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This year Kovler Diabetes Center celebrates its 10th anniversary, capping a decade of cutting edge treatment and research that has made the University of Chicago Medicine a world leader in diabetes care.
We spoke to Kovler's Director, Louis Philipson, MD, PhD, about what Kovler's unique combination of specialists has been able to provide for patients, what's on the horizon for diabetes treatment, and what he tells newly diagnosed patients. What follows is an edited transcript of that conversation.
UChicagoMed: What was the initial idea behind creating the Kovler Diabetes Center?
Louis Philipson: Eleven years ago, there was no diabetes center here, and when several faculty recognized the need the decision was made to create one that was both within and beyond the scope of section of Endocrinology, Diabetes and Metabolism.
Some of the University's endocrine faculty and physicians over the years, including some of the finest physicians in the Medical Center-our dean, Ken Polonsky, our former chairman of Medicine, Arthur Rubenstein, and Richard Landau, who was head of the Endocrinology section for many years-were able to develop a comprehensive diabetes care program based on their knowledge of diabetes and their personal contacts.
What we wanted to be able to do was to more formally establish a group of physicians and staff in multiple disciplines specifically interested in diabetes care, education and research, broadly defined. That included the main diabetes doctors in adult and pediatric endocrinology, in a unique partnership. Drs Deplweiski, Littlejohn, Yu, Greeley and Naylor work with pediatric patients with diabetes in a shared clinical space, with our "adult" endocrinologists (among them Drs Cohen, Ehrmann, Thomas, Sam, Sargis and Vokes) making collaborations, research and transitions of care seamless. Our team includes wonderful nutritionists and diabetes educators, plus other key physicians in general medicine and primary care, cardiology, nephrology, gastrointestinal medicine, ophthalmology, transplant surgery, vascular surgery, orthopedics and others.
We also wanted to provide important, value-added services for our diabetes patients in one space. We welcomed a podiatrist, Dr. Ann Zmuda, nephrologist/hypertension specialist Dr. George Bakris and a psychology team headed by Dr. Tina Drossos. The set of go-to colleagues in key areas like ophthalmology, nephrology, cardiology, bariatric surgery, and neurology reflected our needs for colleagues in key aspects of complications of diabetes. That was really the initial impetus, to formulate an umbrella concept to allow one stop shopping for a patient with diabetes in the DCAM environment.Following that idea of organization, the gift of the Kovler family enabled the creation of a named center, give the center an identity and created research space that could be dedicated to various kinds of diabetes research. That really made the diabetes center concept take off. One of the most important aspects of the Kovler Diabetes Center is having the leadership of our wonderful executive director, Peggy Hasenauer, who joined us soon after we developed this concept in 2006. I can't say enough about Peggy regarding her skill in professional development, customer service and in developing authentic personal relationships with our patients and their families. We also have an amazing and thoughtful leader, Sally Kovler, who has been our board chair for the last five years. Sally works closely with Peggy and our leadership board. The Kovler Leadership Board is composed of extraordinary people who either have diabetes themselves or have some loved one who has diabetes.
Is it common to have all diabetes care centralized like it is here?
No. Unfortunately there are only a few places in the country where there is centralized diabetes care, particularly where children, adults and families can be seen all in one space, sometimes in one visit. Unfortunately, I would say fragmentation is the rule, not the exception. We do our best in Kovler to provide personal exceptional customer service and allow patients to receive as much care and education as they possibly can during a visit. Our Department of Medicine Chair, Dr. Everett Vokes and our Endocrinology, Diabetes and Metabolism Section Chief, Dr. Ron Cohen, as well as Dr. John Cunningham, Chair of Pediatrics, have all been extremely supportive. That support and appreciation for our work encourages us to keep developing new programs.
What has that allowed you to do for patients?
The concept of "one stop shopping" is very important. If someone comes in and I want to know what's happening with possible retinopathy, I can have them go downstairs and have their eyes examined, and a wonderful colleague like Dr. Hariprasad makes the report immediately available. That's a very important aspect of their care and demonstrates our commitment to comprehensive preventative medicine.
Likewise, foot care is a critical aspect of diabetes management. With continued diabetes, which is often not perfectly controlled, being sure that foot care is emphasized is very important. People with diabetes may have decreased feeling in their feet from diabetes-related neuropathies. There could be vascular problems with decreased blood flow, and it could happen with either type 1 or type 2 diabetes over many years. So to have a dedicated podiatrist with close ties to vascular surgery and interventional radiology for example, is a very important aspect. It makes a huge impact on the patient to know the doctors are looking at their feet. We have all aspects of diabetes care at a very high level.
One of the most amazing things has been the relationships with our patients real, authentic relationships and friendships outside of the clinic. Our patients are often our greatest cheerleaders, supports, volunteers, advocates and donors. Another wonderful aspect of Kovler in the last six years is the addition of Dr. Tina Drossos, a psychologist who has been absolutely spectacular in organizing an extern program who are in advanced training for their PsyD or PhD in psychology and interested in spending a year in the endocrine clinic. They're available to see every new patient, and to follow up with patients and families. It's part of our intake process for new patients, and a subsequent evaluation of patients who may come in with complex problems. It's been clearly documented that depression is one of the major complicating factors of diabetes. If one can diagnose depression, a huge positive impact can be made in a patient's ability to take care of themselves.
The beauty of our interaction with psychology faculty and externs is that it's without a charge (due to philanthropic contributions from our board members and donors). The patients don't have to feel like they are being sent to see a therapist as a punishment for complicated diabetes management, but feel secure they have someone to talk to during the visit, even if things are going well. Patients and families are then welcome to follow up with the psychologists three or four times for counseling. But most importantly, if we do uncover psychiatric problems, such as extreme fears of low or high blood sugars, eating disorders, or issues with parents of pediatric patients, we have faculty and programs in place here so we can refer them.
What is Kovler and the greater diabetes community doing to address the continuing explosion in cases of diabetes?
Each kind of diabetes requires a slightly different approach. For type 2 diabetes, the focus remains prevention and education. For people who already have diabetes, it is possible that the combination of the newest drugs and continued emphasis on diet and exercise can make a huge impact. So to have a comprehensive solution which emphasizes diet, exercise, psychology and medical therapy, those things in individual cases can make a difference. Peggy has developed an amazing "task force" of volunteers under the name "Kovler Crew." These individuals volunteer their time throughout the year to help us engage communities at special events, workshops and educational sessions. Carla Henault, our Kovler Community Outreach Specialist, is one of the most dedicated professionals I know in creating programs and services for the diabetes community that are free and accessible.
We also work very closely with Marshall Chin's group in the Section of General Internal Medicine-Monica Peek, Elbert Huang, Neda Laiteerapong, and Deborah Burnet, among others. We have great leadership in community based medicine and understanding health care disparities for diabetes. Stacy Lindau's program is also part of this in understanding access to health care and nutritious food on the South Side for people of all ages. I think we have a lot of work to do, and lot of education that still needs to be done, but a lot of it is about access. How do we get folks who have no or minimal insurance to see physicians on a regular basis, and what tools and education can we give them that can help in between these visits?
What's the approach going forward for type 1?
Type 1 diabetes has seen an explosion in new ideas. That means technology for the most part, particularly advances in insulin pump and continuous glucose monitoring. We are able to offer our patients essentially everything that's on the market, because we are blessed with some very bright, capable diabetes educators like Amy Hess, Carlie Paul and Taylor Durkin who are willing to take the time to learn every technology that's out there and share the information with our patients.
The state of the art for type 1 diabetes is a smart pump-pumps that now are guided by glucose sensors. They're not implanted, so the patient has to change them every few days or every week or two in the case of continuous glucose monitors, and they're relatively expensive, time consuming to use, and can be very frustrating. Some people don't want to be "bionic," as they say, so they don't use them, but other people feel like they're naked if they don't use these technologies.
In the department of surgery, Dr. Matthews and Dr. Witkowski (working with Dr. Gelrud in GI) have been very interested in islet cell transplantation for type 1 diabetes. They have a particularly successful program in transplanting islets in people who need to have their pancreas removed. That's been a very exciting program, although the larger idea of treating people with type 1 diabetes with islet transplants has been difficult to move forward because recipients still need immunosuppression. There have been some efforts at encapsulation, but I think it's off in the future as a routine treatment.
We're also working closely with Graeme Bell's research team in monogenic diabetes to explore inducible pluripotent stem cells that could one day be applied to type 1 diabetes, but there's still the problem of autoimmunity that hasn't been solved. We do have a great group here that's been working on autoimmunity with Alexander Chervonsky, Anita Chong, and Stefano Guandalini and Bana Jabri in the Celiac Disease Center. So there's a lot of exciting possibilities.
What's a reasonable expectation for someone who's newly diagnosed with type 1 or type 2 diabetes?
What I tell people is there are very few limits of what you can do if you have diabetes today, and that's very exciting. When I was starting out, parents were often told when their children developed diabetes that they should not expect their child to live past their 30s. Now we have more and more people who are living 40, 50, 60, 70 years with type 1 diabetes. They are sometimes damaged by their diabetes, but they are surviving.
There may be a few years decrease in average lifespan, but now I would expect those people to live a long life. These days you could be a NFL quarterback, you could be a Supreme Court justice, you could be the prime minister of England, and have type 1 diabetes. I think the sky is the limit for someone with diabetes, but a lot of important work remains to be done.