St. Michael’s Hospital Young Adult Diabetes Clinic shares insights into engaging and improving care
July 23, 2018
Young adults are confronted with a plethora of changes as they gain their independence. Many leave home for the first time to attend post-secondary school and must learn how to manage their time, money and health.
It means juggling long nights of studies, fast food, new relationships, social pressures and often working part-time jobs to offset the rising cost of tuition and living.
Dr. Andrew Advani, Staff Endocrinologist at St. Michael’s Hospital and an Associate Professor in the Department of Medicine at the University of Toronto has a unique window of understanding into this cohort.
His multi-disciplinary clinic is devoted to helping care for young adults (aged 18-24) who must manage their type-1 diabetes on top of all of the aforementioned stressors.
“At the St. Mike’s clinic, our team is very cognizant of the fact that patients are also often dealing with a lot of other issues on top of their diabetes. We try to help them navigate that process and steady the ship. It is a multi-disciplinary clinic, so they are seen by a physician, a nurse educator, a dietitian and a social worker,” says Advani.
Many young adults struggle with self-management of their blood- glucose and are at an increased risk of mental health issues at a time when they are busier than ever and adjusting to their new world.
“A lot of what we do in diabetes management for this age group, is to listen and understand, but we are also always striving to find ways to improve their diabetes control and help them self-manage.”
The philosophy of the young adult diabetes clinic at St. Michael’s Hospital is founded on three central tenets:
1) Safety – Making sure that this vulnerable, transitioning population does not develop acute complications of diabetes such as hypoglycemia or diabetic ketoacidosis (DKA).
2) Connectivity – Trying to form relationships with young people with diabetes so that they feel comfortable and trust the team. Then they are more receptive to support.
3) Empowerment – Trying to ultimately reach the point where individuals are ready to take full responsibility for their diabetes and be independent. The goal of the clinic is to give young patients the tools they need so they can feel confident in managing their own diabetes.
The clinic currently cares for around 150 young people with diabetes. The healthcare team strives to see patients every three months, offering increased clinic hours at peak times throughout the year when young adults are likely to be more available for appointments.
These high-volume times tend to be at the end of December during their vacation time, the end of April when the school year ends, and then at the end of August just before students prepare to return to school.
Advani stresses that, “When looking at how to establish a clinic for young adults with diabetes we have to look beyond just conventional outcome measures such as glycemic control and A1c. We are also looking at reducing the risk of acute diabetes complications and measuring the rate of loss to follow-up.”
To better understand the challenges young adults with diabetes face in their daily lives, Dr. Advani and his team have been conducting qualitative research interviews with young adults with type-1 diabetes and their parents.
“We’ve been conducting this research with Dr. Janet Parsons, Dr. Cheryl Pritlove, Ben Markowitz at St. Michael’s Hospital and with Dr. Geetha Mukerji at Women’s College Hospital. What we know is that this generation spends a lot of time on social media, Instagram, Snapchat and other platforms that are all about telling stories. People in their late teens and early 20’s often perceive themselves in the context of the stories that they tell. So, we have been collecting their stories to better understand what it’s like to be a young person living with type-1 diabetes.”
Advani says, “We’ve also come to realize the ongoing importance that the parents of young adults with type-1 diabetes play in their adult child’s diabetes care, but really very little is known about things from the perspective of their parents. We believe that there are important lessons that can be learned from listening to the families, so we’ve extended our interviews to include these family members.”
“It’s important to realize that every patient, particularly within this young adult cohort, is at a different stage in their diabetes journey and their life journey. So, we need to provide advice and support that is tailored to that individual,” says Advani.
The Power of Video
One new strategy that the clinic has recently deployed to help educate and support young adults with diabetes is through short, easy-to-understand diabetes videos – resources that people can view from the comfort of their homes, or play on a tablet computer at the clinic or on the TV screen in the patient waiting area.
Traditionally, healthcare educational materials have been delivered through print or online brochures. Recognizing that young people access information online and prefer an interactive medium like video, it made sense to try something new.
So, Advani and Parsons worked with the animation company 3:AM Design to create a 3-minute explainer video about diabetic ketoacidosis (DKA) and the results speak for themselves.
The video was published in June of 2017 and, to date, has received more than 15,000 views on YouTube. As a result of their clever, creative work, the video project won a special commendation from the Canadian Institutes of Health Research in January of 2018.
Thanks to its success, a second video on hypoglycemia has been developed, with the intent to eventually build a video library under the DiaBiteSize banner that everyone can benefit from.
About Dr. Andrew Advani:
Dr. Advani was appointed to Staff at St. Michael’s Hospital in 2008. He is a Fellow of the Royal College of Physicians (UK). He has over 70 publications and has won awards from the Royal College of Physicians (UK), Diabetes Canada, the Canadian Society of Endocrinology and Metabolism and the Banting and Best Diabetes Centre. Research in the Advani Lab is supported by the Canadian Institutes of Health Research, Diabetes Canada, Heart and Stroke Foundation of Canada, the Banting and Best Diabetes Centre and the Kidney Foundation of Canada.