Children diabetes and nutrition clinic (CDNC) initiative in phra nakhon sri ayutthaya hospital

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND. Objective: To provide one-stop services of health care model of children with nutritional problems such as childhood obesity, diabetes mellitus, and failure to thrive at a regional general hospital setting. Additionally, to establish the Children Diabetes and Nutrition Clinic (CDNC) as a conceptual model staffed by a multidisciplinary teamwork at the regional setting that will help to improve the disease outcomes and efficiency of care and management. Materials and Methods: The present study was an action research, conducted at Diabetic Mellitus and Nutrition Clinic in Phra Nakhon Sri Ayutthaya Hospital. The present study enrolled all children younger than 15 years old who attended the outpatient department (OPD) with malnutrition problems (childhood obesity, failure to thrive, and diabetic mellitus). The line of care was divided into three groups based on disease categories or problems. The one stop services with a multidisciplinary team, consisting of pediatricians, general practitioners, dietitians, pharmacists, and nurses, was engaged to educate, manage, care, and follow-up the patients, and compare the clinical outcomes and successful rate of treatment at baseline, 6 months, and 12 months after the treatment. Results: The gradual reduction rate of obese children, with improvement of weight for height (W/H) at 6 and 12 months after going through the CDNC model, were 20%, 40% of reduction, respectively (p<0.05). Patients with persistent progressive weight gain were admitted in the "Weight reduction camp"and closely followed up by the multidisciplinary team. They also used "line"group-application to enhance compliances and adherence during the follow-up period. The diabetic patients were adjusted to receive standard insulin protocol correctly. They also changed to basal bolus and modified the basal bolus regimens if the conventional regiment did not work. Patients were follow-up and screened to micro and macro-vascular complications and appropriated referred to endocrinologists if needed. The causes of the diseases of the patients that failed to thrive were explored and the appropriate care, treatment, and followed up were provided. Conclusion: Children with nutritional problems, especially obesity, are increasing. Additionally, there is a lack of appropriate care because of the lack of sub-specialty and resources in sub-urban and rural setting. A multidisciplinary teamwork that includes pediatric nutritionist, pediatric endocrinologist, nurse, and dietitian, as well as long-term follow-up plan are needed. The authors demonstrated the CDNC model of care and management of these patients by a multidisciplinary team at a regional general hospital setting. The improvement and success of the CDNC model is recommended to establish good clinical outcomes and parameters.