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Barbara Davis Center for Childhood Diabetes - Clinical Services

 

A brief description of the Barbara Davis Center's clinical facilities is provided below. For more detailed clinical information, visit the Barbara Davis Center's website at www.barbaradaviscenter.org.

General Care Program for Pediatric Patients
The general care program provides families and patients with an understanding of type I diabetes and encourages their confidence in its day-to-day management. The expectation is that by the time patients are ready to leave home for college or the work force, they will have the ability to manage their own blood sugars. Present evidence strongly suggests that consistent blood sugar control greatly diminishes the chances of long-term eye and kidney complications. Our pediatric endocrinologists participate in DirecNet, which investigates improvements in glucose monitoring technology by following patients in clinical trials at our Center. Together with the Adult Clinic, the BDC has been a driving force in diabetes care in the development of new technology for insulin delivery systems and blood glucose monitoring with the goal of constantly improving the management of type 1 diabetes (T1DM) in children and improving long-term outcomes in patients worldwide.

New Onset Classes
Newly diagnosed patients are referred to the Barbara Davis Center from all over Colorado as well as from neighboring states throughout the Rocky Mountain Region. Newly diagnosed patients and their families are given intensive and comprehensive individual training, care, and counseling on a day-to-day basis from clinical care team members. Once a week, a half-day, new-onset class is held for newly diagnosed patients and their families. Newly diagnosed patients continue to be followed intensively, with daily contact if needed, until the patient and family are comfortable with their care and in good control. Most patients will eventually be seen routinely four times a year. However, providers and help are available 24 hours a day, 7 days a week for changes in regimens, emergencies, and illnesses.

All newly diagnosed patients and their families receive a copy of the “Pink Panther” - First Book for Understanding Diabetes - written by one of our clinicians, Dr. H. Peter Chase, available both for purchase and online. The Pink Panther series includes multiple editions, a new Spanish version, and a book written especially for very young patients, as well as a book for new insulin pump users.

Special Courses
The Pediatric Clinic encourages opportunities for continuing education, participation in local support groups, special outings and parties arranged by the Guild of the Children’s Diabetes Foundation, and attendance at annual summer camps sponsored by the Colorado American Diabetes Association. Many of our medical staff, as well as many other employees who have type 1 diabetes themselves, volunteer to staff the camps each summer.

In addition to individual family instruction, the Center runs a number of special one-day courses each year. These include the College Workshop, Grandparents Workshop, and "New to Clinic" Workshops. A national conference for health professionals on childhood diabetes is held every two years.

Clinical Psychology
Many of the obstacles to efficient control of blood sugars are due to important difficulties with family psychosocial issues. The clinic specializes in this field and works with families both on an individual and group basis.

For more information about The Pediatric Clinic, please visit this website:
Barbara Davis Center - Pediatric Clinic

Diabetes Endocrine Specialists
Physician/endocrinologists care for the Center's adult patients (age >18 years) with type 1 diabetes. Those who have been followed in the Center as adolescents often continue to be seen during their adult years, and the clinic accepts new onset adult patients with type 1 diabetes as well as referrals of adult patients with type 1 diabetes. Every patient receives comprehensive diabetes care including services of physicians, nurse practitioners, dieticians, and certified diabetes educators. Patients receive point-of-care A1C testing during each visit and blood draws for all commercial laboratory investigations and research studies if they have signed a research agreement. Opportunities exist for participation in numerous ongoing clinical trials that may be discussed during their clinic visits. The Adult Clinic has facilities for performing an electrocardiogram and Doppler studies to evaluate for peripheral vascular disease if required.

Pump Initiation and Follow-Up Clinics
The Adult Clinic offers pump information classes once a month for patients who are interested in pursuing pump therapy. The class discusses the pros and cons of pump therapy and the different pump options that are available. Patients also have the opportunity to visit with the representatives of different companies who sell the pumps to learn specific features of each device. Before initiating pump therapy patients are encouraged to attend a carbohydrate-counting class held once a month. All insulin pumps are initiated on an outpatient basis beginning with a pump initiation clinic that meets twice a month. The pump clinic is scheduled to facilitate interpatient discussions. The patients continue to work with the nurse practitioner on a daily basis (phone or fax reviews) and return after two weeks for a follow-up visit. The patients may return for an advanced pump class once they are comfortable with the basic pump features.

Continuous Glucose Monitoring Program
The continuous glucose monitoring (CGM) program of the Adult Clinic consists of three components. Patients attend a class introducing them to CGM that allows them to learn about the available products in the market. After attending this informational session, patients work with their insurance companies to seeking coverage for their unit. Secondly, the patients attend a class teaching them the concepts of CGM and operation of the devices. The success of the CGM program is highly dependant on proper understanding of CGM management using each patient’s chosen device. Finally, the patients return after 2-4 weeks of initiating CGM to meet with their provider and educators to “fine tune” their insulin regimen and to focus on the attainment their target A1C levels in concert with the reduction of hypoglycemic episodes.

Pregnancy Program
The Adult Clinic has an extensive pregnancy program for women with type 1 diabetes. This program focuses on educating patients on planning pregnancies. The program integrates several technologies and tools that include CGM, insulin pump therapy, and detailed dietary instructions aimed at achieving excellent glucose control prior to conception in order to improve pregnancy outcomes. Patients see their physician and educators every 2-4 weeks during their pregnancy. BDC physicians work closely with obstetricians in the community to ensure that patients are provided state-of the-art care. We have had over 200 babies born to our type 1 diabetes patients in the past five years. The Center hosts a large party each year honoring our mothers with type 1 diabetes and their offspring.

Cardiovascular Clinic
The Cardiovascular Clinic focuses on macrovascular (large blood vessel) disease associated with diabetes utilizing electrocardiography and peripheral Doppler examinations to detect early heart and peripheral blood flow problems. 24-hour ambulatory monitoring detects variations in elevated blood pressure and/or a loss of diurnal rhythm, risk factors in macrovascular disease.

The Core Laboratory
The Core Laboratory at the Center performs studies that include assays of serum levels of islet cell antibodies and autoantibodies for associated autoimmune disorders, including celiac disease and Addison's disease. These assays can also be performed on patients’ relatives to determine those who are also at risk for developing these diseases. Early detection of autoimmune diseases such as type 1 diabetes dramatically decreases the risk of early and acute complications and, for diabetes, may delay the onset of exogenous insulin requirements.

For more information about The Adult Clinic, please visit this website:
Barbara Davis Center - Adult Clinic

Eye Clinic Mission:

  • To prevent diabetes-related vision loss through accurate and timely detection of diabetic retinopathy
  • To prevent the occurrence and progression of this vision-threatening process by way of thorough patient education

Comprehensive evaluations for diabetic retinopathy are offered to patients of the Barbara Davis Center as well as to persons with Type 1 and Type 2 diabetes in locations across the United States.


Services:

The BDC Eye Clinic is equipped with contemporary equipment that aids in the identification of early and advanced stages of diabetic retinopathy.


Retinal photography

In addition to customary methods of eye examination, photographs of the retina are taken in every patient to aid in the detection of diabetic retinopathy (see examples below). Retinal photography is the gold standard procedure adopted in every major clinical study throughout the world and ensures that even the mildest stages of retinopathy are detected. Several studies have been published, which outline that the combination of live examination and analysis of retinal photos is the most sensitive method for detecting retinopathy. Additionally, photographs are an excellent way to educate patients on eye anatomy and the effects of diabetes on the eye. Additionally, if anything is detected, we can show the patient the specific changes and educate on their significance.

















Optical Coherence Tomography

Optical coherence tomography (OCT) is a relatively new technology. It is essentially an ultrasound of the retina. Unlike routine ultrasounds, OCT uses light waves enabling very high resolution cross-section of retinal layers (see example below). It is commonly used to detect a diabetic condition called macular edema (the most common cause of vision loss in diabetes).








The Fundus Photography and Retinopathy Reading Center (FPRRC)

The Fundus Photography and Retinopathy Reading Center was created in 2007 by Dr. Brian Bucca. The FPRRC functions to allow university and non-university investigators to measure retinopathy outcomes in their diabetic subjects. The reading center has participated in numerous private, industry and NIH-sponsored studies.

Services:

  • 7 standard field stereo photography (digital or 33mm)
  • Early Treatment of Diabetic Retinopathy Study (ETDRS) grading
  • Optical Coherence Tomography

Past Collaborations:

  • Coronary Artery Calcification in Type 1 Diabetes Study (CACTI)
  • Diabetes Primary Prevention Outcomes Study (DPPOS)
  • SEARCH for Diabetes in Youth
  • Novo Nordisk Study 1767
  • Novo Nordisk Study 3594
  • Novo Nordisk Study NN21-1800

Appointments: 303-724-6735
Hours of operation: M-Th: 8:00am – 5:00pm: F: 8:00 – 4:00pm

Click here to go to the Barbara Davis Center Eye Clinic