Meet Maura: A Kovler Extern

Hi, my name is Maura Connors and I am excited to be an extern at the Kovler Diabetes Center! I am a rising second year at the University of Chicago and am planning to major in Geographical Studies, with the hopes of pursuing a career in marketing, advertising, and public relations.

Diabetes is such a widespread issue that affects friends in my sorority and some of my family members. I am very excited to work at an institution that is on the forefront of new advances and treatments for diabetes, as I know how much of an impact these discoveries could have on the lives of my loved ones. I love working with the other Kovler Collegiate Extern team members to organize events (like the upcoming Comer Classic and JDRF Walk), in addition to working with the social media team to promote Kovler events and programs (including our teen advisory panel, “InTransit”). I am eager to learn more about diabetes and gain experience in the field I hope to eventually work in!

Meet Carrie: A Kovler Extern

Hi, I am Carrie, and I am very excited to be working for Kovler as a communications extern! I am currently studying biological sciences and visual arts at the University of Chicago, and I plan on going to medical school after graduation.

My work at Kovler has not only given me a better understanding of diabetes, but has also opened my eyes to the everyday struggles of those who are affected by the disease. Thus, it is very important to me that all patients have equal access to support for their condition as well as key resources for their treatments. Needless to say and perhaps what makes my job at Kovler so enjoyable is that Kovler, too, passionately champions these goals.

Currently, Kovler hopes to extend diabetes resources and care globally to the underserved. In China for example, studies have shown that the prevalence of diabetes in people over the age of 20 has increased to about 9.7 percent in the recent years. Among those who are affected by diabetes, a shocking 60 percent are undiagnosed—this means that about 92.4 million people have the disease, and about 56 million are untreated! These alarming statistics translate to the need for immediate action, and has spurred Kovler’s interest in a potential collaboration with the University of Chicago Center in Beijing to promote wellness events and conferences that would ultimately engage scholars and the Chinese public.

Very soon, I will be meeting with the Office for International Patients on the University campus to discuss the ongoing care for international diabetes patients, and the possibility for Kovler to be involved in an international effort to help diabetes patients.

My work at Kovler will also give me the opportunity to represent diabetes patients through photography. I hope to capture the not only the struggles of those affected by the disease that I hope will advocate access to quality diabetes care, but also their triumphs that I hope will be an inspiration for everyone. Not only has working for Kovler given me the ideal balance between the medical and visual disciplines that I hope to achieve in my future career, working for Kovler has been—and I expect that it will continue to be—very rewarding experience.

Kovler Hosts Conference on Diabetic Nephropathy

We are excited to announce that the Kovler Diabetes Center, in partnership with the ASH Comprehensive Hypertension Center, hosted an August 9^th conference exploring the topic of diabetic nephropathy. This conference brought together some of the brightest scientific minds to discuss issues surrounding kidney function and diabetes. Topics of discussion included nephropathy progression, biomarkers, nomenclature and clinical trials.

The University of Chicago Medicine’s very own Louis Philipson, MD, PhD, FACP, George Bakris, MD, and Michael Eadon, MD presented their work, elucidating the importance of kidney care among populations living with diabetes.

Dr. Louis Philipson

Dr. Philipson, director of the Kovler Diabetes Center and Professor of Medicine and Pediatrics, centered his portion of the conference around the importance of glycemic control in relation to nephropathy progression. Dr. Eadon’s presentation focused on the assessment of kidney function, the comparison of old and new biomarkers and their abilities to predict nephropathy progression, and decisions regarding renal imaging. Dr. Eadon is a nephrology fellow at the University of Chicago. Finally, Dr. Bakris, director of the ASH Comprehensive Hypertension Center, presented fascinating information on topics including nomenclature of nephropathy staging, surrogate markers of nephropathy progression,  and an interactive case presentation.

Team Members Carrie & Jasmine

Conference-goers spent the entire day with our University’s presenters, arriving at the Knapp Center for Biomedical Research and Discovery at 8:30 AM and departing from the Center at 4:00 PM.

Kovler feels privileged to have been able to play a part in furthering education on the relationship between diabetes and kidney disease.

Announcing the InTransit Teen Advisory Panel

Kovler is proud to announce the creation of its InTransit Teen Advisory Panel!

This summer a group of seven Kovler InTransit teens in grades 7-12 met at the Kovler Diabetes Center for an evening of brainstorming, chatting, and connecting with other Kovler teens, their families, friends, and Kovler professionals.

Peggy Hasenauer, Executive Director of the Kovler Diabetes Center, worked with Dr. Beth Littlejohn, Amy Hess-Fischl, and Julia Socke to coordinate a casual meeting between families interested in sharing their ideas about living with diabetes as a teenager. It is the goal of the panel to identify needs and concerns of teens living with diabetes and their families. Kovler would like to work with teens to provide the best care possible at Kovler. It is our hope that teens and their families can use this group to find fun ways to support one another and to become involved in diabetes care and at Kovler.

At the first meeting, teens and parents discussed their thoughts separately and as a group and it was great to see that connections and common experiences could be discovered among the families present. Families ended their evening with an informative and impressive tour of the Kovler research labs at the Knapp Center for Biomedical Discovery. Teens and parents were excited to see where current and cutting-edge diabetes research takes place.

Member of the InTransit Teen Advisory Panel Kelly McGinnis, shares her thoughts on Kovler and on the newly formed panel:

Kelly McGinnis

I think that the teen advisory panel is a really great idea that has a lot of potential!  Seeing all that the Kovler Diabetes Center is doing to help treat type 1 diabetes makes me very excited and hopeful.  I am so glad to be a part of something that is really invested in dealing with this chronic disease.  No other hospital or doctor around is doing anything like the Kovler Diabetes Center.  The InTransit program is the reason I switched doctors and came to the University of Chicago when I was 15.  My parents and I knew that we would need a team and a program that could deal with teenage obstacles and the challenge of moving from a child to an independent adult.

The teen group and the staff involved with the panel all seem very interested in making a difference and giving input on how to make the lives of teenagers with diabetes easier and more manageable.  The small group atmosphere made it easy to share opinions and personal stories.  Another great thing about the group is the range of ages involved because it allows for a wide range of concerns to be addressed, from high school activities to going away to college.  I think we are all excited to see what the panel can accomplish in terms of raising awareness and helping others with diabetes like us.  We are all moving to different phases of our lives and it is helpful having a group who understands the life of a person with type 1 diabetes.

The InTransit Teen Advisory Panel will meet multiple times throughout the year and continue to form relationships with each other and with Kovler. We are truly looking forward to working with the Teen Advisory Panel this year!

If you would like information about becoming involved with the Teen Advisory Panel, please contact Peggy Hasenauer at peggy.hasenauer@uchospitals.edu.

The “Wrong Call”: Mistaking Type 2 for Type 1

Many have asked me about this week about the recent article in the WSJ that was generated from a recent piece that pointed out how type 1 diabetes can sometimes be missed when an adult is thought to have type 2 diabetes. This is nothing new, sadly, but the rising incidence of type 1 as well as type 2 diabetes makes this a critical point to reconsider. Mistaking Type 2 for Type 1 is a potentially fatal error.

At Kovler, we know there in fact many kinds of diabetes and at least some of them can be seen at any age. As the WSJ article correctly points out, Type 1 diabetes use to be to thought of as occurring primarily in children, but this was always a misconception. While the peak ages for type 1 diabetes occur in the childhood to adolescent age group, I have had adult patients as old as 80 years of age receive a new diagnosis Type 1.

The first thing (but not the only thing!) to consider is the BMI (body mass index). Lean patients are much more likely to have type 1 diabetes or some other form of insulin-deficient diabetes (like monogenic, see below).  If the blood sugar is over 250 mg/dl it is very important to consider getting ketone levels. A positive test for acetone or other ketones is not definitive for type 1 but it should raise suspicions when the blood sugar is high.  Adults with type 1 often have a much slower time of progression of their disease, which can also be confusing. Children can appear to develop diabetes practically overnight requiring insulin right away, whereas adults with type 1 might take several years of progressive failure of one oral agent after another until insulin is finally started. This is also known as LADA – latent adult onset diabetes with autoimmunity. The autoimmunity part is really critical. Most but not all patients with type 1 will be positive for auto-antibodies against proteins of the beta cell. Typically we test for anti-GAD65, anti-IA2, anti-insulin, anti-ICA, and/or antiZnT8 antibodies. A positive test in any one of these is consistent with autoimmune type 1 diabetes, and insulin is the only appropriate therapy, although combinations that include insulin can often be helpful. The family history can also provide important  insights. Patients with type 2 diabetes actually have a positive family history of type 2 diabetes much often than patients with type 1 diabetes. Finally in some cases measuring the insulin levels can be helpful if they are high or very low. This is usually done by measuring the c-peptide level, a by-product of insulin secretion that was discovered at the University of Chicago. There are many caveats to this test so by itself it might be misleading in a non-research setting.

I should point out that there are other important forms of diabetes. Most primary care providers would be familiar with steroid-induced diabetes and gestational diabetes. While steroid-induced is a form of Type 2, gestational could be either type 1 or type 2 or monogenic and should be investigated further. Diabetes can also be associated with acromegaly, thyroid disease, and cystic fibrosis, for example.

Our team studies rare forms of diabetes that are strongly inherited – the monogenic forms. These are described on our website www.monogenicdiabetes.org, and several of them were also discovered here at the University of Chicago. These also have the hallmarks of young onset, are antibody negative, and usually positive for tests of insulin production such as the c-peptide test. They are important because they can have specific outcomes, specific treatments, and specific associated factors. They also tell us about genes that are important for normal metabolism. They occur in about 2% of everyone with diabetes, meaning about 3-500,000 people in the United States alone have one of these forms – a significant number that is largely missed.

The bottom line here is that Type 1 diabetes is increasing  in many populations, although perhaps not as dramatically as Type 2 diabetes associated with obesity. Missing type 1 diabetes can be a disaster, or at best a multiyear confusion. What I teach is that it is always important to ask oneself why a given patient has diabetes and what kind they have. Do not assume. If you have doubts, get another opinion, or get a referral to a see a specialist. Persistence can be life-saving.

Lou Philipson

Louis Philipson, M.D., Ph.D., FACP
Professor
Departments of Medicine and Pediatrics- Section of Endocrinology, Diabetes and Metabolism
Director, Kovler Diabetes Center

Introducing Emily: a Kovler Summer Intern

Hello, my name is Emily and I have been working here at Kovler for a little over a month and a half now.  Each day when I walk into work, I am astonished at how awesome this institution is and cannot believe I am able to work here.  Coming into this internship, I was very nervous about the types of things I would be doing and the people I was going to be working with.  Not having diabetes myself and with only a small amount of experience, I was nervous yet excited to begin.

Being a Nursing major my understanding of diabetes has mostly come from my textbooks, and the clinicals I have completed.  This pasted spring I worked on a Cardiac-Pulmonary floor and received the opportunity to care for numerous patients with diabetes.  I was able to assist them in managing their blood glucose levels within the hospital in addition to promoting healthy lifestyles once these patients were discharged.  With what felt like an abundance of knowledge I decided to take the opportunity to come work for Kovler.  But little did I know that I would become even more acquainted with diabetes.

Throughout my time here, I have found a deeper respect for patients with diabetes and the care that these patients need.  I also have so much admiration for the doctors working within Kovler, who have made ground-breaking discoveries through their research.  It’s so incredible and interesting!  Lastly, working with the members of Kovler has shed a new light on proving care.  The people here at the Kovler Diabetes Center are so passionate about what they do and it is incredible to see how they can make a difference for each individual they care for, educate, and support.  I hope to do the same in my own career.

While working close with these members, especially Peggy Hasenauer, I have helped to launch two substantial programs for Kovler this summer: Kovler Krew and the Diabetes All-Star Peer-to-Peer Program.  Both new projects have made great progress so far and we are excited to see where they are headed!

Kovler Krew, a volunteer program, provides members of the community a chance to offer their time, support, and knowledge to assist the Kovler Diabetes Center in expanding its community presence, and helping educate and support patients all throughout Chicago.  Volunteers play a large role in the Kovler team and we are very thankful for those that choose to do so.

The second program, Diabetes All-Star Peer-to-Peer Program is a peer-to-peer mentoring program for Kovler patients from the south side of Chicago who have type 2-diabetes. We believe that through this mentorship our patients, who have struggled in the past, will achieve confidence and stability in managing their diabetes and continue to live healthy lifestyles.

Working with these volunteers and patients, I hope to strengthen the Kovler Team and to build the Kovler connection throughout the Chicago-land area. It has been great seeing the progression of these programs so far, and I am eager to see what else the rest of the summer has to offer.

Guest Blog: Diabetes Prevention Program Outcomes Study

I am the Program Coordinator for the Diabetes Prevention Program Outcomes Study, a multi-center study which has been ongoing since February 1996.  We ended recruitment in February, 1999.  There are two staff members working on the DPPOS here – myself and Rina DeSandre.  We have worked together since the study’s inception!

Our study is looking at how to prevent diabetes in people at high risk.  It was a very stringent screening process, but finally after three years we finished recruitment and randomized 153 people.  There are three treatment groups now.  One is using the medication metformin, which is currently indicated for treatment of diabetes, one group is the placebo and the other group is intensive lifestyle.  Those in the intensive lifestyle group have a goal to lose 7% of their weight and do at least 150 minutes of moderate exercise (like a brisk walk) each week.

Since our study has been going on so long, we actually have some results initially published in the New England Journal of Medicine in 2001.  It was found that lifestyle was almost twice as effective (a 58% reduction in risk) at preventing diabetes as taking metformin for prevention. However, the metformin did have a 31% reduction in risk of getting diabetes.

Our participants are quite loyal – with a greater than 90% retention rate.  They see us twice a year now.  We also have classes on a quarterly basis and all are invited and can bring a guest as well.  There are various topics ranging from stress reduction to resistance training to eating a Mediterranean based diet.

We are planning on continuing the study until 2014.  However, we are also in the process of planning for another extension.  We still have many questions to be answered and our participants are also eager to continue. (What a great job I have!)

Thank you,

Margie Matulik
Program Coordinator,  DPPOS

Making Healthy Choices at the Taste of Chicago

This was my second year on the Humana Healthier Choices panel for the Taste of Chicago and it is always a thrill to take part–I have grown up attending the Taste and it is an honor to help in any small way.

The panel of four healthcare professionals were asked to review a list of foods submitted by various Taste of Chicago vendors to be included as a “Healthier Choice.”

In order to obtain the Humana Healthier Choice logo for the Taste, the items must to meet the following requirements:

Meals/Entrees
:

Less than 500 calories (25% Daily Value)
Less than 4 grams saturated fat (20% DV)
Less than 480 mg sodium (20% DV)

Appetizers/Snacks/Dessert:

Less than 250 calories
Less than 2 grams saturated fat
Less than 240 mg of sodium

Here is a complete list of the foods we selected: Healthier Choices Guide

The most important thing for Taste of Chicago attendees to remember is that the foods that are chosen certainly are healthier choices, but it is the cumulative amount consumed throughout their day at the that contributes to overall health.

Some tips for making healthy choices at the Taste of Chicago:

• Stick to 500-600 calories per meal
• Limit the caloric beverages
• Stick to Taste portions (and possibly share that with family and friends) to get the most bang for your calorie intake
• Take advantage of the surrounding area during the Taste–walk along the lakefront or through Millennium Park and Lurie Gardens to get more physical activity to burn some of the calories consumed at the Taste
• Eat smaller meals surrounding your visit to the Taste to reduce your overall calories for the day
• Enjoy more of the fresh fruits and vegetables when you arrive to fill up on lower calorie foods
• Be sure to visit the non-food vendors at the Taste — there is always something interesting showcasing Chicago

Have a fun (and healthy) weekend at the Taste of Chicago!

Amy Hess-Fischl
Registered Dietitian and Certified Diabetes Educator
The University of Chicago Kovler Diabetes Center

Introducing Megan: A Kovler Summer Intern

I’m Megan Miniat and this is my first summer interning at the Kovler Diabetes Center.  I am currently studying Psychology at Miami of Ohio University and plan on pursuing my Masters of Science to fulfill my goal of becoming a nurse.

Diabetes has always been a part of my life as my brother was diagnosed with Type 1 when he was six years old. I hope that my experience at Kovler will enable me to learn more about diabetes so that I can increase awareness and educate others. I am especially interested in how social media can be used as a tool for diabetes education, awareness, and support. I am eager to apply this knowledge as I move forward in my nursing career.

Guest Blog: Humana Healthier Choices at Taste of Chicago

You Can Eat at a Food Festival and Be Healthy, Too.

By Fredrik Tolin, M.D., medical director and vice president for Humana of Illinois

It’s officially summer – time to get outdoors and have fun! If you live in the Windy City or are planning a trip here, you’ll want to experience the annual Taste of Chicago – the biggest food festival in the U.S. For those of us who need to watch what we eat, though, food festivals can seem a bit scary. The temptations are endless and generally high in fat and calories.

Well, there is good news for Taste-goers. Health and wellness company, Humana, has again published the Humana Healthier Choices guide – and is bringing many health and well-being activities to the Taste of Chicago to help everyone enjoy the festival in a healthful way.

For the past two years, we have had the privilege of working with Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, advanced practice dietitian and coordinator for The University of Chicago Kovler Diabetes Center, to determine which foods made the cut to be listed as a Healthier Choice.

For a food to be considered, restaurants participating in the Taste of Chicago submit nutritional information including: calories, sodium content, saturated fat and the list of ingredients. Each submission is reviewed by a panel of top Chicago-area physicians with expertise in nutrition and diet, including Amy Hess-Fischl. The panel evaluates each submission to ensure they meet specific criteria:  appetizers and desserts must contain less than 320 calories, 300 mg sodium and 2 g saturated fat; main dishes must contain 500 calories or less; 500 mg sodium or less; and less than 4 g saturated fat.

We’re thrilled to announce that this year’s guide boasts a record number of 27 healthier options – from salads to spicy sausage, flatbread to sorbet – offered from 15 Chicago restaurants! You can check out the full listing of Humana Healthier Choices online at www.humana.com/tasteofchicago, and if you feel compelled, please “like” our Facebook page, where you can receive updates on the various health and wellness events and activities Humana is offering at the festival July 11-15.

Dr. Tolin with Humana’s Apple Man

At the Taste of Chicago, the Humana Healthier Choices items will be indicated by a green apple on the menu boards at participating restaurant booths. While you’re enjoying all that Taste has to offer, take a minute to check out the Humana Dining Pavilion at Buckingham Fountain and the Humana Well-Being Tour for innovative, fun and healthy activities, including free dance lessons, exercise classes and even a sock-hop. And, of course, keep an eye out for the Humana Apple Man mascot to snap your picture!

I’d like to personally thank Amy Hess-Fischl and Kovler Diabetes Center for their continued support of our Humana Healthier Choices program. For more information about Humana’s offerings at the Taste of Chicago, please see our press release. We hope to see your there!

Enjoy the summer and stay well.