'Patients Need a Champion' for Their Diabetes Care

Anne L. Peters, MD


October 03, 2022

This transcript has been edited for clarity.

Today I chaired a session on healthcare disparities in countries around the world. I represented the United States; there was a speaker representing Europe and one representing Asia.

I think that, enviably, people in Europe have access, so that's not their biggest issue. They have more concerns around adherence and having enough providers to provide all the education and care that patients need.

Asia presents the biggest problem because, frankly, they have the most patients with diabetes. For many individuals, there is not access to care, medications, or what they need. There are also many issues around food and people developing diabetes earlier, and more people having gestational diabetes, which then frames the metabolic abnormalities in the offspring that increase their risk for subsequent diabetes.

I got to talk about issues in the United States, and my real message is about advocacy because I've been working my whole career in the county of Los Angeles. We're the most populous county in the United States.

I've been working with the Department of Health Services for Los Angeles County. They've changed leadership over time, but we have a diabetes work group consisting of several endocrinologists, several primary care providers, and a number of administrators, and we've just plowed ahead. We meet every other week and have done so for years and years to make guidelines and strategies for the management of diabetes across our population.

The very first thing we did was create a unified formulary, because if you live in one part of Los Angeles County in a safety net system, you'd get one kind of formulary; and then if you were in another part of town — say, the southern part of the county — you'd get another formulary.

We really wanted to not just unify the formulary but to create a formula based on quality, not just cost. Over time, we've been able to get SGLT2 inhibitors on the formulary as well as GLP-1 receptor agonists and basically any kind of insulin you want for patients with type 1 diabetes.

In addition to that, we have guidelines and algorithms that we've created for primary care providers so they can figure out how to use the newer medications. Then we have e-consults and a number of different ways to reach endocrinologists so we can help further advise care.

Another big thing that we've done is on a statewide level where I, along with a number of really involved individuals, have lobbied the state government to approve continuous glucose monitors (CGMs) for people who have Medi-Cal insurance, which is the same as Medicaid in other states.

We've been successful. There were setbacks along the way, but we've succeeded. Now, basically anyone in the state of California with type 1 diabetes can get a CGM. To me that's huge, because in Los Angeles County, where I treat my patients, I used to have trouble getting them CGM. It used to be that this person could get it because they had this kind of insurance, they had Medi-Cal HMO, and this one didn't. Now everybody can have CGM.

In my patient clinic where everyone has type 1 diabetes, pretty much everyone comes in on CGM. Because of that, I used to be able to get pumps, but now I can get pumps that talk to the CGM, and we have automated insulin delivery systems available for appropriate patients.

My message is that patients need a champion. They need us to really go and work to get care systems to provide the tools we need, the medications we need, the devices we need, and the educators we need so that we can help our patients with diabetes achieve their goals. I must say that I'm an optimist in that I believe it's possible.

I know we've done many good things in Los Angeles County and in the state of California, and I think we need to do better still. I'm looking at ways of getting involved nationally to try to make an even bigger difference in terms of the health and quality of life for our patients with diabetes.

Thank you.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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