title: Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center.
abstract: Global rates of type 2 diabetes in children and adolescents have increased significantly over the past three decades. Type 2 diabetes is a relatively new disease in this age group, and there is a dearth of information about how to structure treatment programs to manage its comorbidities and complications. In this paper, we describe the design and implementation of a personalized multidisciplinary, family-centered, pediatric and adolescent type 2 diabetes program at a tertiary pediatric center in Hamilton, Ontario, Canada. We report the process of designing and implementing such a program, and show that this multidisciplinary program led to improvement in glycated hemoglobin (n=17, 8% at baseline versus 6.4% at 1 year, 95% confidence interval (0.1-0.28), P-value <0.0001) and stabilized body mass index, with lowered C-peptide and no change in fitness or metabolic biomarkers of lipid metabolism and liver function. As type 2 diabetes becomes more prevalent in youth, the need for programs that successfully address the complex nature of this disease is central to its management and to mitigate its long-term adverse outcomes.
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
authors.forename: M Constantine
authors.initials: MC
authors.lastname: Samaan
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors.forename: Marlie
authors.initials: M
authors.lastname: Valencia
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Cheung
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada.
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Wilk
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Lau
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Population Health Research Institute, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicines, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
keywords: adolescents; multidisciplinary; pediatric; program design; type 2 diabetes
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