Early in my medical career, I became deeply involved in the care of patients with diabetes. While my initial focus was Family-Centered Obstetrics, I developed a strong interest in gestational diabetes—not just its impact on mothers, but also on their babies and the long-term risk posed for developing type II diabetes. This growing interest led me to conduct research in gestational diabetes, which ultimately expanded into broader work around Type II diabetes, a condition I came to understand more deeply because of its devastating toll on my patients.
Diabetes was becoming increasingly prevalent in the general population, and as a Chicano physician, I was especially concerned by its disproportionate impact on the Latino community—a population that was, and continues to be, rapidly growing in California. It was clear to me that the rise in diabetes was directly linked to demographic trends, and that the state needed to prepare for the serious implications this would have on public health.
In the early 1990s, I reached out to the California Department of Health Services after realizing that the state lacked a coordinated strategy to address chronic diseases, particularly diabetes. I discovered a small program, the Diabetes Control Program, funded by the CDC’s Division of Diabetes Translation. At that time, it was the only program within the department focused specifically on diabetes, relying on federal grants to support small-scale initiatives.
Recognizing the urgent need for a statewide approach, I connected with the program’s director (whose name, I must admit, escapes me now) and joined forces with several dedicated diabetes advocates. Together, we began building momentum by convening clinicians, researchers, public health professionals, and leaders from health systems. We called upon key partners, including the California chapters of the American Diabetes Association and the Juvenile Diabetes Foundation, academic leaders from UC medical schools, and well-known endocrinologists from across the state. Our first strategic meeting took place in Sacramento in the early 1990s, and from that effort, the Diabetes Coalition of California was born.
I was honored to be selected as the Coalition’s first Vice Chair, as well as Founding Chair of the committee charged with developing Evidence-Based Guidelines for Basic Diabetes Care, the first such guide in California. I had come to understand that most diabetes care was provided not by endocrinologists, but by primary care physicians—family medicine doctors, internists, and pediatricians.
My mission became clear: to develop and promote concise, evidence-based guidelines for these frontline providers—just one or two pages long—with references that could guide better diabetes care at the primary level.
As the Coalition and the Diabetes Control Program continued to grow, we were fortunate to gain exceptional leadership, especially when Dr. Ann Albright, a respected PhD and RDN from UCSF, became Director in the late 1990s. During this period, we began to see the immense financial burden that diabetes placed on Medi-Cal, California’s Medicaid program—particularly due to complications among high-risk populations. As these populations grew, so did the cost and urgency. I coined the expression “Tsunami of Diabetes” to reflect the overwhelming and looming impact this epidemic would have on the healthcare system—a rallying cry for action.
One of our proudest achievements was the creation of pocket-sized patient versions of the guidelines, translated into over 20 languages. With support from the CDC and pharmaceutical grants, we distributed thousands of these to patients statewide. The cards included a table to track essential tests and interventions, aligning with what providers should be documenting in their charts.
I’ll never forget a story shared by one of our outreach coordinators. A patient said, Thank you for this pocket card. I took it to my doctor and asked him to fill it out. He agreed, but then said, “What’s this microalbuminuria test? I’ve never heard of it, but I’ll find out.” The next month, the doctor told the patient, “Yes, we need to do this test—it checks for early kidney damage. If it’s positive, we can start medications to prevent diabetic kidney failure. Thank you for asking about it.”
For me, that one story made all the work worthwhile.
In 2007, our Evidence-Based Guidelines for Basic Diabetes Care were published in the Medical Board of California’s newsletter and later served as the foundation for diabetes care protocols adopted by multiple commercial health plans in the state.
The Diabetes Coalition of California continued its work for over 20 years after my departure, influencing policy and practice. I was especially proud when Ann Albright went on to lead the CDC’s Division of Diabetes Translation from 2007 to 2020, continuing to advance the vision we had nurtured together.
This journey has been one of the most meaningful parts of my professional life, and I remain hopeful and inspired by the continued commitment by all segments of our California health system to achieve better diabetes care in California.
