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promotes bimonthly office visits. During these appointments, endocrinologists and certified diabetes educators conduct physical exams, monitor blood glucose levels and ensure patients are develop- ing diabetes management skills. But during adolescence, management can become challenging. "Adolescence is when the waters can get rough," Dr. Levine says. "Some adolescents are responsible and really take ownership of their management. Because they have a good foundation cultivated with help from their parents, they continue the good habits we've taught them. But some rebel and decide not to check their blood sugar multiple times per day. They let their manage- ment slide. We increase our efforts during this time to prevent lapses that may result in complications." New Technologies and Constant Contact Earlier versions of blood sugar-detect- ing technology required a urine sample that provided a general impression of blood glucose hours before the sample. Technological advances have greatly enhanced diabetes self-management over the years and also provide one aspect of continuity in diabetes treatment. "The mutual respect held between our pediatric and adult endocrinology teams is foundational to our program's suc- cess," Peragallo-Dittko says. "Although medical management, treatment goals and educational strategies may differ across the age span, many of the tech- nological advancements are similar." "There has been an explosion of new devices designed for better diabetes management," Dr. Bredefeld says. "Both teams provide training so patients can become competent in using insulin pumps, sensors and glucose monitors. Because needs change during adult- hood, different device features may be required. We support patients to find the best device for their life stage, and we can individualize their care based on their specific needs." Modern technolog y significantly helps both teams of endocrinolog y experts monitor patient data, even if patients are a great distance from the hospital. "We have a number of resources online so patients can keep in touch with us," Dr. Bredefeld says. "This is especially important for young adults. They can upload blood glucose or insu- lin pump data on special software so we can work together and continue to uphold their self-care. If we see changes in the data, we ma ke management changes and communicate via phone or email. Adult patients appreciate the expediency and comfort of these tools, and we appreciate the speed with which the technology allows us to adjust to any problems." While technological advances keep adult patients and their endocrinology patients in touch, even if they are away at college, traditional communication still holds a prominent place. "Around the transition period, the transition coordinator calls patients to remind them about their visits," Dr. Bredefeld says. "Independence is emphasized, but we establish that same close partnership patients formed with their pediatric provider by connecting with them on a personal level." An Embraceable Change W i nt h rop's ne wly con st r uc te d 95,000-square-foot Academic and Research Center will open in early 2015. The new building will be a highly visible representation of the vision of clinical care linked to research and education. It specifically will sup- port the linkage between diabetes/ endocrine clinica l, academic a nd research programs by including adult and pediatric endocrinology as the sole clinical activity. Combining adult and pediatric endocrine services within one f loor of this building f ur ther strengthens the current program for transitioning emerging adults to the adult endocrine practice. Pa r t ner ing to ma na ge ch ron ic diseases is essential to achieving posi- tive outcomes. Winthrop-University Hospital has demonstrated success using a model involving experts at all points on the care continuum for diabetes ma na gement, a nd ot her specialties can learn from the pro- gram's achievements. " This str uctured, multifaceted, evidence-based program works and can be applied to any other chronic disease treatment plan," says Peragallo-Dittko. "When you stop and think about it, that's powerful." For more information about Winthrop- University Hospital's Diabetes and Obesity Institute, visit www.winthrop.org. ■ Winthrop-University Hospital's brand new, 95,000-square-foot Research and Academic Center in Mineola, New York, where diabetes transition care will soon be housed COV ER FE AT UR E 1 0 | Long Island MD NEWS ■ M D N E W S . CO M