The Diabetes Technology Clinic - A Better Way Forward

Diabetes is one of the most common long-term childhood diseases. The Centers for Disease Control and Prevention estimates that one in three American children born today will develop diabetes during their lifetime.

At the National Philoptochos Children’s Medical Fund Luncheon in October of 2013, $136,900 was awarded in grants for innovative research programs to pediatric hospitals and to organizations with special programs that care for children with critical and life threatening illnesses.

One of the grant recipients was University Hospital’s Rainbow Babies and Children’s Hospital in Cleveland, OH, receiving $21,000 for their Diabetes Technology Clinic. Our guest blogger this week is Sarah A. MacLeish, DO, Assistant Professor of Pediatrics, Pediatric Endocrinology at Rainbow Babies and Children’s Hospital. Sarah gives us an overview of new technology being used today as well as how the Clinic is using this technology to help families monitor their children’s diabetes care.

The Rainbow Pediatric Diabetes Technology Clinic was started in November 2012 to help our patients understand and utilize the many areas of diabetes technology available.

Insulin pumps have been around for over 30 years, but newer pumps with more features are quickly becoming available.  Pumps have calculators that help families give the correct insulin dose.  Insulin doses are different for different times of the day and different meals, making insulin dose calculators very helpful.  Insulin pumps allow for very small, accurate doses of insulin which is especially important for young patients who require small doses. Information from the insulin pumps can be downloaded, giving doctor’s information about patient’s blood sugar, insulin dose, and carbohydrate intake, which can then be used to accurately adjust insulin doses. 

Continuous glucose monitors (CGMs) are a newer diabetes technology. Within the past year, more accurate and smaller glucose sensors have become available in the United States.  CGMs involve a very small wire, about the size of a hair, that stays under the skin to measure glucose levels.  Attached to the wire is a small plastic glucose transmitter that sits on top of the skin and collects all the glucose information.  CGMs measure glucose every five minutes, giving a much better picture of what is happening to a patient’s blood sugar than just four to six blood sugar checks in a day.  CGMs can also set off an alarm to alert a patient about a high or low blood glucose. 

Very recently, the first step toward the artificial pancreas was approved for use in the United States.  This system involves an insulin pump and a CGM that work together.  If the CGM detects the glucose is low, it will alarm.  If no one responds to the alarm (such as if someone is sleeping very soundly or if they are unconscious), the insulin pump will stop delivery of insulin for up to two hours. 

At the Rainbow Diabetes Technology Clinic, we place CGMs on patients to use for one week and then we use the information to more accurately prescribe insulin doses.  Patients are also able to try different types of CGMs to see if having a CGM of their own, to use all the time, ia helpful.  We also help educate and train patients to use their insulin pumps and CGMs to their full ability.

Another area of focus is making sure our underserved patients – those on Medicaid insurance or without insurance – are able to use insulin pumps and CGMs to the same degree as their peers.  Last year we piloted a program involving the use of text messaging to communicate with the diabetes care team and were able to help seven underserved children start using insulin pumps.  The program also involved much more frequent diabetes appointments with education from the diabetes nurse and dietician.

One patient who participated in this program had always wanted an insulin pump.  Our patient and the patient’s  mom came to six different appointments to learn how to use the pump and frequently sent text messages to communicate with the doctor.  The patient’s blood sugar average went from 240 to 170, which is a big drop, and the patient is having a much easier time taking care of their diabetes.

We are so grateful for the grant from Philoptochos.  This grant is helping us to purchase CGMs and supplies, and will also help provide patients without insurance with supplies for their insulin pump.  A new part of the program we are just starting with the support of Philoptochos is to use a special computer program that will allow us to download information from almost all of the different types of blood sugar meters and insulin pumps.  This program requires less manpower from medical assistants, giving medical assistants more time for other important tasks.  In addition, the information will all be web-based, so if a patient calls with an emergency outside of office hours, the information from their pump or meter will be available anywhere.  This will also be available for patients to download from their home, so they can send the diabetes care team at Rainbow their blood sugar results between appointments. The grant will also help further train and educate our diabetes nurses in the fast-changing field of diabetes technology. 

Thank you Philoptochos for all of your help in improving Rainbow’s Diabetes Technology Clinic!