Shared Medical Appointments to Improve Outcomes in Adolescents With Type 1 Diabetes

Adolescents and emerging adults with type 1 diabetes (T1D) experience significant struggles
with their diabetes management resulting in worsening diabetes health and increased
complications. This population's declining well-being occurs during a time when they should
be at their healthiest and enjoying multiple exciting life transitions. Their worsening
diabetes management is complicated by the fact they are also learning how to become more
independent from their family in preparation for eventually leaving home. Furthermore, the
number of people under 20 years of age diagnosed with T1D has increased dramatically over
the past 10 years giving rise to increased concern about providing care to this population.

The Team Clinic Intervention is an innovative clinical care approach to address the medical
and developmental needs of adolescents with T1D and their families. A group medical
appointment format will be used for routine diabetes clinic visits in middle school and high
school adolescents with T1D. Parents of these patients will be participating in their own
group during these clinic visits. The Team Clinic model incorporates developmentally
tailored peer support and novel learning tools, (e.g. games, physical activity, and/or
interaction through Internet resources, e.g. blogs, forums) into the shared medical
appointment design.

The goal of Team Clinic Intervention is to improve medical and psychological outcomes in
adolescents with T1D and their parents. The study will investigate, in a randomized
controlled trial, the efficacy of a novel clinical care model that addresses the unique
developmental strengths and weaknesses of the T1D adolescent population. The Team Clinic
format streamlines clinical care delivery to this often-challenging patient population
without placing additional burden on youth, families, or clinics because the intervention
will be completed during routine diabetes care visits. Moreover, the Team Clinic approach
maximizes the benefits of peer support by delivering care in a group format to address the
sense of isolation that teens and families coping with chronic illness often feel.

If successful, the Team Clinic Intervention will not only positively impact adolescents with
T1D and their families, but it could be used as a model of care for other adolescents with
chronic medical conditions struggling to remain involved and invested in their medical care.
Team Clinics may be one approach to successfully engaging adolescents in their diabetes care
prior to their transition away from home, which will help them remain invested and active in
their medical care through adolescence and young adulthood.