Anne L. Peters, MD, CDE; Paola A. Sequeira, MD, MSPH


July 08, 2010

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Anne L. Peters, MD, CDE: Hi, I'm Dr. Anne Peters, the Director of the Clinical Diabetes Programs at the University of Southern California. Today I am joined by Dr. Paola Sequeira, Assistant Clinical Professor, Department of Pediatrics, at the University of Southern California in Los Angeles. Good morning.

Paola and I work together on a program that involves the treatment of both children and adults with type 1 and type 2 diabetes in an underserved community. I wondered if first you could discuss a bit what the community was like and what some of their needs were.

Paola A. Sequeira, MD: In East Los Angeles we have a very underserved population, and some of the problems they have are basically access to care, access to medicines, and access to healthy foods. It's obviously a very big problem if you have type 1 diabetes or type 2 diabetes to be able to address healthy habits, healthy behaviors, and easy access to care. This program is actually a wonderful way of trying to address some of the problems that these patients are facing.

Dr. Peters: Have you created any particular solutions to try to help the people in this community that others might be able to emulate?

Dr. Sequeira: Right now, actually, we're very excited because we're working on a program funded by the Helmsley Foundation called the Let's Empower and Prepare Program -- the LEAP Program. I'm trained in internal medicine and pediatrics, so my focus and my interest are the transition process for patients who are going from pediatrics to adult care. You already have the underlying socioeconomic problems, but when you have the transition process as well, which also involves the psychological transition in some of these patients, we are trying to develop something that will help enable them to transition smoothly from the pediatric to the adult world.

One of the things, though, we did in order to develop the program was to interview different aspects of the things that we thought would be very interesting to get a perspective on. We interviewed providers; we interviewed patients who were already transitioned; and also we interviewed parents and current patients with type 1 diabetes in adolescence.

What we found was that as far as the providers -- some of the big concerns that the providers had -- they do not know where to send the patients, and they don't know about the insurance. Our patients don't have insurance, but they are still able to access care through our public clinics. But some of those patients who have insurance or are transitioning to adults may end up not having insurance at all, and they don't know where to go or what to do. With type 1, you must have access to care; you must have access to insulin to be able to survive.

We're trying to address those concerns with the providers by developing a list of providers in the area who will be able to accept patients with their type of insurance or no insurance, to be able to make sure they can transition and have appointments and follow-ups appropriately.

Dr. Peters: I think that you're talking about a number of really important issues for many people who take care of adolescents and young adults. The first is, obviously, who do you send a patient to? For Los Angeles, we're trying to make a system whereby we know who the patient should go to, but for places around the country, I think it's very important that pediatricians really learn to figure out who in their community will take those patients on.

The second thing is As an adult care provider, I often don't get adequate information, and on the NDEP Website (the National Diabetes Education Program Website), they now have a form that a pediatrician like yourself would fill out to send a patient to me.[1] I'd actually know what was going on with the patient, and then that would allow me to be able to follow the patient subsequently. I think the notion of transitioning patients from one age of medical care, say, pediatric to adult, or even from one system to another, is very important, and what we're really trying to address with our new program that hopefully will work out and help people get the kind of care they need. Diabetes, as you say, doesn't go away just because you change from pediatric to adulthood.

Dr. Peters: Is there any one take-home message about how to deal with a teenager that you would like to leave our audience with? What one thing in diabetes care do you think makes the most difference? Is it peer support; is it being able to communicate on Twitter and Facebook?

Dr. Sequeira: I think it's about empowerment, and that's why I really like this program. Because I think when you've been a child dealing with a chronic disease, other people have been taking care of you -- parents, nurses, and the physicians. I think this program will empower them to be able to move to an adult type of care where they're still being taken care of, but at the same time they feel like they are participating more actively with their care.

I think -- even now -- that physicians can do that. Unfortunately, sometimes the transitions are just so abrupt that it doesn't allow them to really be able to give that empowerment, and you just continue to have that, you know, "I'm still going to be taking care of you up until the very end." I think hopefully by making sure that they're preparing them throughout the last few years, it will enable them to become strong, healthy adults when they move on to their adult care.

Dr. Peters: Those are some really good points. I think hopefully all of us can work with our patients and with the resources that I believe are going to be increasingly available, to empower them to provide them with access to information and then help them continue to have good diabetes care.

This has been Dr. Anne Peters for Medscape. Thank you.


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