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A Fresh Start and New BEGINnings: Two Unique Initiatives To Reduce Diabetes Hospitalizations
In an effort to reduce hospitalizations of diabetes patients, Le Bonheur has developed two clinics, Fresh Start and BEGIN, for children and adolescents with poorly controlled type 1 diabetes. Led by Le Bonheur Endocrinologist Kathryn Sumpter, MD, these clinics use a comprehensive approach to diabetes control, including education, psychoscocial support, social workers and easy access to diabetes providers.
Featured Speaker:
Learn more about Kathryn Sumpter, MD
Kathryn Sumpter, MD
Kathryn Sumpter, MD is a Le Bonheur Endocrinologist and Assitant Professor at the University of Tennessee Health Science Center.Learn more about Kathryn Sumpter, MD
Transcription:
A Fresh Start and New BEGINnings: Two Unique Initiatives To Reduce Diabetes Hospitalizations
Bill Klaproth: Le Bonheur has two unique initiatives to reduce diabetes hospitalizations. So let's talk about the Fresh Start Clinic and the Begin Program with Dr. Kathryn Sumpter, Le Bonheur endocrinologist and Associate Professor at the University of Tennessee Health Science Center.
This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Sumpter, thank you so much for your time on such an important topic. So let me ask you this, I know you have type 1 diabetes, so did your own type 1 diabetes diagnosis impact your decision to help children with diabetes?
Dr. Kathryn Sumpter: Absolutely. I think there's nothing more meaningful to me as a physician than taking care of a kid with whom I have that special connection. I understand the daily grind of diabetes so I feel really privileged to be able to do that every day.
Bill Klaproth: I bet this really does impact your interactions with children and teens, being that you know what it's like and are going through this and have gone through this.
Dr. Kathryn Sumpter: Yeah. I always say it's kind of like my street cred. If I make a suggestion, I can say, you know, "I really understand day in and day out what it's like to have to do this." So they see me as somebody who gets it, which is good.
Bill Klaproth: Right. Absolutely. And the one thing for sure is we want to avoid hospitalizations. So let me ask you this, how does a child with diabetes get to the point where they require hospitalization? And what are the basic ways to prevent it?
Dr. Kathryn Sumpter: So with diabetes, the key is especially with type 1 diabetes, your body can't make enough insulin. And so hospitalization can occur when there becomes an imbalance of the amount of insulin we're giving to the person. If it's not enough, that can make a person develop diabetic ketoacidosis, which requires hospitalization. And also if there's an imbalance in the amount of insulin to the amount of food someone's eating, that can lead to hospitalization. Illness can do it as well.
But the key in all of this is the daily in and out monitoring. So making sure we know what the blood sugar is regularly throughout the day, making sure that the child is taking insulin consistently as they're supposed to, and then balancing that insulin with food.
It takes a lot of work. It takes a lot of monitoring. and the challenge is how do you do that every day for the rest of your life? Like anything you do every day, sometimes we slip up, even someone like me, a diabetes doctor. The key that we're trying to do is how do we help these kids have good healthy habits and maintain those habits on a daily basis?
Bill Klaproth: Yeah. So monitoring is key, as you said, and developing those healthy habits every day. So what about hospitalization rates for children with diabetes? Why do they seem to be higher in Memphis?
Dr. Kathryn Sumpter: You can imagine, as I said, you know, it's something we have to do every single day. And that's hard to do even for somebody where everything else in your life is going well. But when you put a child in a situation where they're living in poverty or dealing with significant psychosocial stress either within the family or on their own, those things tend to get in the way of good healthy habits. And so if you think about just an average person, when you get really stressed out, you're less likely to sleep well, you're less likely to eat well, you're less likely to exercise. And so put on top of that, if the things you have to do every day include taking insulin and counting how many carbohydrates you're eating, that's very hard to do when those stressors come in.
So I think in Memphis, we have a population of kids that are on average more likely to be in poverty than nationwide. Then COVID put on top of that, the level of stress that our kids are facing is just off the charts. So I think all of those things have contributed to hospitalizations being higher.
Bill Klaproth: Yeah, you really painted an interesting picture there. Overwhelming stress, you mentioned lot of these kids are in poverty. Add COVID to it. And then the task of monitoring every day and trying to develop those healthy habits. So it's easy to see why diabetes rates are higher in Memphis.
So let's talk about initiatives now that are going to help combat this. What are the basics of the diabetes initiatives that you have developed for these children called the Fresh Start Clinic and the Begin Program? Tell us about those.
Dr. Kathryn Sumpter: Yeah. So the Fresh Start Clinic started. It arose out of recognition that we had a small number of patients that were being hospitalized repetitively. So we had a small number of patients to which we could attribute probably more than half of our hospitalizations. And so I wanted to really get in and work with those kids one-on-one and try to figure out what can we do to try to help keep them out of the hospital as the number one goal. And the number two goal was to help them actually have better diabetes control. We have several measures that we look at for diabetes control. And so those were the goals.
So we enrolled 12 patients and I see them once a month in clinic, along with our clinical psychologist, Dr. Angelica Eddington. We work closely with our diabetes educators and dieticians, nurses, social workers, and really try to figure out, you know, what are the root causes of these higher hospitalizations and how can we walk side by side wherever they are, help them move to a place where they're healthier? So that's the Fresh Start Clinic.
The Begin Program arose out of a recognition that if we were only seeing 12 to 15 patients in Fresh Start, granted they were the ones who needed it the most, we still had a lot of patients where their diabetes control was not where we wanted it to be, and that increases the long-term risk of complications of diabetes.
We want it to be able to reach a broader swath of our population. So the Begin Program helps us to take the clinic into the patient's home or into their community. I work with the community health educator, who does frequent visits with these patients at home and is able to work with them, whether it's actually in person or on the phone. These kids love to text, so sometimes it's that way, but helping them, we realize we only see these patients once every three months in clinic, and that's usually not enough. In between, they need a little help kind of to maintain the focus and motivation.
Bill Klaproth: And that is important. Once again, two different programs, the Fresh Start Clinic and the Begin Program. So how have these programs enabled you and the endocrinology team to work towards the goal of reducing hospitalizations?
Dr. Kathryn Sumpter: Like we talked about, those healthy habits are the key. And if we can help kids to maintain those healthy habits by supporting them in between visits, that's kind of the idea of Begin. The idea of Fresh Start is just helping at the very basic level of, if we're trying to build healthy habits, trying to help them see how that can happen. Setting a simple goal every day. Checking blood sugars a certain number of times. And then really working to help them think through, "Okay, let's break that goal down. How can we actually do that every day? What would it take to remember?" Could you put a little sticky note on your mirror so that when you're brushing your teeth at night, you remember to do it? Could you set a reminder on your phone?
These things seem very basic, but sometimes helping a kid break it down like that can really make a difference. And so what we've done is helped to reinforce those healthy habits, and that has directly translated to lower hospitalizations in these groups of patients.
Bill Klaproth: So you mentioned the Begin Program is the at-home program. Can you tell us a little bit more about that specific program and how has that been impacted and evolved due to COVID?
Dr. Kathryn Sumpter: Yeah, that was a real challenge because we were just really getting the program up and running in March of last year, so our timing couldn't have been better. But we really did have to evolve. And so, what we realized is that our patients were probably much more ready to do that than we were. Generationally, they're very comfortable with doing things virtually, FaceTime, all the things that we all had to adapt to, the younger generation had already done that. So they were actually quite comfortable with doing some of those what we would have done in person, doing those kinds of things virtually. So that's what we had to do.
If we had a meeting with the parent and the child, we could do that by Zoom. But a lot of personal interactions between a teen and our community health educator, we moved over to FaceTime or that type of media and that worked actually quite well.
That being said, we're excited that now with a lot of our patients being vaccinated and all of our staff being vaccinated, to start doing those in-person visits again, has been really great.
Bill Klaproth: So important those in-person visits. So you mentioned how this program is working and earlier you did say that hospitalizations are down. Can you tell us or share with us any other results that we should know about either anecdotally or from a numbers perspective?
Dr. Kathryn Sumpter: Yeah. You know, our hospital in the Fresh Start group are down over 70%, which is pretty amazing. But we also have noticed their numbers of blood sugar control, so we measure something called the hemoglobin A1c, which gives us an idea of the average blood sugar over the last two months. And that has come down tremendously. We measure it in percentage points.
An A1c for a person with diabetes, our goal is to try to keep it 7% or less. So every point that you lower that decreases your long-term risks of diabetes complications by up to 40%. And so we've seen that our patients in the Fresh Start Program have lowered their A1c level by about 1.8 points, almost two points, which in terms of diabetes interventions is a huge, huge impact. So that was very exciting to us because we know that translates into healthier people long-term, which is great.
Bill Klaproth: So the Fresh Start Clinic has a small number of kids. The Begin Program is the at-home program, which is wider reaching. Do you think this care outside of a clinic setting is crucial to helping children and teens learn to better control their diabetes by going into their own home element?
Dr. Kathryn Sumpter: I think one of the things we've known for a long time is that we see patients every three months in clinic, which to some people may sound like a lot to have to see your doctor every three months. But when you're thinking about something like diabetes that there's something you have to do many times a day, every three months is a lifetime. I mean, it's such a long time. And so what we realized is we got to try to get in front of these patients, we need to be interacting with them more frequently than just every three months. There's no way that we can have the impact we want.
The other piece is diabetes is all about what happens at home. If we can get out into that environment, we have a much better chance of actually making a difference than if we stay in our clinic and have them come to us.
Bill Klaproth: So they're more likely to develop those really important habits through frequency, visiting them more often. And if they're at home, you will teach them certain things or reminders that they have to take care of themselves every day. Is that kind of the basis of this?
Dr. Kathryn Sumpter: Absolutely. The other thing is that sometimes when you actually get into their home environment, you learn things you wouldn't learn in clinic. Our community health educator has told me so many different stories of being in someone's house and making a suggestion and having them say, "Well, I can't do that." for example, for someone with type 1 diabetes or even type 2 diabetes who takes insulin at meals, they need to count how many carbohydrates are in their food. And so we say, "Well, you know, just measure out a cup of rice." Many of our patients don't have measuring cups at home and you may not realize that in clinic. But if you're at home, they might say, "Oh, yeah, we don't have those." It's such a simple thing, but if you can help kind of get over that obstacle, you have the potential to really start improving things. Being in that home environment often gives us a level of insight that we wouldn't maybe ever get in the clinic environment.
Bill Klaproth: Yeah, you can make better informed decisions or inform them better of how they can live a more healthy lifestyle. Don't leave candy out on the counter, right?
Dr. Kathryn Sumpter: Right.
Bill Klaproth: And maybe not have the jar of cookies right there, easy to get to, those types of things. Simple things like that, that you're able to see when you're in the house.
Dr. Kathryn Sumpter: Sure. Absolutely.
Bill Klaproth: Yeah, really interesting. So the Fresh Start Clinic and the Begin Program. Dr. Sumpter, really interesting. So happy that you're with us to update us on these two very important programs. And we're very happy to hear about the initial success as well. So thank you so much for your time. We really appreciate this.
Dr. Kathryn Sumpter: Thanks so much.
Bill Klaproth: That's Dr. Kathryn Sumpter. And to learn more, please visit LeBonheur.org/podcast. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Podcasts, or wherever you listen to your podcasts. You can also check out Le Bonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.
A Fresh Start and New BEGINnings: Two Unique Initiatives To Reduce Diabetes Hospitalizations
Bill Klaproth: Le Bonheur has two unique initiatives to reduce diabetes hospitalizations. So let's talk about the Fresh Start Clinic and the Begin Program with Dr. Kathryn Sumpter, Le Bonheur endocrinologist and Associate Professor at the University of Tennessee Health Science Center.
This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Sumpter, thank you so much for your time on such an important topic. So let me ask you this, I know you have type 1 diabetes, so did your own type 1 diabetes diagnosis impact your decision to help children with diabetes?
Dr. Kathryn Sumpter: Absolutely. I think there's nothing more meaningful to me as a physician than taking care of a kid with whom I have that special connection. I understand the daily grind of diabetes so I feel really privileged to be able to do that every day.
Bill Klaproth: I bet this really does impact your interactions with children and teens, being that you know what it's like and are going through this and have gone through this.
Dr. Kathryn Sumpter: Yeah. I always say it's kind of like my street cred. If I make a suggestion, I can say, you know, "I really understand day in and day out what it's like to have to do this." So they see me as somebody who gets it, which is good.
Bill Klaproth: Right. Absolutely. And the one thing for sure is we want to avoid hospitalizations. So let me ask you this, how does a child with diabetes get to the point where they require hospitalization? And what are the basic ways to prevent it?
Dr. Kathryn Sumpter: So with diabetes, the key is especially with type 1 diabetes, your body can't make enough insulin. And so hospitalization can occur when there becomes an imbalance of the amount of insulin we're giving to the person. If it's not enough, that can make a person develop diabetic ketoacidosis, which requires hospitalization. And also if there's an imbalance in the amount of insulin to the amount of food someone's eating, that can lead to hospitalization. Illness can do it as well.
But the key in all of this is the daily in and out monitoring. So making sure we know what the blood sugar is regularly throughout the day, making sure that the child is taking insulin consistently as they're supposed to, and then balancing that insulin with food.
It takes a lot of work. It takes a lot of monitoring. and the challenge is how do you do that every day for the rest of your life? Like anything you do every day, sometimes we slip up, even someone like me, a diabetes doctor. The key that we're trying to do is how do we help these kids have good healthy habits and maintain those habits on a daily basis?
Bill Klaproth: Yeah. So monitoring is key, as you said, and developing those healthy habits every day. So what about hospitalization rates for children with diabetes? Why do they seem to be higher in Memphis?
Dr. Kathryn Sumpter: You can imagine, as I said, you know, it's something we have to do every single day. And that's hard to do even for somebody where everything else in your life is going well. But when you put a child in a situation where they're living in poverty or dealing with significant psychosocial stress either within the family or on their own, those things tend to get in the way of good healthy habits. And so if you think about just an average person, when you get really stressed out, you're less likely to sleep well, you're less likely to eat well, you're less likely to exercise. And so put on top of that, if the things you have to do every day include taking insulin and counting how many carbohydrates you're eating, that's very hard to do when those stressors come in.
So I think in Memphis, we have a population of kids that are on average more likely to be in poverty than nationwide. Then COVID put on top of that, the level of stress that our kids are facing is just off the charts. So I think all of those things have contributed to hospitalizations being higher.
Bill Klaproth: Yeah, you really painted an interesting picture there. Overwhelming stress, you mentioned lot of these kids are in poverty. Add COVID to it. And then the task of monitoring every day and trying to develop those healthy habits. So it's easy to see why diabetes rates are higher in Memphis.
So let's talk about initiatives now that are going to help combat this. What are the basics of the diabetes initiatives that you have developed for these children called the Fresh Start Clinic and the Begin Program? Tell us about those.
Dr. Kathryn Sumpter: Yeah. So the Fresh Start Clinic started. It arose out of recognition that we had a small number of patients that were being hospitalized repetitively. So we had a small number of patients to which we could attribute probably more than half of our hospitalizations. And so I wanted to really get in and work with those kids one-on-one and try to figure out what can we do to try to help keep them out of the hospital as the number one goal. And the number two goal was to help them actually have better diabetes control. We have several measures that we look at for diabetes control. And so those were the goals.
So we enrolled 12 patients and I see them once a month in clinic, along with our clinical psychologist, Dr. Angelica Eddington. We work closely with our diabetes educators and dieticians, nurses, social workers, and really try to figure out, you know, what are the root causes of these higher hospitalizations and how can we walk side by side wherever they are, help them move to a place where they're healthier? So that's the Fresh Start Clinic.
The Begin Program arose out of a recognition that if we were only seeing 12 to 15 patients in Fresh Start, granted they were the ones who needed it the most, we still had a lot of patients where their diabetes control was not where we wanted it to be, and that increases the long-term risk of complications of diabetes.
We want it to be able to reach a broader swath of our population. So the Begin Program helps us to take the clinic into the patient's home or into their community. I work with the community health educator, who does frequent visits with these patients at home and is able to work with them, whether it's actually in person or on the phone. These kids love to text, so sometimes it's that way, but helping them, we realize we only see these patients once every three months in clinic, and that's usually not enough. In between, they need a little help kind of to maintain the focus and motivation.
Bill Klaproth: And that is important. Once again, two different programs, the Fresh Start Clinic and the Begin Program. So how have these programs enabled you and the endocrinology team to work towards the goal of reducing hospitalizations?
Dr. Kathryn Sumpter: Like we talked about, those healthy habits are the key. And if we can help kids to maintain those healthy habits by supporting them in between visits, that's kind of the idea of Begin. The idea of Fresh Start is just helping at the very basic level of, if we're trying to build healthy habits, trying to help them see how that can happen. Setting a simple goal every day. Checking blood sugars a certain number of times. And then really working to help them think through, "Okay, let's break that goal down. How can we actually do that every day? What would it take to remember?" Could you put a little sticky note on your mirror so that when you're brushing your teeth at night, you remember to do it? Could you set a reminder on your phone?
These things seem very basic, but sometimes helping a kid break it down like that can really make a difference. And so what we've done is helped to reinforce those healthy habits, and that has directly translated to lower hospitalizations in these groups of patients.
Bill Klaproth: So you mentioned the Begin Program is the at-home program. Can you tell us a little bit more about that specific program and how has that been impacted and evolved due to COVID?
Dr. Kathryn Sumpter: Yeah, that was a real challenge because we were just really getting the program up and running in March of last year, so our timing couldn't have been better. But we really did have to evolve. And so, what we realized is that our patients were probably much more ready to do that than we were. Generationally, they're very comfortable with doing things virtually, FaceTime, all the things that we all had to adapt to, the younger generation had already done that. So they were actually quite comfortable with doing some of those what we would have done in person, doing those kinds of things virtually. So that's what we had to do.
If we had a meeting with the parent and the child, we could do that by Zoom. But a lot of personal interactions between a teen and our community health educator, we moved over to FaceTime or that type of media and that worked actually quite well.
That being said, we're excited that now with a lot of our patients being vaccinated and all of our staff being vaccinated, to start doing those in-person visits again, has been really great.
Bill Klaproth: So important those in-person visits. So you mentioned how this program is working and earlier you did say that hospitalizations are down. Can you tell us or share with us any other results that we should know about either anecdotally or from a numbers perspective?
Dr. Kathryn Sumpter: Yeah. You know, our hospital in the Fresh Start group are down over 70%, which is pretty amazing. But we also have noticed their numbers of blood sugar control, so we measure something called the hemoglobin A1c, which gives us an idea of the average blood sugar over the last two months. And that has come down tremendously. We measure it in percentage points.
An A1c for a person with diabetes, our goal is to try to keep it 7% or less. So every point that you lower that decreases your long-term risks of diabetes complications by up to 40%. And so we've seen that our patients in the Fresh Start Program have lowered their A1c level by about 1.8 points, almost two points, which in terms of diabetes interventions is a huge, huge impact. So that was very exciting to us because we know that translates into healthier people long-term, which is great.
Bill Klaproth: So the Fresh Start Clinic has a small number of kids. The Begin Program is the at-home program, which is wider reaching. Do you think this care outside of a clinic setting is crucial to helping children and teens learn to better control their diabetes by going into their own home element?
Dr. Kathryn Sumpter: I think one of the things we've known for a long time is that we see patients every three months in clinic, which to some people may sound like a lot to have to see your doctor every three months. But when you're thinking about something like diabetes that there's something you have to do many times a day, every three months is a lifetime. I mean, it's such a long time. And so what we realized is we got to try to get in front of these patients, we need to be interacting with them more frequently than just every three months. There's no way that we can have the impact we want.
The other piece is diabetes is all about what happens at home. If we can get out into that environment, we have a much better chance of actually making a difference than if we stay in our clinic and have them come to us.
Bill Klaproth: So they're more likely to develop those really important habits through frequency, visiting them more often. And if they're at home, you will teach them certain things or reminders that they have to take care of themselves every day. Is that kind of the basis of this?
Dr. Kathryn Sumpter: Absolutely. The other thing is that sometimes when you actually get into their home environment, you learn things you wouldn't learn in clinic. Our community health educator has told me so many different stories of being in someone's house and making a suggestion and having them say, "Well, I can't do that." for example, for someone with type 1 diabetes or even type 2 diabetes who takes insulin at meals, they need to count how many carbohydrates are in their food. And so we say, "Well, you know, just measure out a cup of rice." Many of our patients don't have measuring cups at home and you may not realize that in clinic. But if you're at home, they might say, "Oh, yeah, we don't have those." It's such a simple thing, but if you can help kind of get over that obstacle, you have the potential to really start improving things. Being in that home environment often gives us a level of insight that we wouldn't maybe ever get in the clinic environment.
Bill Klaproth: Yeah, you can make better informed decisions or inform them better of how they can live a more healthy lifestyle. Don't leave candy out on the counter, right?
Dr. Kathryn Sumpter: Right.
Bill Klaproth: And maybe not have the jar of cookies right there, easy to get to, those types of things. Simple things like that, that you're able to see when you're in the house.
Dr. Kathryn Sumpter: Sure. Absolutely.
Bill Klaproth: Yeah, really interesting. So the Fresh Start Clinic and the Begin Program. Dr. Sumpter, really interesting. So happy that you're with us to update us on these two very important programs. And we're very happy to hear about the initial success as well. So thank you so much for your time. We really appreciate this.
Dr. Kathryn Sumpter: Thanks so much.
Bill Klaproth: That's Dr. Kathryn Sumpter. And to learn more, please visit LeBonheur.org/podcast. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Podcasts, or wherever you listen to your podcasts. You can also check out Le Bonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.