Physician’s Brief clinical and research highlights for our colleagues in endocrinology Ye a r- E n d 2014
The Next Generation of Diabetes Care As our society struggles to adjust to the ever-increasing burden of type 2 diabetes, it becomes a challenge to stem the tide from the deluge of newly diagnosed patients without compromising care of those who have battled the disease for years. Two novel U-M initiatives address both patient populations, and with them, the next generation of diabetes care has arrived.
The Type 2 Diabetes Cure Clinic People with type 2 diabetes diagnosed within the past five years who are overweight (with a body mass index of 35+) are now being referred to U-M’s T2D Cure Clinic, spearheaded by William Herman, M.D., M.P.H., director of the NIH-funded U-M Center for Diabetes Translational Research, and Amy Rothberg, M.D., one of the first physicians to be certified by the American Board of Obesity Medicine. Aggressive plans for weight management
help patients decrease symptoms and approximately 65% of participating patients have reversed their disease, including improved insulin sensitivity and restoration of normal blood glucose control.
enough for maximum effectiveness in turning the disease around, improving patients’ quality of life.
Along with proven weight loss interventions, the Cure Clinic’s success comes from intensive patient education, medical management to improve risk factors, and a personalized approach. “We understand that weight loss is not one-size-fitsall, and each person’s journey is unique,” says Rothberg.
On the other end of the spectrum are patients who have been living with type 2 diabetes for many years, only to find it increasingly difficult to manage their disease. U-M offers an evidence-based clinical approach for them too: the Intensive Type 2 Diabetes Program. As the program’s director, Israel Hodish, M.D., Ph.D. explains, “Diabetes is progressive. After the first ten years, patients often become resistant to oral medications, increasing their likelihood of serious complications.”
Most people with type 2 diabetes receive care from an endocrinologist only when blood sugar spirals out of control or when diabetes complications arise — typically five or more years after diagnosis. By then, much of the damage of diabetes may already be underway. The Cure Clinic’s multidisciplinary team puts their tools to work for patients early
The Intensive Type 2 Diabetes Program
Hodish estimates that about half of all type 2 patients fall into this high-risk category. And studies show that noncompliance is the cause of health problems Continued on page 2
Combating Diabetic
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William Herman, M.D., M.P.H.
Amy Rothberg, M.D.
in only about 20% of cases. Rather, these patients need more frequent attention, especially when beginning insulin therapy. Hodish’s preliminary findings indicate that these patients benefit most when insulin levels are adjusted regularly — once a week or every few weeks — to maintain desired glucose levels. Given the national shortage of providers, such frequent patient interaction often isn’t feasible in a traditional clinic setting. Or is it? To develop a workable clinical model, Hodish first adapted some elements from the proven approach used to manage drugs like Warfarin
Israel Hodish, M.D., Ph.D.
that require frequent adjustment. A suite of communication tools, including email and phone calls, replaces many face-to-face consultations, and U-M-developed software helps keep all of the pieces working together, generating personalized calendars to prompt patient contact, monitoring medications and vital signs, and making it easier to update clinical notes. These elements come together in the U-M Intensive Type 2 Diabetes Program.
To connect with these clinics or to refer a patient, contact M-Line at 800-962-3555.
Elevated blood sugar levels are toxic to every organ and cell in the body, and can ultimately lead to severe complications in the kidneys, nerves, eyes and heart. These progressive complications make diabetes one of the leading causes of death in the U.S., significantly compromise the quality of life of patients and families, and exact a huge economic toll on both individuals and our healthcare system. In both the clinic and the research lab, the University of Michigan Comprehensive Diabetes Center has built a global reputation as a leader in addressing nephropathy, neuropathy, retinopathy, and cardiovascular complications. Although both the symptoms triggered by these conditions and their long-term consequences vary greatly, when it comes to detecting their presence and minimizing their impact, we pursue four critical strategies for all: Early detection — At U-M, clinic visits focus on detecting the onset of complications and addressing them before symptoms become troublesome. Patients benefit from research findings published by our world-renowned specialists in diabetes complications, which are then put into clinical practice here.
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One number. Unlimited assistance.
800-962-3555 Your physician-to-physician connection to over 3,000 U-M doctors and 26 departments, 24 hours a day. Schedule an appointment, coordinate a patient transfer, request a consultation or inquire about any clinical service.
Aggressive treatment — Studies show that the best approach to mitigating diabetic complications n
Complications: A Comprehensive Approach involves optimizing glucose, blood pressure, and cholesterol levels; closely monitoring medications; and encouraging proven lifestyle changes. These are the cornerstones of clinical care at the U-M Comprehensive Diabetes Center.
medicine, ophthalmology, podiatry, transplant and more, while continuing to actively manage their diabetes. We are equally committed to collaborating with patients’ home physicians to ensure continuity of care.
Multidisciplinary care — As part of one of the nation’s most comprehensive health systems, we are fortunate to be able to connect our patients with our expert colleagues in nephrology, neurology, cardiovascular
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Relentless research — Basic, clinical, and translational research informs everything we do at U-M. As the leading institution in the U.S. in the study of diabetes complications, we are able to offer patients opportunities to participate
in numerous cutting-edge clinical trials, many of which originate here, and most of which are offered at only a select list of top centers.
To connect with a U-M expert in diabetic complications, call M-LINE at 800-962-3555.
Controlling Hyperglycemia in the Hospital Setting Patients hospitalized due to a critical illness or following major surgery are at an increased risk of developing hyperglycemia as a result of stress-induced insulin resistance. This is the case for both people with and without diabetes. The major cause of hyperglycemia is the release of counter-regulatory stress hormones (namely cortisol, growth hormone, catecholamines and glucagon) and local tissue cytokines. Additional factors common to a hospital setting, such as excessive nutritional support, sepsis, hypothermia, hypoxemia, uremia and cirrhosis further reduce insulin production and can worsen insulin resistance. Although hyperglycemia in critically ill patients is a serious
risk factor for inpatient morbidity and mortality, it is also a correctable one. Data support the use of carefully monitored insulin infusion protocols to correct hyperglycemia, especially in the setting of cardiothoracic surgery, heart failure and critical care. U-M’s Hospital Intensive Insulin Program (HIIP) is an inpatient program designed to manage diabetic/hyperglycemic inpatients. The program is run by Roma Gianchandani, M.D. HIIP currently operates on the thoracic surgery wings of the University of Michigan Hospital, where it has demonstrated significant reduction in length of stay. Given HIIP’s potential to reduce postdischarge emergency room visits and hospital readmissions, U-M
Roma Gianchandani, M.D.
is currently exploring expansion of the program to additional inpatient surgical services.
To connect with Dr. Gianchandani and learn more about managing inpatient hyperglycemia, call M-Line at 800-962-3555.
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Leaders and Best: Diabetes Treatment, Research and Training at the University of Michigan In 2013, approximately 30,000 outpatient visits were scheduled in the Adult Metabolism, Endocrinology and Diabetes Clinic, where over 6,000 patients with diabetes are seen. U-M currently stewards over $300 million in diabetes research funding, and since 2008 has been ranked first in number of grants and amount of diabetes research dollars from the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.
We are home to one of the largest endocrinology faculties in the U.S., with approximately 45 primary faculty (and an additional 10 secondary and adjunct faculty members) collaborating in the Michigan Comprehensive Diabetes Center. The Michigan Diabetes Research Center is an interdisciplinary research hub for diabetes investigators from across the University. MDRC membership includes over 100 faculty members
working in 35 different U-M divisions, departments, and centers. Between 1975 and 2013, we graduated over 240 endocrinology fellows from our comprehensive, NIH-funded training program. Our second, new NIH T32 grant to train postdoctoral fellows in basic science diabetes research is our innovative response to the need for well-qualified scientists in the field.
University of Michigan Comprehensive Diabetes Center Peter Arvan, M.D., Ph.D., Director 734-936-5505 Executive Officers of the University of Michigan Health System
The Regents of the University of Michigan
Michael M.E. Johns, M.D., Interim Executive Vice President for Medical Affairs; James O. Woolliscroft, M.D., Dean, U-M Medical School; T. Anthony Denton, J.D., MHA, Acting Chief Executive Officer, U-M Hospitals and Health Centers; Kathleen Potempa, Ph.D., Dean, School of Nursing.
Mark J. Bernstein, Julia Donovan Darlow, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mark S. Schlissel, ex officio.
The University of Michigan, is a non-discriminatory affirmative action employer. Š 2014 The Regents of the University of Michigan