Comparison of Adult and Pediatric Resources for Type 1 Diabetes Care among T1D Exchange Centers

Abstract

Background: The American Diabetes Association recommends that patients with type 1 diabetes (T1D) receive care from a multidisciplinary team. We are unaware of studies that have compared staffing resources in pediatric and adult diabetes centers across the United States (U.S.). Methods: In 2015, we performed an environmental scan of staffing resources for centers in the T1D Exchange. Total number of T1D patients and staff full-time equivalent (FTE) for T1D patients were enumerated. Mean staff FTE-patient ratios were calculated and compared within and between pediatric and adult clinics. Results: We collected data on 57 diabetes clinics (38 pediatric, 19 adult) of 77 centers, which collectively cared for 45,873 pediatric and 34,287 adult T1D patients. Staffing ratios did not vary significantly within pediatric or adult clinics. However, upon comparison, adult clinics had approximately half as many staff resources as pediatric clinics, despite having similar volumes of patients (Table 1). Psychologists and social workers were available at 42% of adult vs. 87% of pediatric clinics (p<0.001). Conclusions: Among specialized T1D centers in the U.S., there are stark disparities in staffing in adult vs. pediatric clinics. The relationship of these resources to outcomes is unknown. Benchmarking may be needed to optimize T1D care for pediatric and adult populations with T1D.Table 1. T1D staff FTE to patient ratios of pediatric vs. adult diabetes clinics in the T1D ExchangeStaffPediatricAdultp-valuesMean RatioSDMean RatioSDPhysician1:1711:931:2181:1160.63Nurse Practitioner1:3471:931:6471:192<0.001Certified Diabetes Educator1:581:191:1611:57<0.001Registered Dietician1:3791:1771:7971:133<0.001 Disclosure S. Agarwal: None. E. Hirschfeld: None. A. Garrity: None. A. Shah: None. S. Corathers: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. K.L. Lambert: None. C. Bobik: None. A.B. Cabrera: None. N. Rioles: None. J. Lee: Consultant; Self; Unitio.