Endocrinology Outcomes

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Why Choose Us: Endocrinology

Our Outcomes: The Results of Our Care

Nemours pediatric endocrinologists specialize in diagnosing and treating children with hormone disorders or diseases of the endocrine system. Families come to us from all over the world to receive top-quality care from our top experts in pediatric endocrinology.

A big part of our endocrinology care is helping children with diabetes. Our Nemours board-certified pediatric endocrinologists are specially trained in helping families learn to successfully manage type 1 diabetes (formerly called “juvenile diabetes), type 2 diabetes and maturity onset diabetes of youth (MODY) which are inherited forms of diabetes caused by different gene mutations. Our teams of experts offer the latest treatment therapies, and provide the tools, personalized treatment plan, and ongoing education and support your family needs to help your child maintain a healthy lifestyle.

Why Measuring Results Matters

To provide pediatric care that is safe and effective, we measure our results and compare them to national pediatric rates. Why? So we can:

  • help you make decisions about your child’s care
  • be clear about our results
  • improve so we can consistently deliver better, safer care

Here are a few of the outcomes we track and focus on to improve the experience for both you and your child.

 

Teaching Families About Their Child’s Condition

Teaching Families About Their Child’s Condition


Diabetes Educators Help You Adjust to — and Manage — Life With Diabetes

When your child is diagnosed with diabetes you have to learn and understand so much — from how to check blood sugars to how certain foods affect the body. That’s why it’s so important for families to meet with certified diabetes educators (CDEs) at least once a year as part of their ongoing follow-up care. CDEs are health care professionals who specialize in treating people with diabetes. They can be nurses, dietitians, pharmacists, doctors, social workers or other professionals who’ve passed a national exam that certifies them to teach people who have diabetes how to manage their condition. Our diabetes educators are certified by the American Diabetes Association, which recommends ongoing, individualized diabetes self-management education (called “DSME,” for short).

Nationally, only 76 percent of patients are seeing a diabetes educator or nurse every year. At Nemours, our rate is 90 to 100 percent. We’re here to help answer your family’s questions, address your concerns, and hopefully make living with diabetes every day a little easier.

 

Percentage of Patients With Type 1 Diabetes Who Met With a Diabetes Educator or Nurse in the Past 12 Months

100%

Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)

99%

Nemours Children’s Hospital (Orlando)

90%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

76%

National Average (Benchmark)

 

Data source: Data collected from 2016 electronic health records of diabetes patients at Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.); Nemours Children's Hospital (Orlando); and Nemours Children's Specialty Care, Jacksonville (Jacksonville, Fla.).
Benchmark: Recently published data obtained by the SEARCH for Diabetes in Youth study detailed the level of DSME provided in five major pediatric diabetes centers across the United States. The national data was pulled from almost 1,300 patient questionnaires.

Helping Kids Emotionally Cope With Diabetes

Helping Kids Emotionally Cope With Diabetes


Making Sure Children Get Psychological Care Too

Living with diabetes can be very overwhelming and stressful for children and their families, especially at first. You have to worry about blood sugar levels, insulin shots, and what your child can and can’t eat. Kids may feel isolated or different from their peers, sad, angry, afraid, frustrated, confused, resentful, anxious and/or embarrassed. They may even be in denial — and want to pretend that they don't have diabetes. They also may have disordered eating. If left unaddressed, psychological problems for kids with diabetes can contribute to poor glycemic control and long-term complications. 

Children with any kind of chronic disease may have a hard time coping with the ongoing stress of living with their condition and/or going through treatment, day in and day out. So they may experience depression, anxiety and/or posttraumatic stress disorder (PTSD). That's why at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.):

  • Our diabetes patients get a thorough assessment by our in-house psychology team and social worker. Every child has an individual assessment as well as a family assessment in order to identify any potential barriers and hurdles to helping the child receive excellent care. We schedule ongoing, outpatient appointments with psychology if they need it.
  • We refer children to psychology and/or social work whenever they're admitted to the hospital for a new diabetes diagnosis, or are sent back to the hospital (readmitted).
  • We offer a multidisciplinary Diabetes Care Collaborative Clinic, which takes place once a week and includes care by a certified diabetes educator/nurse and a psychologist. This allows for a “one stop shop” for both diabetes and mental health care.
  • We include members of the psychology division in our weekly staff meetings so we can give our mutual patients streamlined, comprehensive care.

We want to make sure children’s bodies and emotions are feeling as healthy as possible.

 

Psychological Assessment and Care for Patients With Type 1 Diabetes

98%

Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)

58.4%

National Average (Benchmark)

 

Data source: Data collected from electronic health records of diabetes patients at Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.), 2014-2016.
Benchmark: The International Society for Pediatric and Adolescent Diabetes (ISPAD) published the Clinical Practice Consensus Guidelines in 2014 for psychological care of youth with type 1 diabetes. The general recommendation is: “Resources should be made available to include professionals with expertise in the mental and behavioral health of children and adolescents within the interdisciplinary diabetes health care team. These mental health specialists (MHSs) should include psychologists and social workers. All mental and behavioral health specialists should have training in diabetes and its management.”
Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL; International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes. 2014 Sep;15 Suppl 20:232-44. doi: 10.1111/pedi.12191.
de Wit M, Pulgaron ER, Pattino-Fernandez AM, Delamater AM. Psychological support for children with diabetes: are the guidelines being met? J Clin Psychol Med Settings. 2014 Jun;21(2):190-9. doi: 10.1007/s10880-014-9395-2.
Jaacks LM, Bell RA, Dabelea D, et al. Diabetes Self-Management Education Patterns in a US Population-based Cohort of Youth with Type 1 Diabetes. Diabetes Educ. 2014;40(1):29-39. doi:10.1177/0145721713512156.

Helping Kids Stay Out of the Hospital

Helping Kids Stay Out of the Hospital


Preventing Hospital Readmissions for Children With Diabetic Ketoacidosis

Glucose (the principal body sugar) is the body's main energy source. But when the body can’t use glucose for fuel — like when a person has untreated diabetes — the body breaks down fat for energy instead, producing chemicals called “ketones,” which appear in the blood and urine. High levels of ketones cause the blood to become more acidic, often resulting in a condition known as “diabetic ketoacidosis” (DKA). Ketoacidosis can become a severe, life-threatening condition that requires immediate treatment.

When a child has to be admitted to the hospital for DKA, we want to make sure they don’t need to come back (this is called “readmission”) because a problem wasn’t properly recognized, treatment was incomplete, or families didn’t understand what was happening with their child. At Nemours, we’re able to help prevent readmissions through:

  • intensive diabetes education at diagnosis and after discharge
  • a team of specially trained diabetes educators, nutritionists and a licensed family counselor who routinely participate in kids’ care
  • follow-up visits every three to four months
  • education regarding sick days, and having a clearly defined sick day management plan
  • making sure patients have all diabetes management supplies, including insulin

 

90-Day Unexpected Readmission Rate for Diabetic Ketoacidosis

Less than 5%

Nemours Children’s Hospital (Orlando)

Less than 1%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

0%

Nemours Children’s Specialty Care, Pensacola (Pensacola, Fla.)

As high as 10%

National Average (Benchmark)

 

Data source: Data collected from electronic health records of Nemours diabetes patients admitted in Florida: Orlando (Nemours Children’s Hospital) and Jacksonville (Nemours Children’s Specialty Care, Jacksonville patients admitted to Wolfson Children’s Hospital), 1/1/15-12/31/15 and 1/1/16-09/30/16; Pensacola (Nemours Children’s Specialty Care, Pensacola patients admitted in 2017 to The Studer Family Children’s Hospital at Sacred Heart). 
Benchmark: T1D Exchange Clinic Network, an epidemiological database that currently includes 76 pediatric and adult endocrinology practices in 33 states. Their findings were recently published in Diabetes Care ("Current State of Type 1 Diabetes Treatment in the US: Updated Data from the T1D Exchange Clinic Registry," Volume 38, June 2015).

Keeping A1c Levels in Check

Keeping A1c Levels in Check


Monitoring Kids’ Glucose to Keep Their Type 1 Diabetes Under Control

A hemoglobin A1c test (called an “A1C test” or "the glyco," for short) measures how high or low the glucose levels have been for the past three months. If a child with type 1 diabetes has a high hemoglobin A1c, it prompts a full assessment including adjusting insulin doses, modifying diet and exercise, and examining issues of compliance with the program (in order to keep their diabetes under control and decrease the risk for complications).

Poor diabetes control can lead to:

  • serious short-term problems such as severe hypoglycemia (low blood sugars), hyperglycemia (high blood sugars) or DKA
  • long-term complications, damaging the vessels that supply blood to important organs, like the heart, kidneys, eyes and nerves

At Nemours, our patients’ A1c levels often fall below the national averages. We strive to help kids and their families keep diabetes in good control so that they can stay as healthy as possible.

 

Average A1c in Type 1 Diabetes Patients, Ages 0–5

8.1%

Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)

8.5%

National Average (Benchmark)

 

Average A1c in Type 1 Diabetes Patients, Ages 6–12

7.9%

Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)

8.4%

National Average (Benchmark)

 

Average A1c in Type 1 Diabetes Patients, Ages 13–19

8.3%

Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)

8.6%

National Average (Benchmark)

 

Data source: Reports generated through our electronic health records for type 1 diabetes patients at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.) to compare our average A1c to the national average that was recently reported by the T1D Exchange, a U.S.-based epidemiological registry of adults and children with T1D. Children with T1D were separated by age for all visits between 1/1/16 and 09/30/16. The average A1C for each age group was calculated and compared to the national average.
Benchmark: T1D Exchange Clinic Network, an epidemiological database that currently includes 76 pediatric and adult endocrinology practices in 33 states. Their findings were recently published in Diabetes Care ("Current State of Type 1 Diabetes Treatment in the US: Updated Data from the T1D Exchange Clinic Registry," Volume 38, June 2015).

Average A1c in Type 1 Diabetes Patients, Ages 2–6

8.0%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

8.2%

National Average (Benchmark)

 

Average A1c in Type 1 Diabetes Patients, Ages 6–13

8.0%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

8.5%

National Average (Benchmark)

 

Average A1c in Type 1 Diabetes Patients, Ages 13–18

8.6%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

9.0%

National Average (Benchmark)

 

Average A1c in Type 1 Diabetes Patients, Ages 18–25

7.6%

Nemours Children’s Specialty Care, Jacksonville (Jacksonville, Fla.)

8.7%

National Average (Benchmark)

 

Data source: Reports generated through our electronic health records for type 1 diabetes patients at Nemours Children's Specialty Care, Jacksonville (in Jacksonville, Fla.) to compare our average A1c to the national average that was recently reported by the T1D Exchange, a U.S.-based epidemiological registry of adults and children with T1D. Children with T1D were separated by age for all visits between 1/1/16 and 09/30/16. The average A1C for each age group was calculated and compared to the national average.
Benchmark: T1D Exchange Clinic Network, an epidemiological database that currently includes 76 pediatric and adult endocrinology practices in 33 states. Their findings were recently published in Diabetes Care ("Current State of Type 1 Diabetes Treatment in the US: Updated Data from the T1D Exchange Clinic Registry," Volume 38, June 2015).

Our Differentiators: What Sets Us Apart

Our Differentiators: What Sets Us Apart


Why Choose Nemours Endocrinology

Here are just some of the reasons families choose Nemours for their children’s endocrinology care:

  • Comprehensive care for kids. Along with our board-certified pediatric endocrinologists, your child's comprehensive care team includes nurses with advanced training, registered dietitians, licensed clinical social workers, psychologists and certified diabetes educators. Moreover, we’re backed by more than 30 medical specialties that also specialize in caring for children and teens.
  • Centers of excellence for pediatric diabetes care. Our endocrinology practices at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.); Nemours Children's Hospital (in Orlando); Nemours Children’s Specialty Care, Jacksonville; and Nemours Children’s Specialty Care, Pensacola are recognized as a Center of Excellence by the American Diabetes Association (ADA). This distinction recognizes our efforts to provide a high standard of diabetes care and education.
  • State-of-the-art technology. Nemours endocrinologists offer our patients the most contemporary, advanced technology. From smart insulin pumps, to continuous glucose monitors, to hybrid closed loop artificial pancreas systems, our diabetes teams are ready to help families using the best available technology to improve their children’s care.
  • Cutting-edge research. Our physicians are involved in important clinical research and clinical trials to look for better ways to diagnose and treat childhood endocrine conditions. Nemours researchers and specialists at our pediatric clinical research units and labs in the Delaware Valley and Florida investigate diabetes, obesity, growth and nutrition.
  • Kids come to us from outside the area for second opinions. Because of the extensive research efforts of our dedicated physicians and scientists, children diagnosed with complex conditions from around the United States and abroad are referred to Nemours. Disorders of growth and puberty are a common reason for referrals and second opinions.
  • Award-winning physicians. Year after year, many on our team are recognized in “Best Doctors in America®” and local magazines as “Top Doctors” in our regions.
  • Expert providers recognized for our medical contributions. We’re active in local, national and international professional societies. We also regularly share our knowledge at scientific meetings and in peer-reviewed medical journals.
  • Transitioning kids into adult care. After caring for our patients throughout their childhood, we help college-age teens with diabetes learn how to advocate for themselves and manage their own care.
  • Award-winning electronic health records (EHR) system. Our EHR helps us keep all of our providers on the same page. And MyNemours, the parent portal of our EHR, gives you secure access to your child’s records and allows you to communicate by email with your provider(s).
  • Personalized, family-centered care. We treat every child as we would our own, and include you in every decision because we recognize that you know your child best. We work together to address your child’s physical, emotional and social needs at every step.