Type 2 Diabetes Clinic Offers Centralized, Coordinated Care

The daily grind of managing type 2 diabetes can be especially burdensome for children and adolescents, but consistent, well-coordinated medical care can make a difference. That’s why Cincinnati Children’s recently launched a Type 2 Diabetes Comprehensive Care Clinic, which provides these patients and their families with the resources they need, all in one location.

During their initial visit, patients see Amy Shah, MD, MS, a pediatric endocrinologist who leads the clinic; Stavra Xanthakos, MD, MS, a pediatric gastroenterologist who specializes in non-alcoholic fatty liver disease; a diabetes nurse educator; a social worker; and a registered dietitian. This experienced team addresses every aspect of the patient’s well-being, beyond just their blood glucose control.  Patients return to the clinic three or four times a year for follow-up appointments, which include screenings for kidney disease, high cholesterol, sleep apnea and other potential complications. A pediatric psychologist also is available to address concerns such as depression and medication adherence.

“Learning how to live with and care for diabetes can be a challenging experience for children and their families, but this team approach allows us to share treatment recommendations with one, unified voice,” Shah says. “We focus on lifestyle changes that can help patients lose weight, we talk about how to improve blood glucose control, and we ensure patients know about their medical treatment options.”

Currently metformin and insulin are the only medications approved by the Food and Drug Administration for children with type 2 diabetes. However, many FDA-approved adult medications are now being studied for the pediatric population.

Patients with a body mass index of 35 or greater may be considered for bariatric surgery if they wish. Since the clinic opened, about 30% of patients have met with the bariatric surgery specialists at Cincinnati Children’s, and many of them are considering the procedure.

Type 2 diabetes-specific research 

Cincinnati Children’s is one of five institutions participating in the SEARCH for Diabetes in Youth study, the national epidemiological study established in 2000 that aims to characterize the different types of diabetes in youth and better understand associated complications.  

Shah is one of several researchers at Cincinnati Children’s studying how type 2 diabetes affects pediatric patients. Her research focuses on the effects of type 2 diabetes on cholesterol, blood pressure, heart and vasculature.  Recently, her team also investigated the effects of type 2 diabetes on the brain, showing that youth with type 2 diabetes have less gray matter volume and that the disease may be associated with microstructural damage to brain gray matter as well (Journal of Pediatric Endocrinology and Metabolism, Jan. 26, 2018). Shah and Xanthakos also collaborate with several basic scientists at Cincinnati Children’s to understand how inflammation and abnormal metabolism influence the development and progression of type 2 diabetes.

“Identifying ways to expand our current therapies to prevent and limit early onset of complications in adolescents is important to our diabetes team,” Shah says. “We are actively working in our own research and with industry to bring better therapies to adolescents with type 2 diabetes.”

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