Navigating diabetes can feel like an uphill climb for children and their families, requiring a complex regimen of blood sugar monitoring, insulin injections, and careful dietary planning. At Duke Children’s, the diabetes program, which sits within the Division of Endocrinology in the Department of Pediatrics, offers more than just clinical care. It aims to equip children and their families with the tools, skills, and support they need to navigate the challenges of diabetes and thrive.

PEDIATRIC DIABETES: A GROWING EPIDEMIC

Diabetes is a chronic disease that affects how the body produces and uses insulin, the hormone that helps regulate blood sugar levels. Type 1 diabetes, the most common type among children, occurs when the body’s immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Type 2 diabetes, often diagnosed in adults but increasingly affecting children, occurs when the body becomes resistant to insulin and subsequently fails to produce adequate amounts.

The Centers for Disease Control and Prevention (CDC) estimates that 1 in 10 Americans have diabetes, including a shocking 50 percent who are unaware of their condition. Among children, the rate of diabetes is on the rise. More than 350,000 children under 20 are living with the disease, representing approximately one in every 285 adolescents. These numbers are expected to increase exponentially by 2050 to an estimated one million children diagnosed with diabetes in the United States.

In addition to health risks, diabetes has a significant economic impact, with annual health care costs exceeding $400 billion. This figure is projected to grow substantially as the disease becomes more prevalent, placing a greater burden on the health care system.

BEYOND BLOOD SUGAR: DUKE CHILDREN’S HOLISTIC APPROACH TO PATIENT SUPPORTS

For more than a decade, 18-year-old Jasmine Pipkin has been navigating the complexities of Type 1 diabetes with the support of Duke Children’s pediatric diabetes program.

“Living with diabetes is difficult when you’re a child. Simple things like school lunch, going to a birthday party, or participating in extracurricular activities aren’t easy when you constantly have to manage your blood sugar,” shared Pipkin. “I am so thankful for my mom. She would make sure I was on track with taking my insulin. I appreciate everything she’s done for me. Other than her, the people at Duke Children’s have been my loudest cheerleaders. They’ve become like family to me.”

When a child is diagnosed with diabetes at Duke Children’s, they receive a customized treatment plan to help them maintain healthy blood sugar (A1C) levels. But this is just the beginning. Every patient and their family is partnered with a dedicated team of experts, and together they work to achieve optimal diabetes control. Members of this team, including a nurse practitioner, certified diabetes educator, nutritionist, and social worker, provide ongoing support to help children and their families manage their chronic condition, prevent complications, and achieve excellent outcomes.

“At Duke Children’s, we believe in the power of collaboration to improve the quality of life for our pediatric diabetes patients. Our clinicians and support teams are available around the clock, providing hands-on care, while as researchers, we are working to translate discoveries into real-world benefits for young patients, ensuring they have access to the most advanced diabetes treatments now and in the future,” said Pinar Gumus Balikcioglu, MD, MHSc, associate professor of pediatrics.

REDEFINING DIABETES CARE: A NEW MODEL

The Duke Children’s pediatric diabetes program is committed to providing comprehensive care that extends beyond conventional clinic visits. One such program being pioneered is the INNOVATIONS Quality Improvement project (“INNOVATIONS”), designed to engage and assist Medicaid patients and their families between traditional quarterly clinic appointments. Launched in 2021, this program is led by Robert Benjamin, MD, professor of pediatrics; Lisa Rasbach PhD, CPNP; Ginna Purrington, RN, BSN, CDCES; and Deanna Adkins, MD, associate professor of pediatrics. INNOVATIONS aims to improve diabetes control and reduce the number of emergency department visits and hospitalizations.

“INNOVATIONS works with kids who are having a tough time meeting the blood sugar goals that will put them in the position to live a long and healthy life with diabetes. By making changes 

now, we can save health care dollars in the future and, more importantly, improve the long-term quality of life of these kids and their families,” said Purrington. “Our participants have demonstrated sustained, statistically significant improvements in their blood sugar levels, often lasting for two years or more following program completion.”

Made possible through a generous grant, INNOVATIONS has served dozens of children, offering these pediatric patients ages 2-18 and their caregivers intensive diabetes support. This includes weekly calls with a diabetes nurse educator, monthly video visits with a nurse practitioner, and access to a nutritionist, social worker, and other services as needed. The program’s goal is to empower patients and families to manage diabetes effectively at home and prevent complications.

According to Benjamin, “The INNOVATIONS program has played a significant role in improving the quality of life for kids with Type 1 diabetes and reducing the risk of serious complications. Our 360-degree approach gives empathetic and individualized attention to each patient and equips their families to help them achieve better blood sugar control.”

A former participant in INNOVATIONS, Pipkin credits the program with providing the tools and knowledge she needed to take command of her health as she transitioned to young adulthood. Lisa Rasbach, Pipkin’s primary diabetes care provider, notes, “The program has helped support Jasmine’s efforts in optimizing her diabetes management and life with diabetes.”

A LIFELONG PARTNERSHIP

Despite the day-to-day challenges that come with managing her diabetes, Pipkin has been determined to live a normal life and pursue her goals. Under the watchful eye of Rasbach, Pipkin has thrived. Rasbach’s unwavering dedication and expertise have been influential in guiding Pipkin through the ups and downs of managing her condition and gaining access to life-changing technology.

Pipkin explains, “Lisa has been an incredible source of support. I absolutely love her. She is always there to answer my questions, give advice, and offer encouragement. She even pushed me to consider new treatment options.”

A game changer for Pipkin has been the introduction of technology. Use of a continuous glucose monitor (CGM) system and insulin pump has transformed her diabetes management, allowing her to track her blood sugar levels in real-time and make informed decisions about her insulin intake. Pipkin shares, “The CGM was a turning point for me. It has given me freedom and peace of mind.”

The INNOVATIONS program has also provided Pipkin with valuable, consistent emotional support. Weekly check-ins with Purrington and monthly visits with Rasbach have been essential in helping her navigate the psychological challenges that often come with living with diabetes. “It’s been incredible to have a support system that genuinely gets what I’m facing,” Pipkin says.

HOPE FOR A BRIGHT FUTURE

As the rate of diabetes continues to rise, especially among children, the Duke Children’s pediatric diabetes program persists in providing comprehensive care that extends far beyond traditional clinic visits. Through unique initiatives like INNOVATIONS, dedicated and caring clinicians, and an advanced support team, children and their families are able to effectively manage the complexities of diabetes. Duke Children’s investment in diabetes prevention through research, community outreach, and education is building a foundation for a future with lower rates of diabetes and improving the overall health and well-being of children now and for generations to come.

“They’ve given me the strength and motivation I need to keep going,” Pipkin says of her Duke Children’s team. “My advice for other kids is to keep striving and never give up.”