Catlin Dennis on Understanding COVID-19’s Impact on Vulnerable Youth With Diabetes

For already underserved populations, COVID-19 exacerbated existing social risk factors, said Catlin Dennis, MPH. the program manager of Novel Interventions in Children's Healthcare (NICH) at Doernbecher Children’s Hospital in Portland, Oregon. Dennis’ presentation “COVID-19’s Impact on the Most Medically and Socially Vulnerable Youth with Diabetes” was presented at the American Diabetes Association’s 81st Scientific Sessions.

Transcript

Can you introduce yourself and describe your work?

My name is Catlin Dennis, and I'm the program manager for the NICH program, which stands for Novel Interventions in Children's Healthcare. We're based out of Doernbecher Children's Hospital in Portland, Oregon.

How did you conduct your research on COVID-19’s impact on the most vulnerable youth with diabetes?

Initially, our research really was not very formal. It was meant to inform program-level operations on the fly. We didn't develop the study in a super coherent method originally. It was really just to get information that could help inform program operations in an effort to best support patients and families with their immediate needs, which were rapidly changing because of the pandemic. We didn't have any protected health information (PHI) we were collecting; there wasn't an institutional review board (IRB) attached to it initially. There now is, and we're starting to go back and look in more detail to better understand the impacts that this had on the patients and their families that we serve.

How did you define the most medically and socially vulnerable youth with diabetes?

I think I'll try to separate it out and speak first to how we define medically vulnerable. The way we define this for our kids with diabetes is that these are youth with repeat diabetic ketoacidosis (DKA). Typically, they have around 5 or more in a year, some with as many as 30 to 40 DKAs by the time that we engage with them in the NICH program. The other factor we look for is high glycated hemoglobin (A1C). Most of the kids, by the time we engage with them in the NICH program, they have A1Cs that are above 14%.

Then in terms of social vulnerability, we're really looking at any number of what we call psychosocial vulnerabilities. Most kids report at least 4 or 5 of these. There's quite a lot going on. Many people are familiar with the term ACEs, so we look at adverse childhood experiences that the child may have experienced prior to their 18th birthday. We also look at the social determinants of health that are in play. I think the most frequent that we see across the board for patients that are enrolled in the NICH program are financial insecurity, housing insecurity, and what we would consider to be parent or caregiver challenges. These are large things that are happening in the parent or caregivers' life that may make it really difficult to best support their child with diabetes management. This could include parents that have their own significant health challenges that they're trying to manage simultaneously while supporting their child's health, substance abuse, interpersonal violence, incarceration of a parent or caregiver, or deportation. Then lastly, I think an important component to highlight too is just the experience of racism. We serve a disproportionate number of youth that come from families of color, and Oregon is a very white state. This really represents the health disparities that we see. I think it's really important to acknowledge that the lived experience of many of these children is very different because of racism that they're experiencing in a variety of contexts, but unfortunately, even within the health care system itself.

I think the last thing I would say is, there's a common misperception that these children live in families that are disorganized or neglectful. That's really not the case. We see that these parents and caregivers are deeply committed to supporting their kids, but they just have so many competing challenges happening that the diabetes management really falls to the bottom of the priority list because they're trying to work to keep a roof over their child's head or put food on the table. It's easy to understand how these many stressors going on are interfering with being able to keep diabetes front and center in terms of all of the aspects that go into managing that diagnosis. I think often these families come from intergenerational cycles of financial insecurity and trauma. They've either never been taught some of these skills, or they've never had the privilege of having the time to really sit down and practice and master these skills. That's what we try to help support them with.

What were the main findings of your research?

Some of the main findings, we boiled it down to 3. For this already underserved population, I think COVID-19 really exacerbated existing social risk factors like unemployment, transportation difficulties, food insecurity, rent insecurity. This kind of goes along to the second finding that, unfortunately, we found that the pandemic really hit communities of color the hardest, which was consistent with a lot of the nationwide data that were coming out. In terms of diabetes management, I think we had a somewhat surprising finding in that our families were really split. We had families that, in terms of supporting their child's diabetes management, really, really struggled as a result of the pandemic and we had other families that were actually doing the best they've ever done for a number of reasons because of the pandemic and just the unique environment it presented. That actually worked in their favor in terms of improving the management of their child's health.