In Reply.—We appreciate the interest of Drs Brouhard and Cunningham in the question of who should care for children with diabetes. Obviously, there are many opinions but no right answers to the question of whether a general pediatrician or a subspecialist should be primarily responsible for the care of children with chronic illnesses such as diabetes. We agree about the need for active involvement of a multidisciplinary team in pediatric diabetes care. It is not clear, however, that such a team necessarily needs to be in a traditional tertiary care setting.
We can envision alternative models in which a tertiary care program works to support a team of nurse educators, dietitians, and mental health professionals in a community hospital who, in turn, provide support to community pediatricians. In that we have clearly documented the active and often sole involvement of general pediatricians in diabetes care,1 and in view