The birth of a comprehensive diabetes program for children and youth at the University of Florida
A veteran and champion of the DCE organization, we asked Dr. Rosenbloom to share his perspective about the history behind the development of a comprehensive diabetes program for children and youth at the University of Florida:
“Before my arrival in Gainesville in summer 1968, children with diabetes were managed by the pediatric nephrologist who had left a few months earlier, and the diabetes camp was run by an internist endocrinologist on the faculty of UF. The nearest other pediatric endocrinologists were in Augusta Georgia, Miami, and Birmingham Alabama, and only the one in Augusta did diabetes! When I opened the file cabinet containing the charts of the patients with diabetes, I found only six files. In those days, most pediatric diabetes was taken care of by internists, general pediatricians, and general practitioners.
Although I was not scheduled to start work until September 1, the chairman of pediatrics, Dr. Gerold Schiebler, wanted to take me out to the diabetes camp in the hopes that it could come under pediatric direction. On the way out to the rather primitive Boy Scout camp in Keystone Heights, much to his dismay, I informed him that I did not like the idea of a special camp for kids with diabetes, that I saw it as a form of discrimination, that kids with diabetes should be participating in the same camps as other kids. I had also had, during my fellowship, some negative experiences with patients who had been to camp. However, when I saw what was going on at the camp, I agreed that it needed to come under pediatric direction. Some 75 campers were subjected to continuous 24 hour urine collection and weighing and measuring of food at the table. Episodes of ketoacidosis and hypoglycemia were frequent. Over the next several months, I ingratiated myself with the internist and he agreed to have me participate in the 1969 Camp, which was to be moved to Camp McConnell in Micanopy, managing the nutrition aspects. I came to camp with a medical student and a pediatric resident from Jacksonville, thereby doubling the staff! The director made sure to tell the dietitian to keep the scales handy because my liberal approach was going to be disastrous! As it turned out, this was the first time in the 7 years of camp that there were no instances of ketoacidosis and very little hypoglycemia. Together with a young internist/endocrinologist with whom I had begun research endeavors and who was comfortable with my approach, we were able to ease the director out by organizing a ceremony at camp where he was presented with a plaque for his years of service.
When the accounts for camp were turned over, it was apparent that there was considerable misappropriation. I immediately proceeded to incorporate the camp with a board of directors as a not-for-profit entity separate from the University of Florida, but with the agreement that camp would be an extension of the academic facility, essential for recruitment of health science and other students and participation of faculty. It is inconceivable that such an arrangement could be made now. Support was undoubtedly affected by the fact that one of the initial board members, a woman with diabetes, was the wife of university president Stephen O’Connell. Other board members included internist diabetologists from around the state and pediatricians.
Within a couple of years of pediatric takeover of the camp, the numbers of campers, now in two sessions at Camp McConnell, increased to over 200, and there was extensive participation of medical students, pediatric residents, nurses, dental students and faculty, psychologists, and pharmacy students, providing service and generating a long series of research projects.
The arrival of John Malone on the faculty at the University of South Florida in 1973 doubled the number of pediatric diabetologists in Florida and provided invaluable co-direction for the further development of camp as a service, educational, and research resource.
When I arrived in Gainesville, I was given the directorship of the Birth Defects Center, and used the funding to support a nurse educator to develop our diabetes services for children and youth. Although I had some clinic space for endocrinology services, there was no space available for a separate diabetes clinic. Thus, we began the UF pediatric diabetes clinic on Saturday mornings, without any administrative support from the institution.
During the 1973 camp an historic meeting was arranged with the director of the Children’s Medical Services program, newly elevated to Bureau status, Dr. F Edwards Rushton, along with Dr. Schiebler. We met under an oak tree at Camp McConnell where I inquired why CMS should not support camperships as military insurance (CHAMPUS) was doing. Dr. Rushton readily agreed, based on his experience as a pediatrician, seeing the effect that camp had on his patients. We also discussed the possibility of broader commitment to diabetes by CMS, which led to an award of a pilot grant for regional program development in 1974. This award supported a full-time diabetes nurse clinician, and regional care expenses. We were able to document substantial cost savings through this program and expand the funding. Our experience was published, the first to document the effect of a comprehensive program, and led to numerous consultations from around the country. Eventually, the regional diabetes program encompassed quarterly clinics in Pensacola, Panama City, Tallahassee, Daytona Beach, and Rockledge, and monthly clinics in Orlando and Jacksonville. Except for Daytona Beach, all of these sites now have local diabetes specialist providers.”
**Arlan Rosenbloom, MD, is an Adjunct Distinguished Service Professor Emeritus of Pediatrics at the University of Florida College of Medicine. At the University of Florida College of Medicine (UFCOM) since 1968, he is the founder of the Pediatric Endocrinology Division, Florida’s Diabetes Camps, the UF Diabetes Research Education & Treatment Center, and the Regional Diabetes & Endocrine Program for Children, and directed the General Clinical Research Center.