It was inspiring to read the interview that HCI Senior Editor Gabriel Perna conducted recently with Gnanagurudasan Prakasam, M.D., a pediatric endocrinologist based in Sacramento, California. What Dr. Prakasam has achieved goes beyond a surface “win” do a deeper type of accomplishment, and should be widely noted.
As Dr. Prakasam, the director of the Pediatric Endocrinology, Diabetes and Healthy Life Style program for children at the Sutter Medical Center, told Gabe in the interview, “I run one of the biggest Type 1 diabetes practices in the country. We have more than 1500 children coming as far as six hours away. Kids ranging from less than one years old up to 21 years of age. They have to live with diabetes. They have to take five shots of insulin per day. They have to check their blood sugar eight to ten times [per day]. That’s the population they are. They are intensely monitoring it all the time. They live and breathe diabetes all of the time. If they missed insulin, even for a day, they can go into severe dehydration and up to a coma.”
Further, he noted, “It's a unique patient population, it affects their day-to-day life from sports to school to their day care providers. Having them interconnected and supporting each other creates a better standard of living for them.”
What’s more, he emphasized in the interview, “The most important thing I do is I interconnect these patients so they can talk to each other on a regular basis. They talk about how they deal with this on a daily basis. They are supporting each other. For instance, when the parents are out of town and the kid is staying at the grandparents, they are on the phone supporting the grandparents. I'm the link between all these guys meeting each other on a consistent basis. They have developed relationships. As far as I know,” he added, “this is the only physician-run support group” connecting via social media.
This is really important. All chronic illnesses are challenging to the people who have them, and all chronic illnesses in children are difficult for those children. But Type 1 diabetes is particularly challenging for children and teenagers, because of the constant monitoring and interventions required (checking blood sugars several times, regular injections of insulin), and also because of the social isolation and marginalization involved. Kids with diabetes are constantly reminded that they are not “normal” in the way that fully healthy kids are. What’s more, Type 1 diabetes, in which the body produces no insulin on its own, poses potentially severe danger at all times, and is a lifelong condition that cannot be reversed.
Or, as Dr. Prakash puts it, “The management is intense. Type 2 diabetes patients, if they forget to take their medicine, they're not going to land in the hospital. If they don't take care of it over a period of time, their health will deteriorate. Whereas, these patients, if they miss insulin, even for a single day, they can go as far as getting in a coma. It occupies their life. It drags on the family to have to live with that. They have to live and breathe every single day of their life. That's why it's important.”
And, as he adds, the parents of these children “are giving me an opportunity to take care of their child. I feel by being available to them in different modes, apart from the traditional way of managing diabetes, makes me more human. It makes them feel I’m part of their life. It makes them feel I am not away from them.”
And the results speak for themselves: the children whom Dr. Prakash cares for—all 1,500 of them, whto whom he is available 24/7—have a hospital readmissions rate of 5 percent, while the nationwide rate is between 9 and 15 percent. That is a huge breakthrough.
I just hope that more clinicians and more care managers learn about Dr. Prakash’s innovative program, and emulate it; it could mean huge improvements not only in clinical outcomes, but in outlook and quality of life, for so many children living with diabetes.
Fortunately, Dr. Prakash is speaking at the Health IT Summit in San Francisco, sponsored by our sister organization, the Institute for Health Technology Transformation (iHT2), early next month, where he’ll be participating on a panel entitled “mHealth & Telehealth Enabled Consumer Directed Healthcare,” on March 3. I hope the awareness of his breakthrough is disseminated as widely as possible.
