The Delivery of Pediatric Diabetes Care: Who is in Control?

Background: The morbidity and mortality associated with diabetes can be significantly reduced by timely and effective treatment. However, unless patients with diabetes have access to this treatment, and resources to utilize it, outcomes will not meet goals. We wanted to explore the impediments to effective care for the pediatric diabetes population. However, most studies evaluating diabetes care delivery have focused on the adult diabetes population, who tend to have different problems and a different constellation of providers. Evaluating the delivery of care for pediatric diabetes remains a challenging topic due to many medical, social, and economic factors. Methods: We began by surveying 100 families with diabetic children in our university practice, seeking their opinions about the delivery of diabetes care. In a confidential questionnaire, we asked about family demographics, family experiences relating to accessibility of care, freedom to choose facility, funding, and unmet healthcare needs. Results: Based on our pilot survey, it seems that families still have control in choosing a pediatric endocrinologist for diabetes care of their children. A reasonably high rate of second opinion visits suggests that families still have this choice. There is also evidence that physical distance to the practice is not a deterring factor from making clinic visits. Dissatisfaction with insurance companies’ understanding the funding that is needed for diabetes care of children has been also noted. The survey found a desire for psychological support of children with diabetes. Discussion: Based on this survey we can design a larger enquiry and suggest revisions in care design. It is very important to recognize and address psychological needs for family and children with diabetes. Finally, the multidisciplinary approval seems to be the key of success in providing diabetes care.