Transcription:
The Current State of Diabetes in the Pediatric Population

Melanie Cole (Host): Diabetes has become a significant and increasing burden in adolescents and young adults. Here to discuss strategies for research, prevention and treatment of the disease, is my guest, Dr. Ana Arbelaez. She’s a Washington University Pediatric Endocrinologist at St. Louis Children’s Hospital. Dr. Arbelaez, explain a little bit about the current state of type 1 and type 2 diabetes in the pediatric population as we are seeing this increase and we did not used to see this before, I mean now even type 2 used to be called adult onset and wow, it’s so different now. Tell us what’s going on today.

Ana Arbelaez, MD (Guest): Hi Melanie. It’s very nice that you have invited me to be on your show. You are correct. As you and many have heard, the rates of new diagnosed cases of type 1 and type 2 diabetes are increasing among youth in the United States and the shocking situation is that the cost and health burdens are really staggering. You know, it’s been estimated that about 18,000 new cases of type 1 diabetes occur per year in young patients in this country and about 5,000 with type 2 in the pediatric population. But as you stated before, these numbers are certainly on the rise. Just to remind the listeners, that even though type 1 and type 2 diabetes share the same underlying defect, which is an inability to deploy insulin in a manner that keeps blood sugar from rising too high; they arise from many different processes. So, type 1 diabetes which is the most common form of diabetes in young people; is a condition in which the body fails to make insulin. Though the cases of type 1 diabetes are still unknown, disease development is suspected to follow exposure of genetically predisposed people to an environmental trigger, stimulating like an immune attack against insulin producing beta cells of the pancreas. Therefore, after these cells are actually attacked, they are destroyed and their ability to make insulin is compromised.

Different than type 1 diabetes, in type 2 diabetes, the tissues that need insulin to take up glucose such as the liver, the muscle or fat; they become resistant to insulin’s presence and action. So, the insulin producing cells, those beta cells that I mentioned before; respond by going into like overdrive. First, they make more insulin than normal and then they lose the ability to keep up with the excess glucose in the blood and eventually, some end up just being unable to make insulin at all. So, they become sort of insulin-dependent or insulin-requiring patients with type 2 diabetes.

You know we are uncertain of the causes for the increased numbers of diabetic patients worldwide. In the past, type 2 diabetes, as you said before was extremely rare in youth, only occurred in adults, but in the most recent years, with the onset of the obesity epidemic, these numbers have been rising and we have been attributing the increased numbers of type 2 diabetic patients to the obesity epidemic. Contrary in patients with type 1 diabetes, that we are seeing these rising trends; we yet don’t know what the causes for it and the possible culprits are that have been out there have been thought to be part of this epidemic is quite long.

Melanie: Now when you were discussing the causes, in type 1 you know we used to talk as type 2 became more prevalent and we are talking about the obesity epidemic, but why would you think that we are seeing an increase in type 1 as well when that seemed to kind of be separate. It was thought of as a separate disease that was juvenile onset, maybe a genetic component, something like that. Why would you be seeing an increase in this do you think?

Dr. Arbelaez: Correct. We don’t know, however, there has been different studies that have looked at this, some done in Europe and some done in the United States. Some of it actually came due to the fact that they noticed that the rise on the numbers are actually worldwide. They don’t seem to occur on a specific area and that’s why they actually think that the causes are multiple. Some people have thought of the hygiene theory where they used to think that maybe it is triggered by now people being so extreme- using extreme hygiene methods in early childhood, other people used to think that there was an association to gluten. Others have though that there are new emerging environmental triggers such as viruses or other infectious processes that seem to trigger these autoimmune processes that take place in this condition.

Melanie: Tell us about the breadths of services offered at the Diabetes Program at St. Louis Children’s Hospital including inpatient and outpatient services doctor, and what do you offer that other institutions don’t?

Dr. Arbelaez: Effective diabetes management requires a team of medical professionals who each bring a unique expertise to the child’s care. Therefore, we have a multidisciplinary diabetes team at St. Louis Children’s Hospital Washington University Diabetes Center that includes physicians, nurse practitioners, certified diabetes nurse educators, registered dietician and a social worker. We currently provide clinical services for infants, children, adolescents and young adults with type 1 and type 2 diabetes but also for patients that have neonatal diabetes, monogenic forms of diabetes or cystic fibrosis related diabetes. You know we are the metro area’s largest pediatric diabetes program and our diabetes team sees nearly about 200 new patients each year and cares for more than 3000 patients with diabetes overall. Patients visit us from Missouri, Illinois, Arkansas, Kentucky and Indiana for management of these different forms of diabetes.

So, we have convenience access for patients and families as one of our program priorities. So, we currently provide 24-hour access to our diabetes team members should a question or problem occur, or outpatient diabetes clinics are available at St. Louis Children’s Hospital as well as at St. Louis Children’s Specialty Care Center which is located at the Interstate 64 and Mesa Road and next month we will start seeing patients at Children’s Hospital at Memorial Hospital in Shiloh, Illinois. As part of our program, I can tell you that our diabetes team partners with patients and families to encourage independence, self-reliance and collaboration. We help our patients to achieve better control of their diabetes and help the families navigate the different types of challenges that they may face. So, to do this, we provide services in-house and as outpatients and in addition, we have diabetes focused clinics to see these different forms of diabetes such as our high-risk diabetes clinic for patients that are really struggling with their management of diabetes or new-onset or first follow-up. We also have a diabetes technology clinic because as you are well-aware, in the past, we only used to have injections to take care of our patients with type 1, but nowadays, one of the things that has made a huge impact in the care of people with diabetes is not only our new forms of insulin, but our diabetes technology that includes pumps and sensors, so we have a clinic devoted for diabetes technology. We also have a clinic for patients that have cystic fibrosis related diabetes and we have a pediatric to adult diabetes transition clinic at the Center for Advanced Medicine. So, those are some of the services that we have in-house and outpatient.

We also have an education program because education is the key to successful management of diabetes. So, we have a diabetes education series in which we provide group education to patients or their caregivers or their family outside of the clinic setting. Some of these courses are classes that we provide on a regular basis. Our summer caregiver workshop that will be happening pretty soon where you can have either the nanny, or the grandma or anybody that’s involved in the caregiving of a child or a young adult with diabetes, even that is seen at Children’s Hospital or Glennon or any other place can come and be part of these classes. We have other classes that are called Adulting for kids that are transitioning from the pediatric to adult care more for our teens that you are trying to have more self-reliance, more self-management of their care so we have classes to teach them how to do their prescriptions, how to start being an adult and taking care for themselves. We have a refresher skill class. We have an insulin pump class. We have a series of different classes that we provide on a regular basis here at Children’s Hospital for our patients and our families with diabetes.

The other thing that we do, and we have been championing I think heavily mostly this year is we have a pediatric diabetes support group that organizes age-appropriate activities for families and children with diabetes either type 1 or type 2 and these we have actually be running them in partnership with the American Diabetes Association, the JDRS Foundation and other local partners. In addition, our program is the only pediatric hospital in St. Louis and one of two pediatric facilities in the state of Missouri that is recognized by the American Diabetes Association for excellence in diabetes education.

Melanie: Wow. So, do patients need a referral to the program?

Dr. Arbelaez: Nope. Patients do not need a referral, though that is preferred. Their primary care provider can call our office at 314-454-6051 or they can call the main hospital number and ask to speak to the diabetes team and we will be glad to see them right away. If they are a new-onset diabetic patient, we will admit them to the hospital, but otherwise, we will see them within three to four days.

Melanie: Are there some treatments or research that you are doing at St. Louis Children’s that other physicians might not be aware of and where do you see this going next maybe ten years in the field. Give a little blueprint for future research.

Dr. Arbelaez: Sure, so, the diabetes program at Washington University and our research program as been at the forefront of patient care and diabetes research since the 1920s. it was the first place in the United States in which actually insulin was used to successfully treat a child with diabetes. We are currently part of one of the most important diabetes clinical trials for both type 1 and type 2 which provides patients with cutting edge research opportunities on management and diabetes technology, so I foresee that we will continue to be there for our patients at the research level and at the patient care setting.

Melanie: Wrap it up for us. What else would you want a referring physician to know about the program. Tell other physicians what you would like them to know about this current state of diabetes in the pediatric population and when you want them to refer.

Dr. Arbelaez: We want them to refer their patients any time that they have a question, or they feel that they will benefit from having this multidisciplinary approach because the reality is that I want the PMDs to know that we appreciate all that they do for the kids. We are here to partner with them to provide the best care for our patients and their patients as a team approach.

Melanie: Thank you so much Dr. Arbelaez for such great information on this current state of diabetes because it really is becoming quite an epidemic and thank you for all the great work that you are doing. A physician can refer a patient by calling Children’s Direct Physician Access Line at 1-800-678-HELP. That’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital, you can go to www.stlouischildrens.org, that’s www.stlouischildrens.org. This is Melanie Cole. Thanks so much for listening.