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Shared medical appointments benefits adolescents with type 1 diabetes
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Adolescents with poorly controlled type 1 diabetes who attended a series of shared medical appointments for 9 months experienced stabilization of HbA1c and improved overall quality of life, according to recent findings.
Baraka D. Floyd, MD, clinical instructor in the department of general pediatrics at Stanford University School of Medicine, and colleagues analyzed data from 32 children with type 1 diabetes aged 12 to 16 years with baseline HbA1c between 7.5% and 11%, recruited from Lucile Packard Children’s Hospital at Stanford’s diabetes clinics (mean age, 13.7 years; 56% boys; 53% white; mean baseline HbA1c, 9.1%; 69% insulin pump users). Children attended shared medical appointments (three to six children at a time with their families) approximately once every 3 months, along with one individual appointment, for a total of four visits. Shared medical appointments included private history, physical exam and lab work, followed by group sessions focusing on self-management, communication skills, goal setting, glucose pattern recognition and peer/diabetes team support. Researchers measured retrospective and prospective glycemic control and treatment adherence; quality of life was measured with the Pediatric Quality of Life Inventory (PedsQL) and the PedsQL Diabetes Module.
All children attended at least three visits, and 26 children completed all four visits. In the 9 months leading up to the study, HbA1c worsened by an average of 0.7%; after shared appointment intervention, there was no change in HbA1c (P = .98).
Researchers found improvements in overall quality of life (P = .005), school function (P = .006), psychosocial function (P = .008), barriers (P = .02), adherence (P = .01) and communication (P = .02). Improvements in school function and communication reached clinical significance, according to researchers.
“Our opinion is that the time built into our [shared medical appointment] model for individual attention during goal setting, history and physical, and wrap-up allowed for flexibility to personalize group sessions based on recurrent themes among the individuals, leading to these improvements,” the researchers wrote. – by Regina Schaffer
Disclosure: Endocrine Today was unable to determine relevant financial disclosures.
Perspective
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Olga T. Gupta, MD
Adolescence is a vulnerable time for the deterioration of glycemic control in patients with type 1 diabetes mellitus, and currently there are few efficient and cost-effective tools to support this population. Stabilization of HbA1c following participation in shared medical appointments with multidisciplinary teams is an encouraging finding with a positive benefit that will likely extend past this critical time period. Support from peers and diabetes team members is necessary for successful glycemic control, but difficult to achieve in standard clinic visits, which can be brief and isolating. Shared medical appointments “break the ice” by allowing longer contact with the diabetes team and facilitating camaraderie and a fruitful exchange of ideas. Floyd and colleagues demonstrate success using this strategy in an adolescent patient population, particularly in the young male Hispanic subgroup. I look forward to a randomized controlled trial and further research that can help identify ways to optimize this approach to benefit all adolescent patients with type 1 diabetes and those with suboptimal control.
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