Endocrinology-Led Program May Help Prevent Type 2 Diabetes in Children
Improving Long-Term Outcomes for At-Risk Patients
Obesity affects nearly 13.7 million children and adolescents in the U.S.1, and numbers continue to rise. Children with obesity face a significantly increased risk of developing type 2 diabetes (T2D). Endocrinologists and nurse practitioners in the Division of Endocrinology and Diabetes at Children’s Mercy Kansas City see more than 300 new patients and 1,500 visits per year for weight-related concerns. Yun Yan, MD and Kelsee Halpin, MD, the two endocrinologists in the Division, developed the Type 2 Diabetes Prevention Program with the aim of identifying children with a high risk to develop T2D, and thus implementing changes in lifestyle and, if necessary, medical treatment to prevent, or at least delay, the onset of T2D.
Under Dr. Yan’s direction, the program brings together specialists from pediatric endocrinology, nutrition and social work. Since its inception in 2014, the program has seen approximately 100 referrals per year from pediatricians and other endocrine programs. The team helps patients and families understand how T2D can be prevented and how families and the care team can work together to improve long-term quality of life for at-risk children.
Patients Who Qualify for the Program
The precipitating factor for an initial referral to the program is a body mass index (BMI) in the 85th percentile or higher, along with one or more of the following conditions:
- HbA1C ≥ 6%
- Fasting glucose > 100 mg/dL
- Abnormal oral glucose tolerance test
- Abnormal lipid profile
- Abnormal liver function
- Patients < 5 years old, regardless of laboratory results
The team tests each patient, with a goal of identifying a hormonal cause for the weight gain or signs that indicate prediabetes or T2D. The endocrine team also collaborates closely with Children’s Mercy Weight Management Clinic and the Bariatric Surgery Program to ensure patients are receiving a comprehensive evaluation.
How the Program Works
Upon the patient’s arrival, the team looks for potential underlying endocrine problems that may be causing weight gain. They also screen patients for comorbidities that can become the consequences of excessive weight gain.
With support from a questionnaire completed by the parents, a nutrition specialist assesses each child’s dietary and exercise habits. The nutrition specialist and social worker collaborate with the family to set goals to promote a healthy lifestyle and provide support resources if needed.
Improving Families’ Understanding of Weight Gain
The team spends significant time with patients and families during the visit to ensure they understand why and how weight gain occurs. They discuss the importance of exercise and explain the relationship between glucose and insulin. The team breaks down the science of nutrition and T2D to ensure families’ understanding.
Anecdotal feedback gathered over the past few years suggests that families appreciate this multidisciplinary team approach and the thorough discussion during the visit regarding the mechanisms underlying excessive weight gain. Parents often tell the team they have never understood the cause of their child’s weight gain before being seen at the T2D Prevention Program.
Improving Understanding of T2D Through Research
To improve long-term outcomes for pediatric patients with obesity and T2D, the Division of Endocrinology and Diabetes is conducting multiple research projects, sometimes in collaboration with other pediatric centers. Three projects are currently underway:
- A biorepository containing specimens from obese, insulin-resistant children has been developed. It will allow researchers to identify early biomarkers that can predict and monitor the risk of progression to type 2 diabetes.
- A team of endocrinologists is collaborating with researchers in Precision Therapeutics at Children’s Mercy to develop a patient-specific approach that will optimize response to metformin therapy.
- Overweight and obesity are seen today in very young children, including toddlers. Children’s Mercy is collaborating with researchers in pediatric genomic medicine to identify and explore novel and known genetic factors responsible for early-onset severe obesity.
Children’s Mercy Kansas City is an independent, non-profit, 390-bed pediatric health system, providing over half a million patient encounters each year for children from across the country. Children’s Mercy is ranked by U.S. News & World Report in all ten specialties. We have received Magnet® recognition five times for excellence in nursing services. In affiliation with the University of Missouri-Kansas City, our faculty of nearly 800 pediatric specialists and researchers is actively involved in clinical care, pediatric research and educating the next generation of pediatricians and pediatric subspecialists. The Children’s Mercy Research Institute (CMRI) integrates research and clinical care with nationally recognized expertise in genomic medicine, precision therapeutics, population health, health care innovation and emerging infections. In 2021 the CMRI moved into a nine-story, 375,000-square-foot space emphasizing a translational approach to research in which clinicians and researchers work together to accelerate the pace of discovery that enhances care.