10 minute read
Elevating diabetes care
Thanks to game-changing medicines and technology, it’s a new world for those with diabetes. Our experts are at the forefront, passionately helping patients lead fuller lives.
Joanne Wills didn’t learn she had type 1 diabetes until her early 50s.
Often, people think of it as something surfacing in childhood. In her case, a routine checkup with her new Newton-Wellesley primary care physician led to an antibody test confirming her diagnosis.
Hoping to find care close to home, Joanne sought an appointment at NWH’s Diabetes Clinic. “I feel very lucky and grateful that Dr. Steppel-Reznik had an opening,” she says. “I see it as if someone was watching over me.”
Today, the Needham resident sees both Jeanne Steppel-Reznik, MD, Chief of the hospital’s Endocrinology and Diabetes Division, and Elyse Rayney, CNP, the clinic’s lead nurse practitioner. “I rely on them,” she says.
For Joanne, her own family history made the initial diagnosis unnerving. She had lost her older sister at age 51 after having lived with complications related to diabetes since her teens. Dr. Steppel-Reznik reassured her of the difference that advances in technology and medication have made—something which Joanne wishes her sister could have benefited from.
“They tell me, ‘Everybody’s diabetes is different, and in time you’ll know your diabetes best,’” Joanne notes. “That resonates with me.”
“I could go on and on about my team,” she adds. “They’re on the cutting edge. They’re knowledgeable. They’re really smart. They listen incredibly well.”
Importantly, “you’re going to people who truly care.”
A growing division
When Dr. Steppel-Reznik first arrived at Newton-Wellesley in 2005, she was only the second full-time endocrinologist on staff. They had one diabetes educator and one dietitian, based in a different location.
Today, as division chief, she oversees a bustling clinic specializing in diagnosing, treating, and managing a wide range of endocrine conditions, including not only diabetes but also thyroid disorders, osteoporosis, and more.
Her team now consists of seven endocrinologists as well as a highly trained and experienced team of nurse practitioners, nurses, and registered dietitians.
“We’ve grown into a very strong division,” she notes proudly. With a focus on individualized care, “our staff stay up to date with the latest breakthroughs and offer patients the best choices for them.” A recent move to a new location within the hospital enabled staff from across the division to be in one space, taking advantage of their interdisciplinary expertise. The combination of the clinic’s team, technology, and new home position them well moving forward.
NWH has continually added to a growing array of services. The American Diabetes Association-certified Diabetes Management Program now provides individual assessments, group classes, and support groups for a large outpatient diabetes population. Over time, the division has also created a thriving nurse-practitioner based service for inpatients with diabetes.
From the start, Dr. Steppel-Reznik realized “community medicine is where my heart is.” Looking to the future, she’s always hoping to be able to provide patients with more and better options. With the growing understanding of connections between chronic diseases, she envisions more comprehensive care—and work toward prevention— that bridges fields of medicine.
Advances in care
Like Joanne, Dr. Steppel-Reznik has her own family history with the disease. She often shares with her patients the story of her mom’s experience after being diagnosed with diabetes at age 9 in the 1950s.
The perspective influenced her path in medicine and deepens her understanding and compassion for patients and families. Put simply, “it makes me a better doctor,” she says.
For patients like her mom, it was a very different time with far fewer options. When her brother was diagnosed with diabetes just a decade ago, the field had vastly changed.
Today, “it’s not an easy disease but it’s much easier to manage the day-to-day ups and downs and allow people to live their lives more fully,” Dr. Steppel-Reznik reflects. She’s grateful for the ongoing advances both in technology and medication and what they have meant for millions of patients and their families.
Through the years, she’s seen massive change in the understanding of type 2 diabetes, for example. “We’re fortunate to be blessed with new medications, which has led to tremendous improvement in treatment,” she notes. Every year they get better access to data through advances in the technology of devices. “Literally 24/7 we can monitor levels,” she adds.
At same time, the need for care locally and nationally is on the rise. In the last two decades, the prevalence of diabetes has increased at an alarming rate among US adults ages 18 or older. By 2022, nearly 30 million people had been diagnosed with diabetes, and an estimated 8.6 million others had yet to be diagnosed, according to the Centers for Disease Control and Prevention. An estimated 97.6 million US adults have prediabetes.
Embracing technology
“Diabetes impacts everyone from all walks of life,” says Elyse Rayney, CNP. She originally developed her own passion for diabetes working in research at Massachusetts General Hospital. A desire to work more directly with patients led her back to school to become a nurse practitioner.
Thankfully, “there’s now so much creativity in how we can manage diabetes,” she says. “There are so many aha moments where patients see how small changes can make a huge difference.”
Like Dr. Steppel-Reznik, she also appreciates how far the division has come. When Elyse first came on board, she was the team’s only nurse practitioner; now she’s one of four. Ever since, “I’m proud of how we’ve embraced technology and stayed ahead of it,” she says. “We’re at the forefront, and we’re giving people a menu of options to make sure they have access to the latest and greatest.”
In an “ever-changing medication and technology landscape,” many things constantly need to be re-evaluated, she explains. Everyone on staff needs to be nimble.
The advent and evolution of continuous glucose monitors, for example, has been a “game changer.” Patients can see information in the moment as well as see how changes in behavior impact their levels. “It’s been a huge shift in the diabetes community and how we give guidance to our patients,” she says.
She’s excited to see where the field goes next. Day to day, “our team and our patients keep me energized,” she says. Importantly, every patient is an individual. The team works collaboratively with them to achieve their goals. “When you see someone succeed, it’s a great feeling.”
Learning to manage diabetes
“What excites me is how we continue to add elevated services for our patients,” says Kim Sabada, MS, RDN, CDCES, the lead registered dietitian and American Diabetes Association (ADA) coordinator for the practice.
Along with seeing patients individually, she also helps to lead the ADAcertified program of group classes, educating patients on the day-to-day management of type 2 diabetes to allow them to live healthier, happier lives. During the pandemic, the team pivoted to virtual classes. “Our enrollment has exploded,” she says.
What started as a three-part series now includes optional fourth and fifth classes. Participants are in the same cohort for their first three sessions, getting to see familiar faces and become more comfortable talking with one another.
Two years ago, Kim began offering a free, monthly support group. She’s there to moderate. Sessions typically draw 15 to 20 people, and it’s been beloved by those who attend.
The field of nutrition is ever changing, ever growing. With social media, “what’s also changing is people’s exposure to misinformation,” she adds. She strives to make sure that she’s pointing patients to good information.
One misconception: “they think that I’m here to tell them what they can’t eat,” she says. She stresses “getting out of this all or nothing mindset.” For her, it’s about moderation. “You have to meet patients where they are,” she adds. Her key questions: How long can they sustain this? How do we not only manage your diabetes but also manage your quality of life?
Echoing Elyse’s point about continuous glucose monitors, Kim appreciates how they allow her patients to see very tangible data: “when I eat X, this is what happens.” They can feel the highs and lows with their blood sugar.
As much as she recommends that people with diabetes take advantage of newer medications, they’re not a substitute for getting nutrition and eating an adequate diet, she believes. Nine times out of ten, having good food habits also makes a medication’s side effects more manageable.
Now in her seventh year at NWH, “it’s definitely home for me,” Kim says. Both for herself and her patients, she finds the division’s team-oriented approach rewarding. She loves seeing the collaboration in action.
“Always trying to up my game”
“Our patients make us the best doctors,” Jeanne Steppel-Reznik likes to say. For her, being able to know many of her patients by following them throughout their lives adds a special dimension to her own work.
For Joanne, one of Dr. Steppel-Reznik’s hundreds of grateful patients, it’s now been seven years since diagnosis. She’s continually seen advances in the technology. “The progression in such a short time has been phenomenal.” She initially took advantage of a continuous glucose monitor. “Now I’m on a pump [for the delivery of insulin], which has been life-changing.” Hers is a wireless system, already in its fifth generation.
As Joanne recounts her experience, she notes that “today is a big day.” She’ll begin a new quick-acting insulin suggested by her team.
“They’re always trying to up my game,” she adds. “If they can make my life easier, it’s a win.”
A family’s generosity makes key technology possible
Established in 2023, the Welsh-Loveman Family Fund for Diabetes and Endocrinology has already made a difference for patients by making possible two very important types of technology.
First, the new fund has enabled the purchase of a retinal camera, allowing patients to have images taken of the inside of their eyes as part of their visit and read by ophthalmologists. Going forward, having the technology on site will enable patients to be routinely checked each year, easing access to screening and early detection of diabetes-related eye conditions.
Second, the family’s gift has provided funding for a point-of-care hemoglobin A1C machine. This device will allow staff to get data on patients’ A1C levels as part of a routine check of vital signs.
Again, having that technology at the clinic will provide the team with the benefit of knowing more information right at the time of the visit. It will increase productivity dramatically.
Dr. Steppel-Reznik and her entire team are immensely grateful to Kathleen Welsh and Gary Loveman, PhD, for their amazing generosity. “Every year, there are new recommendations about diabetes-related technology and medication,” she reflects. For the sake of their patients, “we try very hard to stay on the cutting edge.”
Along with its timely investment in the division’s capabilities, the Welsh-Loveman Fund provides a wonderful reminder of the power of philanthropy to advance care.
