Improving Diabetes Care for High-Risk Patients at the Barbara Davis Center
By Mattie Peck
Every doctor has those adolescent patients who aren’t interested in caring for their diabetes. This ranges from not getting enough blood sugar checks a day to blatantly ignoring the disease altogether. This leads to high blood sugars, an outrageous A1c, and increased chances of long-term complications.
These high-risk patients are what encouraged Dr. David Maahs of the Barbara Davis Center, along with Dr. Elizabeth Mayer-Davis and Michael Seid, PhD to develop the Flexible Lifestyle Empowering Change (FL3X) study, a research study with a motivational interviewing and intervention style appointment. The plans started in 2008 and the study came to life in April of 2014 with 250 study subjects to be enrolled. The appointments focus on developing problem-solving and communication skills as opposed to simply educating. This is the difference between saying, “you should get at least four blood sugar checks a day” and “If it’s important to you to do more blood sugar checks how can we work together to make that happen?” It’s a slight difference, but has created some amazing results.
The patients in this study are 13-16 years old with an A1c over 8%. This age group often sees difficulties because they are focused on their peers and don’t want to be the “special case.” They want to fit in with their group of friends and not be judged for being different. Each patient is in the study for a year and a half and during that time, has a monthly appointment that starts with a questionnaire to determine what is difficult for the patient right NOW. Individual issues are constantly changing so the study is able to stay dynamic along with the individual’s case.
Another common issue is the patient’s communication with their parents. The study works with teens and a parent to improve communication for more effective care. This allows teens to ask for more or less reminders, make weekly or daily meetings with their parents, etc. Parents are invited into the session at the end of the appointment to discuss what changes need to be made in order to improve daily diabetes care and issues in communication. They are taught to trust their teens and support them by using a communication style that best fits the teen. Patients become more empowered when they have developed these problem-solving skills and are able to create a better outlook and diabetes care routine.
Tonya Jenkins, RD, CDE, who is a coach for this study, runs these intervention style appointments and says “it’s very rewarding to see families turn things around from shaming and blaming to strategies that work for each individual teenager and their parents.” Because the patients are seen monthly, the coaches really get to know and understand their patients and the obstacles they need to overcome.
Eventually this study will be a model for high-risk patient care. Other diabetes clinics will be able to implement this same approach to improve quality of life, A1c results, and parent/child interaction and communication. If the results continue to be this positive, these motivational interviewing and problems solving techniques may eventually be implemented as a standard of care.
Dr. David Maahs continues to dive head first into diabetes research. In clinics, he gets to watch kids grow up and is able to help them through this disease. This FL3X study, along with his other research will make an incredible difference for his patients and the diabetes world. One of the most exciting studies at the Barbara Davis Center is the artificial pancreas. There are currently 3 multi-center clinical studies funded by the NIDDK testing prototypes of the artificial pancreas from the University of Virginia, Cambridge, and Boston University, respectively. The Barbara Davis Center is excited to be one of only two research centers to test all 3 systems. These human trials will provide data that will determine FDA approval to have the systems commercially available in the
future.
You can support these research studies by donating to the Children’s Diabetes Foundation here: https://secure.acceptiva.com/?cst=f3e8a2
