And the Juvenile Diabetes Research Foundation at www.jdrf.org.
Dr. Mary Lauren Scott is a pediatric endocrinologist at Children’s of Alabama and an Assistant Professor of Pediatric Endocrinology at UAB