The Culture of Different MKTG_150064494_2018 Service Line Big Book Full_FIN | Page 64

Type 2 Diabetes Treatment and the Future of Healthcare
Diabetes and Endocrinology • Lifestyle Medicine • Pediatric Surgery
Psychiatry
published more than 100 peer-
reviewed manuscripts.
Bariatric surgery shows
promising results for weight
loss maintenance and remission
of type 2 diabetes. In a multi-
institutional study published
in The New England Journal
of Medicine, Dr. Inge found
that kids’ chances of diabetes
remission were about 95
percent, three years out from
surgery. The rates seemed
much better than those for
identical operations performed
in adults with diabetes.
(Above) Megan Kelsey, MD,
and Thomas Inge, MD, PhD,
collaborate in their workroom
in the Multidisciplinary
Clinic. (Below) Claudia
Retamal-Munoz, RN, diabetes
educator, meets with a patient
in the Lifestyle Medicine
Endocrinology Clinic.
“The use of bariatric surgery
in adolescents is gaining more
visibility,” says Dr. Inge. “As
more primary care providers
and families learn of the
positive outcomes these
operations bring for teens,
greater numbers of teens will
likely choose surgery to take
control of their weight and
reverse health complications.”
For some, bariatric surgery is
most certainly the best solution;
for others, it’s not ideal.
To even qualify, many insurance
companies require six months
of medical supervision. The
team uses this time to prepare
patients and their families for
the lifelong commitment to
lifestyle changes.
*“A Clinical Trial to Maintain
Glycemic Control in Youth
with Type 2 Diabetes,” by the
TODAY Study Group, The
New England Journal of
Medicine, June 14, 2012.
It takes three to six months
after surgery to see significant
weight loss. Kids still must
commit to lifestyle changes
afterward. And there are so few
pediatric surgeons specializing
in bariatric surgery that many
kids don’t even have access.
Embedding type
2 diabetes in
lifestyle medicine
Until the last few decades, type
2 diabetes was almost unheard
of in anyone under age 18.
With childhood obesity rates
increasing at alarming rates
nationwide, so is the prevalence
of type 2 diabetes, starting at
age 12 or 13. Children’s Colorado
sees approximately 50 new
kids a year with the disease,
and there is no sign of these
numbers decreasing. If they
continue to rise, healthcare
professionals will inevitably
need to shift to prevention.
If Max were at another hospital,
upon his immediate diagnosis
he might go to an endocrinology
clinic that groups kids with type
1 and type 2 diabetes. This is
how Children’s Colorado used
to do it, but the team found that
was a reactive approach.
“In type 1, there’s a lot of focus
on getting the right ratio of
insulin to carbs,” Dr. Kelsey says.
“But what about when you’re
trying to limit carbs?”
Now, at Children’s Colorado,
Max goes to his first
appointment in the Lifestyle
Medicine Clinic, originally set
up to treat kids with obesity and
metabolic syndrome. — The
Clinic, it turns out, is perfectly
suited to address the complex
medical and weight loss needs
of kids with type 2 diabetes.
Max immediately goes to tier 2
of Lifestyle Medicine, where he
is assigned an endocrinologist
and other specialists to treat
his comorbidities, plus a
dietitian, exercise physiologist,
psychologist and diabetes
nurse to help him address
behavior change.
“In their first meeting with
us, teens are very appreciative
of the opportunity to have
someone focus on their
feelings, the different roles
and respo nsibilities of family
members in helping with
type 2 diabetes management,
and emotional and logistical
adjustment to the diagnosis,”
Dr. Abramson says.
Plugging in
communities
“It’s not just getting families to
show up for a doctor visit, have
a blood test and take a pill,”
says Heidi Baskfield, JD, Vice
President of Population Health
and the Children’s Health
Advocacy Institute. “It requires
layers of behavior change,
forever, in an environment that’s
conducive to behavior change.
The time and energy someone
previously had to dedicate to
their healthy lifestyle might
not be present because they’re
having to use it to survive the
challenges of their daily life.”
For example, Max might not
have access to nutritious food
or safe, outdoor play areas.
Maybe the people around him
aren’t physically active. These
“barriers to health” might
explain why kids with type
2 diabetes can’t lose weight.
Ignoring the barriers, the overly
simplistic “eat less, move
more” solution fails to offer
support for healthy lifestyles
when and where kids need it.
In the traditional model, which
treats the symptoms without
addressing the underlying
cause, there may be no hope
for remission or prevention
besides surgery.
The multidisciplinary
structure of Children’s
Colorado’s Lifestyle Medicine
Endocrinology Clinic is set up
to start breaking those barriers
from various touch points.
“It’s not just the endocrinologist
individually saying, ‘It’s really
important that you make
changes,’” says Dr. Abramson.
“It’s the exercise physiologist
meeting them that day, taking
them to the gym, getting them
on the treadmill, getting a plan
that day. It’s the psychologist
coming in and assessing family
dynamics. And it’s the dietitian,
walking in with food models
and showing them exactly what
is the right portion size, being
right there in that moment. Our
clinic does a really wonderful
job of understanding why
someone might be deteriorating
in their management.”
“Electricity is a finite resource
that we don’t think about,”
Baskfield says. “But every time
we need it, it’s there. Healthcare
should operate the same way.
When you ‘flip the switch,’ the
thing you need to be healthy
should be there.”
If you can go into communities,
assess their lifestyles, beliefs,
challenges and strengths,
Baskfield says, you can arm
them with tools tailored to
meet their needs. For Max, that
means the places he spends
the most time would offer him
more outside physical activities
and access to healthier food. It
means influencing the people
around him to support a healthy
lifestyle. If this idea of wellness
surrounds Max, he might have
a greater chance at weight loss
maintenance.
This is the essence of Population
Health, an approach to
healthcare gaining popularity
around the world. For Children’s
Colorado’s part, Baskfield and
her team are currently building
relationships with organizations
in three major categories
— primary care, K12 school
settings and community-based
organizations — to build the
“grid” of wellness in Colorado.
They have initiated programs
like Bikes for Life, which gives
new bikes to kids through the
Boys & Girls Club; and Cooking
Matters, which teaches families
how to cook healthy meals
and grocery shop on limited
budgets.
Dozens of hospitals around the
country are producing similar
efforts; they predict that this
approach will — and must —
lead healthcare in the future.
“At first, it’s going to feel so
foreign,” says Baskfield. “Ten
years from now we’re going to
wonder how we could have done
it differently and how it took us
so long to get here.”
The Culture of Different
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