Driving Advances in Diabetes Care

“I tell them they’re stuck with me forever,” Anne Peters, M.D., says with a smile. And for the legions of patients Peters cares for as director of USC Clinical Diabetes Programs that is, indeed, a very good thing. That’s because Peters, who also serves as a professor of clinical medicine at the Keck School of Medicine, is a world-renowned diabetologist, having spent more than 25 years working exclusively with people with diabetes.

Along the way, she pioneered best practices for the effective management of type 1 and type 2 diabetes. These practices include working with patients to devise appropriate lifestyle changes, such as regular exercise, healthy eating choices and weight loss. Peters, who authored the best-selling book Conquering Diabetes, divides her time between the USC Westside Center for Diabetes in Beverly Hills and the Los Angeles County+USC Diabetes Disease Management Program at the Roybal Comprehensive Health Center in East Los Angeles.

USC Westside Center for Diabetes Although the vast majority of people with diabetes have type 2 diabetes (see “Diabetes Defined” sidebar), Peters notes, “I collect type 1’s,” particularly the most challenging cases.

DIABETES DEFINED
According to the American Diabetes Association, nearly 24 million Americans have diabetes, which is categorized as either type 1 or type 2.

Type 1 diabetes accounts for 5 to 10 percent of all diabetes diagnoses. Usually striking children and young adults, type 1 diabetes occurs when the immune system attacks the pancreas, preventing it from producing insulin that converts sugar into energy. Consequently, patients with type 1 diabetes must receive insulin through injections or an automated pump.

The vast majority of diabetes cases - 90 to 95 percent - are type 2. Most frequently associated with older age, obesity, a family history of diabetes and lack of physical activity, type 2 involves the body’s inability to properly use insulin; gradually, the pancreas loses its ability to produce insulin. Most patients with type 2 diabetes can control their blood sugar through diet, exercise and oral medications.

Elite athletes with type 1 diabetes certainly constitute such a challenge, pushing their bodies to superhuman extremes while simultaneously trying to maintain safe blood-glucose levels. Peters has worked so extensively with elites − from 10-time Olympic swimming medalist Gary Hall Jr. to professional race car driver Charlie Kimball − that she’s the go-to expert. Recently, for example, she was asked to share findings from her research focusing on the prevention and treatment of exercise-induced hypoglycemia (low blood sugar) in serious athletes at the American Diabetes Association’s Scientific Sessions in New Orleans. Blood sugar can fall too low after exercise, but according to Peters, the effects can be mitigated and managed by careful monitoring of activity levels, time of workouts and insulin levels. Once an athlete recognizes the individual pattern of post-workout glucose levels, the athlete can develop a plan to combat hypoglycemia by balancing insulin with fast-acting carbohydrates.

Type 1 moms-to-be are another Peters subspecialty. “Twenty years ago, women with type 1 diabetes were told to adopt,” explains Peters. “We take care of a lot of pregnant women with type 1 diabetes, and we have a wall filled with photos of healthy babies.”

Type 2 diabetes has undergone a similar sea change. “We used to say that type 2 diabetes just got worse over time, but that’s certainly not the case today,” Peters says. She attributes the improved outlook to increased awareness about the importance of eating healthily, exercising regularly, controlling body weight and having access to improved medications.

LAC+USC Diabetes Disease Management Program The program for diabetes treatment that Peters launched in 2000 has since been duplicated − throughout Los Angeles as part of the L.A. County Department of Health Services Clinical Resource Management Program − as a model for providing cost-effective, quality care to low-income people with type 2 diabetes. In addition, she has worked with others from the Keck School of Medicine to establish a clinic for patients with type 1 diabetes.

Peters and her team instituted a standardized approach to managing diabetes in a specialized, County clinic setting, thus easing the burden patients previously placed on emergency rooms and urgent care centers. Community outreach is another central component of the clinic’s success, with Peters spearheading efforts to establish farmers markets, hold healthy cooking demonstrations and train Spanish-speaking diabetes educators. Better , Better , Better When she’s not providing hands-on clinical care, Peters is likely conducting research designed to improv diabetes treatment. She has played a particularly pivotal role in one of the most significant technological advancements of late − the continuous glucose monitor (CGM). Peters tested prototype CGMs − devices that provide around-the-clock, real-time glucose-level readings. “Since I’ve been using these devices way before they were publicly available, I’ve become a CGM expert and champion of the technology,” she says.

“Everything about treating patients with type 1 diabetes has gotten better,” she says. “The insulin is better, the monitoring technology is better, and longterm outcomes are better.” However, she notes, it takes a team of health care providers, which she has established both on the Westside and Eastside, because until there is a cure, patients need the best treatment possible.

To make an appointment at the USC Westside Center for Diabetes, or for more information, call 310-657-3030 or visit www.uscdiabetes.com.