DIABETES and METABOLIC SYNDROME PROGRAM.

DIVISION OF ENDOCRINOLOGY METABOLISM AND DIABETES Department of Medicine Leon Fogelfeld, MD Chairman FACULTY Attendings Ambika Babu, MD Rasa Kazlauskaite, MD Evelyn Lacuesta, MD Susana Mascarell, MD Network Diabetes Program Pat Speirs, RD, CDE.. MS Clinical Coordinator Geri Holt, APN, CDE MS Barbara Savoy, RD, CDE Leila Herrera, RD, CDE Sol Farias, Pharm.D, CDE Pam Pontikas, Pharmd.D, Fellows (Combined program with Rush University) Padma Berikai, MD Chung Koh, MD Maria Lydia Patacsil, MD Gitana Staskus, MD

NETWORK DIABETES PROGRAM (NDP): The Division has developed and is responsible for a comprehensive diabetes program for the Cook County Bureau of Health Services . This includes 3 acute care hospital and 30 ambulatory sites for an estimated population of 30,000 patients with diabetes. The basis of the program are multidisciplinary diabetes teams operating in several sites throughout the Cook County area. The team consist of primary care physicians, Certified Diabetes Educators (CDEs) including dietitians, nurse practitioners, clinical pharmacists, clinical psychologists and social workers. The diabetes teams provide patients education and management in conjunction with the primary care physicians. The teams also serve as a diabetes resource for the health care providers, develop with standards of care and maintain diabetes patients database to generate diabetes care outcomes. The current four NDP sites include Fantus Clinics, Near South Clinics, South Suburban Clinics, and Western Hub 4 clinics serving mainly the Hispanic population. Clinical psychologists, psychology externs and a social worker, with specialties in individual and group counseling and stress management, provide the behavioral and social support for the Diabetes Program. The NDP staff is involved (as part of “Bridges to Health” project) in developing diabetes education skills for Latino peer mentors

“Promotores”. Five diabetes Promotores trained in NDP serve already in other County Clinics. The NDP in its fourth year has managed about 7,000 single patients for almost 20,000 visits. All the patients data are recorded in a detailed computerized database which tracks longitudinally parameters of diabetes control, laboratory and medication data, and self-management information (glucose monitoring, adherence to medications, diet and exercise). Psychosocial problems are tracked as well. The NDP Center in Fantus is an ADA recognized Diabetes Center. The Division of Endocrinology is responsible for the entire diabetes program. In the Diabetes Center a multidisciplinary Diabetes Clinic staffed by endocrinologists manages patients with difficult and uncontrolled diabetes on daily basis. Patients with unstable diabetes arriving to emergency care sites are having immediate access to diabetes care. Such treatment includes medical management of diet, oral, and injectable medication for diabetes, As part of quality improvement, the four NDP teams participated 2002-2003 in the Chicago Regional Diabetes Collaborative (Dr. Fogelfeld, the medical director of the NDP, was the Co-Chairman of the Collaborative), which implemented the “Chronic Care Model” components. TRAINING: The Division provide intensive education in clinical endocrinology to medical students, medicine, family practice podiatry and ophthalmology (in planning phase) during their monthly rotations. Medicine residents are participating on an elective basis in yearlong continuity outpatient endocrine clinic. Combined Fellowship Program with Division of Endocrinology Rush-Presbyterian Medical School provides clinical and research training to 4 fellows. The NDP is serving as a professional resource for the clinical providers (physicians and non-physicians) across the CCBHS sites. Currently, structured programs of multidisciplinary management of diabetes are taking place and are involving physicians, physician assistants, nurses, nurse practitioners, residents and students. The NDP has been a site for several master theses in the course of “Masters in Clinic Research” by Rush University as well as dissertations for clinical psychologists RESEARCH and DEVELOPMENT: The NDP is also involved in several research projects in the area of diabetes. For example, the outcomes of care of diabetes in CCBHS and NDP will be presented this year in 5 abstracts in the annual scientific meeting of the American Diabetes Association. A new multi-year program for detection and management of pre-diabetes/metabolic syndrome is currently being launched by NDP in conjunction with primary care sites of ACHN. The principles and resources needed for such an extensive program are being delineated. The clinical space needed for one of the components of this program the “Lifestyle School” has been recently identified and secured in the Fantus Clinics. RESEARCH INTERESTS:

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Diabetes Outcomes and Care delivery Diabetes Self Management PreDiabetes/Metabolic Syndrome Investigator initiated drug studies

MULTICENTER TRIALS 1. Exanatide for Type 2 DM

2. 3. 4. 5. 6. 7.

Glimeperide vs. Metformin in Type 2 DM in children Ertapenem in Diabetic Foot Rosiglitazone in Type 2 DM (beta cell preservation) Glargine vs. TZDs in Type 2 DM Pioglitazone in atherosclerosis NAPH Diabetes Studies (with Dr.Reilly)

STUDIES (original and ongoing) 1. Metabolic Syndrome in adolescent Hispanics. 2. Motivational Interview for New Diabetics 3. Diabetes burden in CCBHS (with Dr. Shiff group) 4. Accuracy of Home Blood Glucose Monitoring 5. Safety-net therapy for unstable diabetes (With ED Department) 6. Asymptomatic ventricular dysfunction in new diabetics (with Div. of Cardiology). STUDIES IN ADVANCED PLANNING 1. Detection and management of prediabetes and metabolic syndrome-feasibility phase 2. Multifactorial intervention in patient with advanced nephropathy (with Renal Division) PUBLICATIONS Smith A, Fogelfeld L, Bakris G. New Therapies in Diabetes- Thiazolidinediones. Emerging Drugs 2000; 5 (4) 1-16. Collins B, Chiappetta G, Schneider A, Santoro M, Pentimalli F, Fogelfeld L, Gierlowski T, ShoreFreedman E, Jaffe G, AND Fusco A. RET expression in papillary thyroid cancer from patients irradiated in childhood for benign conditions. Journal of Clinical Endocrinology and Metabolism 2002; 87(8) 39413946 Schneider AB and Fogelfeld L Pathogenesis of thyroid cancer(pp:569-575). Oxford Textbook of Endocrinology (John A.H. Wass and Stephen A. Shalet, Editors) Oxford University Press, 2002. 26. Ambika Babu, C.R.Kannan, Theodore Mazzone. Diabetes, Hyperlipidemia and Stroke" Pages 173-182. In Stroke Prevention Published by Kluwer and Plenum, Parthenon publishing, 2002. R Kazlauskaite and L Fogelfeld. Insulin Therapy in Type 2 Diabetes. Disease a Month 2003 49 (6) 373420 Akhrass F, Evans AT, Wang Y, Rich S, Kannan CR, Fogelfeld L, Mazzone T.Hormone Replacement Therapy is Associated with less Coronary Atherosclerosis in Postmenopausal Women. J Clin Endocrinol Metab. 2003 Dec;88(12):5611-4. Ambika Babu, MD and Arcot Dwarkanathan MD, FACE. Cushing’s Syndrome from Ectopic ACTH Production by a Metastatic Gastrinoma. Endocrine Practice, 2003 May-June 9(3):229-32. Evans, A, Kazlauaskaite, R Training in flexible intensive insulin management improved glycemic control and quality of life in type I diabetes, ACP J. Club 2003 May-June 138(3):68

Steinle NI, Kazlauskaite R, Imumorin IG, Hsueh WC, Pollin TI, O'Connell JR, Mitchell BD, Shuldiner AR.Variation in the lamin A/C gene: associations with metabolic syndrome. Arterioscler Thromb Vasc Biol. 2004 Sep;24(9):1708-13. Epub 2004 Jun 17. Fu M, Kazlauskaite R, Baracho Mde F, Santos MG, Brandao-Neto J, Villares S, Celi FS, Wajchenberg BL, Shuldiner AR. Mutations in Gng3lg and AGPAT2 in Berardinelli-Seip congenital lipodystrophy and Brunzell syndrome: phenotype variability suggests important modifier effects. J Clin Endocrinol Metab. 2004 Jun;89(6):2916-22. John R and Fogelfeld L. Inpatient Management of Diabetes and Hyperglycemia. Disease a Month 200450 (8) 433-480 Babu A, Herdegen J, Fogelfeld L, Shott S And Mazzone T . Treatment of Obstructive Sleep Apnea with Continuous Positive Airway Pressure Improves Glycemic Control in Type 2 Diabetes. Archives of Internal Medicine (Accepted). Schiff G, Kim S, Krosnjar N, Wisniewski M, Bult J, Fogelfeld L and McNutt R. Missed Hypothyroidism Uncovered by Linking Laboratory and Pharmacy Data. Archives of Internal Medicine (Accepted). A.Babu, E. Lacuesta, S. Patel. Blastomycosis masquereding as thyroid mass. . Endocrine Practice (Accepted) Kazlauskaite R, Evans A, Mazzone A, Fogelfeld L. Ethnic Differences Predicting Ketonuria In Type 2 Diabetes Journal Of Diabetes And Its Complications (submitted). Ambika Babu, C.R.Kannan And Theodore Mazzone. Hyperlipidemia And Peripheral Vascular Disease, In Lower Extremity Arterial Disease. D.G. Caralis And G.L. Bakris Editors. (In Press).

ABSTRACTS Ambika Babu, Billie S. Strauss, Kelly Kozik, Carolyn Pesquira and Leon Fogelfeld. Abs No 1622-P. Psychosocial Characteristics and Glycemic Control in Patients with Diabetes in an Urban Setting American Diabetes Association, June 2001 at Philadelphia. Babu, J. Herdegen, C. Kannan, L Fogelfeld, S. Shott, T. Mazzone. Treatment Of Obstructive Sleep Apnea With Continuous Positive Airway Pressure Improves 24 Hours Glucose Control. American Diabetes Association, 62nd Annual Meeting, 2002, San Francisco. L. Fogelfeld, K Kozik. Challenges And Barriers To Diabetes Care In A Huge Underserved Urban Population. American Diabetes Association, 62nd Annual Meeting, 2002, San Francisco. Fu M, Kazlauskaite R, Wajchenberg BL, Celi FS, Shuldiner AR. Mutations in BSCL 1 Locus and BSCL 2 (seipin) Are Not Common Causes of Congenital Generalized Lipodystrophy Syndromes (2246 PO). 2002 ADA 62nd Scientific Sessions Abstracts. Diabetes 51(S): A544. Ambika R. Babu, Evelyn Lacuesta, Subhash Patel. Severe hypoglycemia-an unusual presentation of adrenocortical carcinoma". Abstract number – 51. Presented at the 11th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists held on May 2002, Chicago, Illinois.

C. Yerrapareddy, E. Lacuesta, S. Patel. Blastomycosis masquereding as thyroid mass. . Presented at the 11th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists held on May 2002, Chicago, Illinois. S. Shah, S. Kim, M. Wisniewsky, R. Tomar, G. Schiff and L. Fogelfeld. Use of public hospital electronic registries to assess the burden of diabetes in a large underserved population. American Diabetes Association, 63nd Annual Meeting, 2003, New Orleans. G Staskus, L Fogelfeld. High dose I -131 therapy in Graves’ disease. The 85th Annual Meeting of The Endocrine Society, Philadelphia, June 2003. Fu M, Kazlauskaite R, Barracho FP, Goretti N Santos M, Villares S, Celi, FS, Wajchenberg BL and Sculdiner AR. Mutations in Gng31g and AGPAT2 in Baradinelli-Seip Congenital Lipodystrophy and Brunzell Syndrome: Phenotype Variability Suggests Important Modifier Effects (1076 P). 2003 ADA 62nd Scientific Sessions Abstracts, Diabetes 52(S2): A250. Fu M, Kazlauskaite R, Barracho FP, Goretti N Santos M. Villares S, Celi, FS, Wajchenberg BL and Sculdiner AR. Congenital Generalized Lipotrophic Diabetes in Large Kindred from Brazil is Caused by a Mutation in the BSCL2 Gene (1055 P). 2002 ADA 62nd Scientific Sessions Abstracts. Diabetes 51(S2): A260. Meenakshi Pande, Maria D Camargo, Carolyn Lopez, and Leon Fogelfeld. Metabolic Syndrome Factors in Hispanic Adolescents: Association with Atherosclerosis Markers. American Diabetes Association, 64th Annual Meeting, 2004, Orlando. Maria D Camargo, Meenakshi Pande, Carolyn Lopez, and Leon Fogelfeld. Social and Behavioral Factors are associated with Metabolic Syndrome Components in Hispanic Adolescents. American Diabetes Association, 64th Annual Meeting, 2004, Orlando. Fogelfeld L, Shaffer T and Lipton R. How Unusual Are Type 2 Patients with Onset before Age 30? American Diabetes Association, 64th Annual Meeting, 2004, Orlando. Shaffer T, Fogelfeld L, Cooper A and Lipton R. Risk factors for complications in uninsured youngerversus older-onset adults wit diabetes. American Diabetes Association, 64th Annual Meeting, 2004, Orlando Kazlauskaite R, Evans A, Mazzone T, Fogelfeld L.Low HDL-cholesterol is associated with ketosis in Hispanic/Latino but not African Americans patients with type 2 diabetes. American Diabetes Association, 64th Annual Meeting, 2004, Orlando