Transdisciplinary Care for Adolescents With Type 1 Diabetes: Development of a Provider Cross-Discipline Training Curriculum.

Abstract

Only 17% of adolescents with type 1 diabetes achieve glycemic control targets (1), and many are at risk for psychological concerns (e.g., depression, anxiety, and diabetes distress) (2,3), diminished quality of life (4), and the development of diabetes complications (5,6). Psychological functioning and the quality of parent-child interactions can heavily influence self-management in adolescents with type 1 diabetes and are therefore among the greatest concerns of adolescents with type 1 diabetes, their parents, and their health care providers (HCPs) (7). However, conventional models of care are ill equipped to address these issues effectively. Approximately 30% of diabetes teams do not have access to mental health providers (8), and teams with access to such professionals struggle to efficiently incorporate them into routine care (9). The increasing incidence of youths diagnosed with type 1 diabetes each year (10,11), coupled with the limited supply of pediatric endocrinologists (12) to treat these patients, exacerbates these challenges. Thus, there is a need for novel and alternative models of health care delivery for adolescents with type 1 diabetes that address behavioral and psychological barriers to diabetes management and dietary management and are more time-efficient for diabetes clinicians. Multiple models for integrated pediatric care of type 1 diabetes exist and aim to meet American Diabetes Association (ADA) guidelines for care (13). The ADA recommends a collaborative care approach among HCPs and families, including the incorporation of shared decision-making, medical nutrition therapy, and psychosocial support during routine ambulatory care visits (13). These treatment teams may include endocrinologists, advanced practice nurses, physician assistants, dietitians, certified diabetes care and education specialists (CDCESs), social workers, and psychologists. Multidisciplinary care, typifying much of type 1 diabetes care in the United States, engages several disciplines, but each discipline stays within its boundaries, and knowledge of other disciplines …