Mary Lauren Scott, MD is an endocrinologist in the Division of Pediatric Endocrinology and Diabetes at Children’s of Alabama and an Associate Professor at the University of Alabama at Birmingham. Dr. Scott also serves as Director of the High-Risk Diabetes Clinic, the Type 2 Diabetes Intake Clinic, and the Pediatric Endocrinology Fellowship Program at Children’s of Alabama. 

Dr. Scott is a JDRF Board Member and recipient of the JDRF 2023 Volunteer of the Year award for the Southern States Chapter in Alabama.  

 

Interview with Mary Lauren Scott, MD 

In this interview, Dr. Scott discusses her involvement with the T1D Exchange Quality Improvement Collaborative (T1DX-QI), as a pediatric endocrinologist and researcher whose focus is on identifying and addressing practices that perpetuate barriers to equitable care. 

The T1DX-QI was established in 2016 — with the support of The Leona M. and Harry B. Helmsley Charitable Trust — to refine best practices and improve the quality of care and outcomes for individuals living with T1D. Growth has been tremendous, with 62 endocrine clinics from across the U.S. participating in the Collaborative.  

Fueled by top leaders in diabetes care, the T1DX-QI has become an engine of innovation and inspiration. By engaging with its shared, data-driven, and systematic methods, clinics have seen unprecedented success in their approach to diabetes management.  

With members working closely to identify gaps in care, discover and refine best practices, and share research — the process has become knowledge-sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be” by applying shared, evidence-based methods for improving care. 

 

Why pediatric endocrinology? 

“My father was a physician, and I was always that kid who wanted to be a doctor. On top of that, I developed type 1 diabetes in December of my 6th-grade year,” said Scott, whose diagnosis cemented her path in medicine and her eventual career as a pediatric diabetologist at Children’s of Alabama. 

“One of the reasons I picked pediatric endocrinology is the opportunity I’m given to meet a child and their family at a really hard time in their life and help them process and normalize life with T1D,” said Scott. “I really enjoy supporting and empowering my patients as they move forward, with the goal of having the same hopes, dreams, and successes as they did before diagnosis.” 

“In a way, I do think having T1D makes me more empathetic — because I truly understand what my patients are going through,” explained Scott, who has lived with T1D, herself, for over 30 years. 

 

Let’s talk about Children’s of Alabama and the T1DX-QI  

“Children’s of Alabama has been involved with the Collaborative for a handful of years — joining in 2019 before COVID,” said Scott, who serves as the site co-PI along with Dr. Schmitt. 

“It’s incredibly helpful to have clinical experts from across the country ‘all in one room’ sharing solutions for similar issues. It helps generate new ideas, mobilize internally, and get things done more efficiently,” said Scott. “This sharing mentality also helps to jump-start projects at other institutions.” 

“Our initial involvement in the T1DX-QI CGM and Insulin Pump Equity projects helped us develop changes we desperately needed,” explained Scott. “With Medicaid coverage expansion in 2018, it improved access to diabetes technology for our patients, and we’ve seen a huge uptick in its use.” 

“Since then, our CGM prescription rates have increased to about 70-75% for both private insurance and Medicaid patients. Now we’re working on actual fill rates and streamlining steps to get more devices in patients’ hands.” 

“As part of our involvement in the Pump Equity Project, a handful of providers (myself included) went through provider bias training,” explained Scott. “It brought to light some of the things that were affecting prescription rates for certain patient demographics. Because of this, most of our prescribing habits have changed.” 

“It’s definitely striking when you see kids who are struggling and where that ends up taking you as far as metrics and social determinants of health are concerned,” said Scott. “We have a high Medicaid population here with about a 50-50 split (private pay vs. Medicaid).  

“While we do have privately insured patients who come from financially stable, two-parent households when you look at the cohorts of patients who hit our high-risk metrics, they’re primarily minority-race, single-parent households on Medicaid,” said Scott. 

 

Can you tell us about the High-Risk and Hyperglycemia Clinics at Children’s of Alabama? 

“We have two clinics at Children’s for kids who are struggling with T1D: the High-Risk Diabetes Clinic and the Hyperglycemia Clinic,” explained Scott.  

“The High-Risk Clinic was formed to capture our most frequently admitted patients with DKA,” said Scott. “We see between 6 to 10 patients once a month in the clinic together. They work as a group with a counselor, a child life specialist, and a registered dietitian.” 

“More recently, we established the Hyperglycemia Clinic to capture kids at high risk of DKA,” explained Scott. “More specifically, those with A1Cs higher than our scale can measure — which goes up to 14%,” explained Scott. 

“So, if they’re above 14% for two visits in a row, we’ll see them in the Hyperglycemia Clinic every other month. Because of this, we’ve captured 2 cohorts with about 20 to 30 patients in the program, and we try to provide resources they may not have previously received.”

“We’re bringing what we’ve learned from the High-Risk Clinic into the Hyperglycemia Clinic. It’s a relatively ‘judgment-free’ zone and that helps kids be more open and honest,” said Scott. “Ultimately, it’s their diabetes, and they’re in the driver’s seat — but we’re starting to see greater patient success.” 

“For example, I was seeing two brothers in the High-Risk Clinic because one was having frequent hospital admissions, and both had A1Cs in the teens. So, I brought them in together. They’re both on Automated Insulin Delivery (AID) systems, have A1Cs in the 8% range, and have graduated from high school feeling empowered and happy. AID devices are helping them achieve what they couldn’t before,” said Scott. 

 

What are your current research areas?  

“We have three different projects in the works including smart insulin pen access, diabetes distress scale use, and transition work.” 

“We’ve been working with InPens as part of a smart insulin pen use project. While we ran into some data issues with an EMR switch, we’re looking at how our Medicaid patients are, or aren’t, provided access to smart pens,” said Scott.  

“In terms of the diabetes distress scale project, we’re starting off with a small working group in the Hyperglycemia and High-Risk clinics,” said Scott. “The plan is to use the scale in all of my clinics (under a single provider) to see what we gather from patients.”  

“We’ll stagger the screening because we also screen for depression and anxiety. So, we’ll be starting there and gathering data that I can use to shape how I interact with patients,” said Scott 

“We also have some transition work underway, which is a big project. One of our PIs has established this work and we’re bringing it under the umbrella of the T1DX-QI and capturing the data in our T1D metrics,” said Scott.  

“Beyond that, we’ve done some social determinants of health screening,” said Scott. “Many of our families come from impoverished communities and face issues with transportation, stable housing, and food insecurities.”  

We’re connected with the University of Alabama Food Bank and keep emergency dry goods bags in the clinic,” said Scott. “We’ve had to refill bags three or four times in the last year for families in dire need of food. Generally, we’re able to connect them with food banks and other long-term options.” 

 

Shifting away from blame and shame 

“As a provider, I realize how much judgment is placed on individuals — especially those with diabetes,” said Scott. “Expecting someone to be ‘perfect’ with T1D affects their psyche and how they handle their own body. Managing T1D is a tremendous task.” 

“I’ve found that it’s so important for my patients to know that I understand what they’re shouldering each and every day,” explained Scott.  

“Stigmas persist with diabetes, particularly in youth with type 2 diabetes. They’re often told they caused their condition. While we know these kids haven’t ‘given themselves’ diabetes, the words we choose are important, especially given that youth with T2D have even higher rates of depression than those with T1D.” 

“Whenever I see a new patient with diabetes, I make sure they know it isn’t their fault, period,” said Scott. “I tell them: ‘People may judge you, but I need you to hear me as your doctor — you didn’t cause this.’” 

 

Outside of work 

When Dr. Scott isn’t at work, she enjoys spending time with her husband, traveling, and hiking with their two dogs, Franklin and Eleanor. Franklin, who is 140 pounds of pure joy, is in training to be a therapy dog for the diabetes clinic, while his sister, Eleanor, prefers to stay at home.