ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes

Limbert, Catarina; Tinti, Davide; Malik, Faisal; Kosteria, Ioanna; Messer, Laurel H.; Jalaludin, Yazid Muhammad; Benitez‐Aguirre, Paul; Biester, Sarah; Corathers, Sarah; Sengbusch, Simone von; Marcovecchio, Maria Loredana

doi:10.1111/pedi.13417

Cited by 24 publications

(17 citation statements)

References 282 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,2 This care includes visits every 3 months with a pediatrician or advanced practice clinician (APC, which includes nurse practitioner and physician assistant) specializing in diabetes to evaluate management, growth and development, education needs, and risk for comorbidities. 2 Visits should include annual assessments in partnership with multidisciplinary team members, including a diabetes care and education specialist (DCES), dietitian, psychologist, and social worker. 2 Though comprehensive, some families may encounter challenges in trying to engage with the health care system this frequently.…”

Section: Introductionmentioning

confidence: 99%

“…2 Visits should include annual assessments in partnership with multidisciplinary team members, including a diabetes care and education specialist (DCES), dietitian, psychologist, and social worker. 2 Though comprehensive, some families may encounter challenges in trying to engage with the health care system this frequently. Barriers to care may be at the patient level or diabetes center level and include access to adequate health insurance, availability of and distance to specialists, medical and appointment-related costs, or lack of a consistent medical home.…”

Section: Introductionmentioning

confidence: 99%

“…Following diagnosis, the goals of ongoing pediatric type 1 and 2 diabetes care are to optimize glucose control, prevent complications, and promote well-being. Both national and international guidelines recommend that youths with diabetes be treated by a multidisciplinary care team encompassing diabetes education, nutrition, and psychosocial support . This care includes visits every 3 months with a pediatrician or advanced practice clinician (APC, which includes nurse practitioner and physician assistant) specializing in diabetes to evaluate management, growth and development, education needs, and risk for comorbidities .…”

Section: Introductionmentioning

confidence: 99%

“…Both national and international guidelines recommend that youths with diabetes be treated by a multidisciplinary care team encompassing diabetes education, nutrition, and psychosocial support . This care includes visits every 3 months with a pediatrician or advanced practice clinician (APC, which includes nurse practitioner and physician assistant) specializing in diabetes to evaluate management, growth and development, education needs, and risk for comorbidities . Visits should include annual assessments in partnership with multidisciplinary team members, including a diabetes care and education specialist (DCES), dietitian, psychologist, and social worker …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

March,

Byerly,

Siminerio

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceYouths with type 2 diabetes are at higher risk for complications compared with peers with type 1 diabetes, though few studies have evaluated differences in access to specialty care.ObjectiveTo compare claims with diabetes specialists for youths with type 1 vs type 2 diabetes and the association between specialist claims with multidisciplinary and acute care utilization.Design, Setting, and ParticipantsThis cross-sectional study used Optum Clinformatics Data Mart commercial claims. Individuals included in the study were youths younger than 19 years with type 1 or 2 diabetes as determined by a validated algorithm and prescription claims. Data were collected for youths with at least 80% enrollment in a commercial health plan from December 1, 2018, to December 31, 2019. Statistical analysis was performed from September 2022 to January 2024.Main Outcomes and MeasuresThe primary outcome was the number of ambulatory claims from an endocrine and/or diabetes physician or advanced practice clinician associated with a diabetes diagnosis code; secondary outcomes included multidisciplinary and acute care claims.ResultsClaims were analyzed for 4772 youths (mean [SD] age, 13.6 [3.7] years; 4300 [90.1%] type 1 diabetes; 472 [9.9%] type 2 diabetes; 2465 [51.7%] male; 128 [2.7%] Asian, 303 [6.4] Black or African American, 429 [9.0%] Hispanic or Latino, 3366 [70.5%] non-Hispanic White, and 546 [11.4%] unknown race and ethnicity). Specialist claims were lower in type 2 compared with type 1 diabetes (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]; P &lt; .001) in propensity score–weighted analyses. The presence of a comorbidity was associated with increased specialist claims for type 1 diabetes (IRR, 1.07 [95% CI, 1.03-1.10]) and decreased claims for type 2 diabetes (IRR, 0.77 [95% CI, 0.67-0.87]). Pooling diagnosis groups and adjusted for covariates, each additional specialist claim was associated with increased odds of a claim with a diabetes care and education specialist (odds ratio [OR], 1.31 [95% CI, 1.25-1.36]), dietitian (OR, 1.14 [95% CI, 1.09-1.19]), and behavioral health clinician (OR, 1.16 [95% CI, 1.12-1.20]). For acute care claims, each additional specialist claim was associated with increased odds of admission (OR, 1.17 [95% CI, 1.11-1.24]) but not for emergency claims (OR, 1.03 [95% CI, 0.98-1.82]).Conclusions and RelevanceThis cross-sectional study found that youths with type 2 diabetes were significantly less likely to have specialist claims despite insurance coverage, indicating other barriers to care, which may include medical complexity. Access to diabetes specialists influences engagement with multidisciplinary services. The association between increasing ambulatory clinician services and admissions suggests high utilization by a subgroup of patients at greater risk for poor outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

March,

Byerly,

Siminerio

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…The International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 guideline emphasises the influence of demographic and geographical factors on the local care organisation though also advocates that diabetes teams should treat a minimum of 150 patients to acquire sufficient experience and expertise. 7 Moreover, they advise patients to consider travelling to a specialised team; otherwise, local healthcare providers should have readily available access to experts' knowledge. Similarly, the American Diabetes Association (ADA) 2022 guideline stresses the importance of expertise in managing age-specific challenges in children with diabetes.…”

Section: Introductionmentioning

confidence: 99%

Does size matter? Hospital volume and resource use in paediatric diabetes care

de Vries,

Bak,

Mul

et al. 2023

Diabet Med

View full text Add to dashboard Cite

AimsPaediatric diabetes care has become increasingly specialised due to the multidisciplinary approach and technological developments. Guidelines recommend sufficient experience of treatment teams. This study evaluates associations between hospital volume and resource use and hospital expenditure in Dutch children with diabetes.MethodsRetrospective cohort study using hospital claims data of 5082 children treated across 44 Dutch hospitals (2019–2020). Hospitals were categorised into three categories; small (≥20–100 patients), medium (≥100–200 patients) and large (≥200 patients). All‐cause hospitalisations, consultations, technology and hospital expenditure were analysed and adjusted for age, sex, socio‐economic status (SES) and hospital of treatment.ResultsFewer hospitalisations were observed in large hospitals compared to small hospitals (OR 0.48; [95% CI 0.32–0.72]; p < 0.001). Median number of yearly paediatrician visits was 7 in large and 6 in small hospitals, the significance of which was attenuated in multilevel analysis (OR ≥7 consultations: 1.89; [95%CI 0.74–4.83]; p = 0.18). Technology use varies between individual hospitals, whereas pump usage and real‐time continuous glucose monitoring showed no significant differences between hospital volumes. Mean overall expenditure was highest in medium‐sized centres with €6434 per patient (IQR €2555–7955); the difference in diabetes care costs was not significant between hospital patient volumes.ConclusionsCare provision patterns vary by hospital patient volume. Large hospitals had the lowest hospitalisation rates. The use of diabetes technology was not different between hospital patient volumes. Medium‐sized hospitals showed the highest overall expenditure, but diabetes care costs were similar across hospital volumes.

show abstract

Continuous improvement of quality of care in pediatric diabetes: the ISPED CARD clinical registry

Nicolucci,

Graziano,

Lombardo

et al. 2024

Acta Diabetol

View full text Add to dashboard Cite

Aim In Italy, the ISPED CARD initiative was launched to measure and improve quality of care in children and adolescents with type 1 diabetes. Methods Process and outcome indicators and the related information derived from electronic medical records were identified. A network of pediatric diabetes centers was created on a voluntary basis. Results Overall, 20 centers provided data on 3284 patients aged < = 18 years. HbA1c was monitored ≥ 2/year in 81.2% of the cases. BMI was monitored ≥ 1/year in 99.0%, lipid profile in 45.3%, and blood pressure in 91.7%. Pubertal status, albuminuria, eye examination, and screening of celiac disease and thyroiditis were underreported. From 2017 to 2021, average HbA1c levels decreased from 7.8 ± 1.2 to 7.6 ± 1.3%, while patients with LDL cholesterol > 100 mg/dl increased from 18.9 to 36.7%. Prevalence of patients with elevated blood pressure and BMI/SDS values also increased. In 2021, 44.7% of patients were treated with the newest basal insulins, while use of regular human insulin had dropped to 7.7%. Use of insulin pump remained stable (37.9%). Conclusions This report documents the feasibility of the ISPED CARD initiative and shows lights and shadows in the care provided. Improving care, increasing number of centers, and ameliorating data recording represent future challenges.

show abstract

ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes

Cited by 24 publications

References 282 publications

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

Does size matter? Hospital volume and resource use in paediatric diabetes care

Continuous improvement of quality of care in pediatric diabetes: the ISPED CARD clinical registry

Contact Info

Product

Resources

About