P-44: Fifteen years of sustained improvement in access and outcomes: a dedicated multidisciplinary clinic for high-risk youth with type 1 diabetes (2010–2025)

Introduction

Adolescents and emerging adults with poorly controlled diabetes and adverse social determinants of health are at high risk for disengagement, elevated HbA1c, and recurrent emergency department (ED) visits and diabetic ketoacidosis (DKA). In 2010, we established a Diabetes Multidisciplinary Comprehensive Care Clinic (DM CCC) to provide continuous, individualized care for high-risk patients.

Objectives

To evaluate long-term changes in access to care, glycemic control, and acute care utilization from program inception (2010) through 2025.

Methods

The DM CCC is a team-based model embedded within pediatric endocrinology emphasizing flexible scheduling, individualized goal-setting, psychosocial support, and sustained engagement without premature discharge. Telehealth was integrated in 2020. Outcomes included clinic show rates, mean HbA1c, proportion with HbA1c ≥10%, ED visits, and DKA admissions, obtained via longitudinal EHR review.

Results

Show rates improved from <50% at baseline (2010) to 74% by 2018–2019, increased to 85% with telehealth expansion in 2020–2021, and were sustained at >88% through 2025.

Mean HbA1c decreased from 11.2% (2010) to 9.6% (2019), 9.0% (2022), and 8.5% (2025). The proportion of patients with HbA1c ≥10% declined by >45%.

ED utilization decreased by approximately 35%, and DKA admissions declined by nearly 40% compared with baseline. During the COVID-19 pandemic, while division-wide DKA rates rose among newly diagnosed patients, rates within the established DM CCC cohort remained stable and subsequently declined further post-pandemic.

No patients were discharged for non-adherence; all exits occurred through structured transition to adult care (mean age 19.6 years).

Conclusions

Over 15 years, a relationship-centered multidisciplinary clinic for high-risk youth with diabetes produced sustained improvements in access, glycemic control, and acute care utilization, including during the COVID-19 era. This scalable model advances equity while delivering durable clinical impact.