Editor's note: In the "Practice Profiles" department of Clinical Diabetes, we spotlight clinicians who have chosen to dedicate a significant portion of their time to the care of patients with diabetes. Suggestions for clinicians to interview in the future are welcome and can be e-mailed to levetan@juno.com.

Where are you from originally? Who inspired you to go into medicine?
I am from the Denver, Colorado, area, and I have no family members who are physicians. When I was a child, although I suffered from no particular illness, I seemed to have more than my share of minor ones and was taken to the doctor frequently. My family doctor really fostered my interest in medicine.

Tell me a little about your background.
As an undergraduate at the University of Colorado in Boulder, I majored in biochemistry and also in molecular, cellular, and developmental biology. After school, I worked as a research assistant for Dr. Boris Draznin in the Department of Endocrinology at the University of Colorado School of Medicine. The project that I was most involved in with Dr. Draznin involved studying the molecular biology of glucose transporter proteins. I went to medical school at the University of Colorado School of Medicine and did my internal medicine residency at the University of Colorado as well.

When did you become interested in diabetes?
During my years of study, both before and during medical school, with Dr. Draznin.

When did you become interested in gestational diabetes in particular?
During my first year of medical school, a very dear friend of my wife, who had diabetes, became pregnant, and I became interested in the problem of diabetes occurring during pregnancy. I wrote a term paper titled "Medical and Psychosocial Complications of Diabetes Mellitus During Pregnancy." Later, during my residency, I had the great opportunity to work closely with Dr. Lynn Barbour, a general internist specializing in the medical complications of pregnancy and an attending physician at the High-Risk Obstetrics and Gynecology Clinic at the University. Still later, shortly after I had entered private practice in internal medicine in Denver, I was asked by the Planned Parenthood Prenatal Program to become their consulting internist.

Tell me about the Planned Parenthood Prenatal Program.
The Planned Parenthood Prenatal Program is a collaborative effort among Planned Parenthood of the Rocky Mountains, Rose Medical Center, the Women's Choice Midwifery Group, and my practice. It is staffed by Dr. Peter Vargas, a board-certified obstetrician/gynecologist, an internist (myself), two women's health nurse practitioners, six midwives, a licensed clinical social worker, two case managers, and a registered dietitian. In addition to the main clinic at Rose Medical Center, there are a number of satellite clinics in suburban locations surrounding the Denver metro area.

The program provides comprehensive care for pregnant women from diagnosis of pregnancy through the postpartum period. At Rose Medical Center, which is an affiliated hospital of the University of Colorado School of Medicine, our patients have access to specialists in all major subspecialties. We deliver between 35 and 50 patients per month. At any given time, I take care of about 10 gestational diabetic patients through the Planned Parenthood Program.

What diabetes services are provided?
Because of the particular ethnic mix of patient population, all of our pregnant women are screened with a 1-h 50-g glucose tolerance test. Those who are positive receive the 3-h 100-g confirmatory glucose tolerance test. Patients who meet the American Diabetes Association's most recent guidelines for diagnosis are referred to the Diabetes Treatment Center at Rose Medical Center, which maintains a separate gestational diabetes program.

Initially, an individual appointment is set up with a diabetes nurse educator and dietitian. Each consultation lasts a bit over 2 h with the patient spending 1 to 1.5 h with the nurse and about 1 h with the dietitian. At these individual visits, issues are addressed such as home monitoring procedure, target glucose ranges, and meal planning. Patients receive pregnancy-specific diabetes education.

The patients are given a variety of educational materials and diabetic and dietary flow sheets, which they then discuss with me and the staff of the Diabetes Treatment Center at weekly intervals, either by fax machine or by phone depending on the particular patient. I usually see patients every 2–3 weeks. All of the diabetic patients, whether diet-controlled or insulin-requiring, consult with our obstetrician, who establishes a plan for prenatal monitoring, such as nonstress testing where appropriate.

After delivery at Rose Medical Center, the patients receive follow-up glucose tolerance tests 4–6 weeks postpartum. Many of the patients continue to see me during follow-up for their general medical needs.

How are these prenatal services paid for?
Reimbursement for the most part is through Medicaid or private insurance, which includes insurance coverage for diabetes services. The Diabetes Treatment Center at Rose is a hospital-based service, which helps in reimbursement issues.

When a patient goes to the Diabetes Treatment Center, how do the nurse and educator communicate back to the referring doctor?
We stay pretty close by fax and, furthermore, patients have a comprehensive flow sheet that they take to all of their prenatal visits, medical visits, and visits to the Diabetes Treatment Center.

How are referrals made to endocrinologists?
There are a number of endocrinologists at Rose Medical Center, and occasionally, I will refer a patient to one of them, using a standard Medicaid form. The few patients I have referred to an endocrinologist have had type 1 diabetes that I found difficult to control.

Tell me about patient outcomes.
I am very proud of my patients because, as pregnant women, they are extremely motivated to be compliant with therapy and with monitoring requirements because they want to do everything to ensure a favorable obstetrical outcome. They work hard at glucose monitoring, insulin administration, and all the documentation associated with this. I am also proud of the fact that the Planned Parenthood Prenatal Program is nurse midwife-based, and I am proud of the Gestational Diabetes Program at the Rose Diabetes Treatment Center for doing such a good job with these patients.

Because of this, almost all of my gestational diabetes patients are able to achieve glucose levels in accordance with the recommendations of the International Workshop Conference on Gestational Diabetes Mellitus, and the rates of cesarean sections, neonatal hypoglycemia, and fetal macrosomia are hardly different from those of the nondiabetic population.

Do you have any suggestions for doctors in practice who would like to get more involved with diabetes care?
Don't be afraid of diabetes—there are a lot of new options for therapy. Take continuing medical education courses and workshops, join the diabetes committee at your hospital, and keep diabetes flow sheets in your charts. If you get the word out to your colleagues that you are interested in diabetes care, the referrals will come.

What hobbies or areas of interest do you pursue when you have the time?
I am an avid reader and enjoy ancient Greek and Roman history, classical music, and opera. I have also watched every episode of "Thomas the Tank Engine" at least 10 times each with Justin, my 4-year-old son.

Claresa Levetan, MD, is director of diabetes education at MedStar Research Institute in Washington, D.C. She is an associate editor of Clinical Diabetes.