My 11 year old son developed diabetes nine years ago, and his pediatrician manages his diabetes. We do not have a local pediatric endocrinologist in our city. The nearest university hospital is 75 miles away, and it is not convenient to take our kid there. Do you know of any medical center that will manage his diabetes on-line, and without our physical presence?

You should be working with a pediatric endocrinologist and diabetes team. Knowledge about diabetes is terribly important and worth the while to make the trip every 2-3 months. Depends a lot, of course, on your son’s hemoglobin A1c results, who is looking at his eyes, blood pressure, microalbumin levels, thyroid functions, lipids, how much hypoglycemia he has, and how sophisticated your pediatrician is.

I don’t know of any physician who would provide e-mail care without some face to face time as well. I would be worried about lack of contact since diabetes care is much more than just insulin and blood glucose management.

SB
Additional comments from Dr. Donough O’Brien:

The best one I know is DiabetesWell. I think they probably do a rather good job with adults, but I really don’t know about children.

DOB
Additional comments from Dr. Tessa Lebinger:
75 minutes away is not an impossible trip. Many people travel this long to and from work every day. There may be many doctors who will help you manage his diabetes on-line in between visits to minimize the number of visits, but nothing takes the place of talking to patients in person and also examining them. On-line management is just a supplement, or a second best for people who live many hours away from a specialist and can’t afford transportation.

TGL
Additional comments from Dr. Jim Lane:
I would disagree with any process that doesn’t allow for working with patients and seeing first hand what is going on. A lot will be lost in the translation. The physical exam is still an important part of taking care of patients. People are looking into telemedicine where video cameras replace the human eye, but we are still a ways from that being the standard of care. I think a reasonable concession is to have your pediatrician see your son and expect to see a pediatric endocrinologist once or twice a year.

JTL
Additional comments from Dr. Larry Deeb:No not never. P.S. — 75 miles isn’t far and your child is worth it.

LD
Additional comments from Stephanie Schwartz, diabetes nurse specialist:
Many people who do not have local pediatric diabetes centers will take their child to one once or twice a year and have diabetes co-managed in conjunction with the local doctor. Between visits, parents and the local doctor can then consult, as needed by phone, fax, and/or e-mail. I suggest that you consider this option since personal interaction with a diabetes team, comprised of physicians, nurses, dietitians, mental health specialists and others experienced in the care of children, can be of great benefit. This is especially true as your son enters puberty (which wreaks havoc with control).

SS

[Editor’s comment: For a review of DiabetesWell, see David Mendosa’s article at the American Diabetes Association website, at DiabetesWell.

The topic of Internet-based medical care can clearly arouse passion as well as markedly differing opinions. Let me add my personal opinion: Anyone who would take on the responsibility of providing diabetes care (or other chronic disease care) without at least an initial and scheduled routine follow-up in-person contact is a fool, and probably is in violation of State medical licensing laws. See Telemedicine at the Federation of State Medical Boards website for additional thoughts.
WWQ]