T2D Pediatric Working Group November 8, 2024
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T2D Pediatric Working Group 11/8/2024: 11:00am
Attendees: Ori Odugbesan, Timothy Bol, Ryan Brad, Alissa Guarneri, Grace Kim, Leena, Mamilly. Nicole Rioles, Sean DeLacey, Risa Wolf, Monica Bianco, Megan Kelsey, Rohan Henry, Mili Vakharia, MD, Sejal Shah, Shylaja Srinivasan, Shideh Majidi
Introductions were made. Aims for the group will be made today, KDD – IRB Approval needed.
A1c Outcomes were suggested by Ori. Risa Wolf, MD asked about some ideas that were previously discussed by this group. Ori mentioned 5 measures that we have already discussed. A1c seems like the primary driver. A1c, prescription of statin, SGLT2 inhibitor, GLP, or BMI
The KDD was shared and opinions were solicited: Megan, first thing we should do is have a1c as an outcome fees like we should have every class of medication in the key driver. Measuring how insulin is being used affects BMI so that should be included, as well. There is less use of insulin these days so that should be considered in our focus. The group is aligned with the aim as it is general enough to include medications that are not included in the smartsheet. “increasing by 10%” language was approved by the group. Ori suggested selecting top 3 medications fo the pruose of this exercise. Feasibility of getting patients on medications was raised. Simplify even more by saying “Non insulin medications”? Ori agreed. Questions were raised about “populations” which was responded to by some medications not being available to children under 10 years of age. The world “eligibility” was ambiguous enough? Megan thinks we should have uniform eligibility across the network and proposed a minimum age of 10. Everyone agrees to change the language to read “eligible for populations 10 and above”. A question was asked about terzepitide but no one uses it so no need to include it. Private insurance doesn’t cover it but public does, and other institutions have the opposite experience. Nicole asked if we should change Glp reception agonist classes to something else and what that should be? No response.
Primary Drivers – “Standardized practice care…” standards have been rapidly changing so what does this mean. Discussion occurred about how metformin is not included and limited guidance on treatments due to insurance coverage so it’s difficult to standardize practices. Change standardized guidelines and the group believes this will translate to better bmi outcomes and not an unreasonable plan.
Secondary Drivers – For providing self management support, a question was asked if any centers had any success with tracking education? Templates help resolve that issue – there is already a pattern established for T1, there is a template for T2, Ryan Murphy from Children’s Mercy would be a great resource due to their success in tracking what patients have learned over time and other information. Scoring tests after education for T1, but changing just a few questions to be relevant for T2 is in the works. One center has hundreds of handouts ready for patients. The group agrees that this is a great opportunity for further action.
Change Ideas – Feedback for adding Metformin in the last box was. “Promotes patient use” for insulin we are trying to decrease usage, specifically short acting insulin for now. Nicole, shall we specify long acting insulin or removing insulin as a whole? Don’t remove it, as it is necessary, but we are trying to promote not using short acting insulin in the care of patients with T2. Language about ACE inhibitors and minimizing triglycerides was discussed. It was also suggested for this effort, we should address the insurance coverage problem, through better appeal letters or advocacy, she feels this is an important driver in this particular outcomes. Adding it to the change ideas is a good idea. Nicole loves that idea. Can we go to State legislators for better coverage? A secondary driver was decided would be a great addition.
Next Steps – update and modify the KDD while each group is working internally to make the data reports for Smartsheet in addition to data mapping and have an example by the end of the year.
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