Reflecting on 2012, Looking Forward to 2013!

As we come to the end of the year, the Kovler Diabetes Center at the University of Chicago has much to celebrate.

In 2012, our doctors and nurses treated thousands of individuals with diabetes. Diabetes experts also established or strengthened clinical partnerships throughout the world and provided diabetes management and prevention education at events large and small across Chicagoland and the U.S. You can read more about the amazing work over the last fiscal year in our first-ever Kovler Annual Report.

Based in the heart of one of the world’s great academic institutions, Kovler scientists are doing innovative research informed by a century of scientific discoveries and breakthroughs at University of Chicago. Our genetics team recently identified new genes that cause diabetes. Their work could lead one day to a better understanding of the effects of gene mutations on insulin production and metabolism, and provide pathways to treatments that once seemed unimaginable.

Alongside research, this type of outstanding, personalized patient care is at the heart of Kovler’s mission. From infants through adulthood, we provide the nation’s only fully-integrated pediatric and adult diabetes programs. Our Family Behavioral Health and Wellness Program is forging a national model for family-centered diabetes care. And three doctors in the Kovler Diabetes Center, including director, Dr. Lou Philipson, were recognized by U.S. News & World Report in its ranking of the nation’s top physicians in the field.

This year, we launched critical initiatives including our volunteer initiative Kovler Krew, InTransit Teen Advisory Panel, Peer to Peer program in our Southside Community and held multiple Kovler for Kids events throughout the city. To learn more about the work we do and ways to get involved, visit the Kovler website. You may also contact Peggy Hasenauer, Executive Director, directly via email peggy.hasenauer@uchospitals.edu or by calling 773.834.4789.

This year, as you and your family choose charitable causes, we hope you will consider Kovler Diabetes Center.  Your charitable support is critical to expanding clinical research programs and telemedicine initiatives, as Kovler’s leadership embarks on an expanded model for virtual diabetes care and greater access to diabetes clinical trials – bringing new discoveries and possible cures directly to those with diabetes.  For more ways to learn how to give to Kovler, please visit this website and be sure to note Kovler in the memo section.

From the Kovler Diabetes Center Family to yours, we wish you a wonderful holiday season and happy New Year filled with health and happiness.

Peggy Hasenauer, MS, RN
Executive Director
The University of Chicago Kovler Diabetes Center

Our Inaugural Annual Report

On behalf of the entire leadership team at Kovler, we are honored to share our inaugural Annual Report. 

The report includes:

• The latest information regarding the global pandemic of diabetes and the rise in cases of type 1, type 2 and other genetic forms of diabetes locally, regionally and nationally.
• A reflection on the accomplishments, challenges and priorities of the Kovler Diabetes Center and the entire University of Chicago Medicine diabetes enterprise.
• Examples and highlights from Kovler’s five main pillars… We Care, We Discover, We Educate, We Unite, and We Lead.

Much of the work that the Kovler Diabetes Center has accomplished, and continues to pursue, could not happen without the generous contributions and support from our partnering individuals and organizations. While we look back and celebrate the successes of 2012, we also look forward to continuing our mission in 2013 and beyond.

We wish you and your loved ones a happy and healthy holiday season!

Kovler & Centered Chef: InTransit Teen Cooking Class

The Kovler InTransit Teen Advisory Board held their fall meeting at Centered Chef, a Chicago based cooking school that shares our concern for healthy eating and our passion for educating the community. Today, we are excited to share a guest blog post from the team at Centered Chef about their experience partnering with Kovler.

In a society where there are over 20 million people living with diabetes, it is imperative that we begin to learn what foods can help prevent diabetes and manage overall wellness. At Centered Chef, we have innovative cooking classes and workshops that educate, entertain and a  healthy lifestyle, by blending culinary arts with nutrition.

Instead of looking at nutrition like a restriction, we focus on the opportunity of eating more healthfully.  In letting go of the foods you can’t have as a philosophy, we focus on the foods you can have and why!

So, when it comes to maintaining healthy blood sugar levels, it is important that you eat balanced amounts of fruits, vegetables and whole grains, along with clean proteins. Since understanding how to eat healthfully can be overwhelming, Centered Chef excels in creating experiences around eating optimally.

“As part of our educational outreach, we were proud to partner with the University of Chicago’s Kovler Diabetes Center, Teens In Transit Advisory Board,” said Centered Chef’s founder and CEO, chef Ryan Hutmacher. “During an incredibly impactful and educational day at Centered Chef, teens as well as, their parents explored the challenges and opportunities that are encountered when living with Type 1 Diabetes.”

In Centered Chef’s innovative culinary studio, chef Melissa Schwenk and adjunct dietitian, Lyndsay Riffe (RD/LDN, CDE), who’s also a Type 1 diabetic, worked with the teens to prepare several diabetic friendly recipes.  In this hands-on cooking class, the teens prepared chicken rosamarino skewers, whole grain quinoa griddle-cakes, grilled green beans and a spinach salad.  As part of the final experience, the teens showcased their meal to both parents and Kovler Diabetes Center staff, proving that healthy food can be simple and delicious!

Family members of the InTransit teens taste the final products!

“It was an amazing to see the teens in action, and in the end, the buffet they created looked amazing!” explained chef Melissa.  “As we look to empower people to make healthy decisions around food, there’s no doubt these teens learned some amazing tools around eating clean.  I look forward to working with the Kovler Diabetes Center in the future, and continuing to support their Teens In Transit Advisory Board!”

Special thanks to Ryan, Melissa, and the entire Centered Chef team! 

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.

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

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.

A Story about Diabetes from the Center for International Patients

Vicky Ochoa, the Program Coordinator for the Center for International Patients, shares a wonderful story about what is possible when teams from the University of Chicago work together.

We have an international patient who has suffered from cystic fibrosis-related diabetes, post lung transplant. Despite multiple attempts to manage her diabetes with daily injections of various types of insulin, her blood sugars were increasingly unstable. She was the perfect candidate for an insulin pump. Not surprisingly, she was initially hesitant to try the pump. However, through her own research and discussions with the physicians, educators and nutritionists at the Kovler Diabetes Center she was helped to see the benefits an insulin pump could offer. After learning about its invisibility under clothing and the fact that she could work out or swim without disconnecting it, she agreed to give it a try.  Now that she has become more confident in adjusting the doses and maintaining her diet, her blood sugars are regulating. She is much happier with the on-the-go freedom she now enjoys. Many thanks to the entire endocrinology team for helping change this woman’s life!

The World Health Organization estimates that 346 million people worldwide have diabetes and that more than 80% of diabetes deaths occur in low- and middle-income countries. Our partnership with the Center for International Patients is vital to addressing the needs of patients with diabetes throughout the entire world. Thank you to the entire University of Chicago Medicine Center for International Patients for their work on this case and so many others!