Diabetes Q&A

Children’s Hospital at Montefiore: Dedicated to Health of Kids With Diabetes

Eileen Koutnik-Fotopoulos

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Diabetes is among the most common chronic conditions affecting the pediatric population in the United States. While most children with the condition have type 1 diabetes, type 2 diabetes has been reported with increasing frequency among children and adolescents in the last 2 decades, with more than 13,000 young people receiving a type 2 diabetes diagnosis each year in the United States, according to the Centers for Disease Control and Prevention.1

The treatment and management of diabetes in children requires a multidisciplinary approach. The Children’s Hospital at Montefiore (CHAM) Division of Pediatric Endocrinology and Diabetes is dedicated to meeting the complex needs of its patients with diabetes and empowering them to control this chronic condition. Located in the Bronx, New York, CHAM has received national recognition from the American Diabetes Association (ADA) for its pediatric diabetes self-management education program, which provides individualized instruction, educational materials, and support to patients on how to manage their condition through goal-setting, counseling, and evaluation. Each patient works with a team of clinicians including a certified diabetes educator, a registered dietician, a social worker, and a physician to adhere to the program, an approach that has been shown to significantly improve outcomes.

To achieve the pediatric program’s recognition, Rubina Heptulla, MD, Chief of the Division of Pediatric Endocrinology and Diabetes, and her team went through a 2-year application process to demonstrate how the department meets the ADA’s National Standards for Diabetes Self-Management Education and Support.2

In an interview with Consultant for Pediatricians (CFP), Dr Heptulla, who has been at CHAM for 4 years, discussed the diabetes program and the importance of education in the fight against diabetes.

CFP: Is the prevalence of diabetes among children and adolescents increasing or decreasing? To what do you attribute this change?

Dr Heptulla: Type 1 diabetes, an autoimmune disease, is not preventable. Type 2 diabetes is the result of insulin resistance and is now a real disease because of the worldwide prevalence of obesity, which is leading to the rise of pediatric type 2 diabetes.

CFP: How many pediatric diabetes patients does your division treat a year, and what is the age range?

Dr Heptulla: We treat 700 to 800 patients a year and see about 40 to 50 new patients a year. We treat infants to age 23.

CFP: What are some of the complex needs of your pediatric diabetes patients?

Dr Heptulla: Our patients have many needs. Diabetes is not like any other disorder I know. We ask patients to learn to check their sugar, count carbohydrates, take insulin, and adjust their dose to effectively manage their condition. We also ask a lot from our families. These families require many types of social services such as a social worker to work with insurance companies on getting the necessary supplies. It takes a village to raise a child with diabetes.

CFP: What is your initial approach when treating a pediatric patient with diabetes?

Dr Heptulla: First, we determine if the patient has type 1 or type 2 diabetes and come up with a treatment plan. It is not a cookie-cutter approach. Each person has individual needs, and we must determine the child’s needs at home, school, and their activities to design an appropriate medical plan.

CFP: What are some CHAM diabetes programs that have been successful in educating patients and their families?

Dr Heptulla: We have had many successes. We start out with the premise that we can help every child with diabetes. We try not to make diabetes the main focus of their lives. It is just something that is part of their life, along with everything else. Our tween and teen support groups have been successful.

We also provide many fun activities for the kids that include an education component. Our annual Family Diabetes Day at the Bronx Zoo is a favorite program among children and parents. It provides an opportunity for children and families to connect with others who are dealing with the same condition. The day includes educational activities and informative guest speakers. Another popular event is the Candy Exchange, which happens the day after Halloween and allows kids to bring in their candy in exchange for a gift. During the exchange, we educate, for example, about how they can use candy to treat blood sugar.

In partnership with the Juvenile Diabetes Research Foundation Westchester County Chapter, we offer Parent Coffees, at which 15 to 30 parents/caregivers meet every 6 to 8 weeks. It provides an opportunity for parents to hear a speaker and learn how to manage their child with diabetes.

CFP: Why is diabetes education so important in helping young patients manage their disease?

Dr Heptulla: The goal is for them to manage their own disease. Education is crucial, because there are many components children need to do at home to be adept at managing their disease. Also, when educating patients and their families, we need to consider what is going on with the family at the time of diagnosis, and we may have to reeducate if the family situation changes.

CFP: What was the process in obtaining national recognition from the ADA for the diabetes self-management education program at CHAM?

Dr Heptulla: It was a rigorous 2-year process. We had to have a standardized diabetes plan, a multidisciplinary approach, and data on patient outcomes. To keep our recognition, we have to provide the ADA with data every year on patient outcomes.

CFP: In your opinion, what should health care professionals and the community be doing to combat diabetes in the pediatric population?

Dr Heptulla: The worldwide increase in obesity cannot be handled just by physicians. We need a community effort. We need more playgrounds for kids, kids need proper gym programs and gym time in schools, and schools need to provide healthy, nutritional food and remove the vending machines. Parents need to make sure kids are eating and sleeping well, getting exercise, and not totally dependent on technology.

The Children’s Hospital at Montefiore (http://www.cham.org) is 1 of the 4 hospitals that make up Montefiore Medical Center. CHAM is a state-of-the-art facility providing family-centered care in a nurturing environment. Staffed by the internationally renowned faculty of the Albert Einstein College of Medicine, CHAM provides an extensive range of specialty services for children, including asthma, infectious diseases, rheumatology, childhood cancers and blood disorders, and gastroenterology.

Eileen Koutnik-Fotopoulos is a contributing editor to Consultant for Pediatricians.

References

1. Children and diabetes — more information. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/diabetes/projects/cda2.htm. Updated September 25, 2013. Accessed April 14, 2014.

2. Haas L, Maryniuk M, Beck J, et al; 2012 Standards Revision Task Force. National standards for diabetes self-management education and support. Diabetes Care. 2012;35(11):2393-2401.