A Collaborative Approach to a Community-Wide Problem: Diabetes

In 2007, a joint strategic planning initiative by the UC College of Medicine, UC Health University Hospital and University of Cincinnati Physicians identified diabetes and obesity as an area of great strength in the Academic Health Center and consequently chose it as one area of emphasis of four "centers of excellence.”

From that planning, and in partnership with researchers and clinicians at Cincinnati Children’s Hospital Medical Center, the Cincinnati Diabetes and Obesity Center was formed.

The role of the center is to bring together the array of metabolic research and clinical teams involved in diabetes, obesity and metabolic diseases from across the UC campus and its health care partners to facilitate better care for patients, improved education for trainees and physicians, increased outreach in the community and focused research for the development of novel and advanced treatment strategies.

This collaborative approach will allow the Cincinnati Diabetes and Obesity Center to serve as a node—facilitating community-wide solutions for the pressing problems associated with diabetes and obesity.

Scope of the Diabetes Problem
The American Diabetes Association estimates there are more than 200,000 people in Greater Cincinnati with diabetes. Like so many across the country, numerous people live with the disease for years without being diagnosed, suffering from the damaging consequences that come with unmanaged blood sugar levels.

Randy Seeley, PhD, director of the Cincinnati Diabetes and Obesity Center and Donald C. Harrison Endowed Chair in Medicine within UC’s endocrinology, diabetes and metabolism division, says tackling the problem of diabetes will be possible only through a large and coordinated effort.

"We have to address the problem of diabetes from many angles,” says Seeley. "We have to continue investigating its causes and treatments, we must provide excellent care and we must educate people—health care providers and the public—on the prevention and diligent treatment of the disease. Combining all of these things is how we will effect change.”

Excellent Clinical Care
Outpatient clinical care for diabetes became hospital-based in 2011 and patients of the UC Diabetes and Endocrinology Institute  have access to a growing group of physicians who have expertise not only in the care of diabetes but also in more specialized issues, including cardiovascular disease, low testosterone and infertility, polycystic ovarian syndrome, management after gastric bypass surgery and follow up for gestational diabetes, to name a few.

In 2012, the institute named Michael Canos, MD, its clinical director. Canos oversees outpatient diabetes and endocrinology care on the Clifton campus. He is skilled in the management of diabetes and in general endocrinology and will lead an expanded practice which includes five other endocrinologists. 

Mercedes Falciglia, MD, is director of inpatient diabetes management at University Hospital. She has developed a program (Diabetes Now initiated in 2006 and now operative in all units of the hospital) with the goal of improving the care of hospitalized patients with diabetes and high blood glucose (hyperglycemia)—from admission to discharge and beyond.

The program has already prompted policy changes with regard to the timing between meal delivery, consumption and insulin administration—a care process that is critical for the safe and effective treatment of hyperglycemia.

The UC Diabetes and Endocrinology Institute has developed a formal plan with Cincinnati Children’s for transition of pediatric diabetic patients to the adult endocrine center. This transition has traditionally been difficult because of the many changes that occur in late adolescence/early adulthood.  The formal transition plan, which began in 2012, is meant to ensure that patients are able to maintain top-rate diabetes care as they move through this time of life.

Research and Discovery
Researchers with the Cincinnati Diabetes and Obesity Center are conducting a number of basic science studies relevant to the center’s mission. It’s these studies’ relevance to clinical care that’s perhaps most exciting for the center’s members.

For example, Seeley is working with a team of other faculty to use rodent models to recreate the physiological responses to surgical weight-loss procedures (currently the most effective treatment for weight loss and one that often reduces or eliminates the need for diabetes medications).

His studies—supported by $4.1 million annually from Ethicon Endo-Surgery—are designed to determine what these procedures do to alter the communication from the gut to other key organs such as pancreas, liver and brain. Insights from these experiments are already leading to the development of less-invasive procedures available to a broader segment of the population.

David D’Alessio, PhD, director of UC’s endocrinology, diabetes and metabolism division and UC Health endocrinologist, and Darleen Sandoval, PhD, UC assistant professor, are studying how the gut hormone glucagon-like peptide 1 (GLP-1) helps reduce blood glucose levels.  In the presence of glucose, GLP-1 is known to increase insulin secretion from the pancreas.

"There are a handful of diabetes drugs based on GLP-1’s action as a hormone,” says D’Alessio. "We hypothesize that GLP-1 works not just as a hormone to stimulate insulin secretion, but as a neurotransmitter—in communication with systems in the brain.” The two have received grants to test this hypothesis in both mice and humans.

"University-based health centers are constantly chipping away at the unknown,” says D’Alessio. "Ultimately, we want to figure out how to improve care in our region and we must ask ourselves how we can shift our research to address the most pressing needs. Everything we do plays some role in advancing the quality of diabetes care.”

Education and Outreach
Both Canos and Falciglia were trained at the UC College of Medicine and University Hospital (Falciglia from medical school through fellowship training and Canos from residency through fellowship). They aren’t unlike many other caregivers throughout Cincinnati—many of whom are still interested in having a connection to the university and UC Health.

For that reason, diabetes specialists are working to make sure they are in regular contact with primary care providers who refer patients into the practice.

More specialized training in nutrition is now being offered through a new MD/MS dual degree program made possible through a partnership between UC’s College of Medicine and College of Allied Health Sciences.

Future plans for education and outreach include:
• weekly telemedicine sessions with UC and community physicians to discuss case presentations, and
• the formation of a certified diabetes educator program with easier access to CDE training requirements in order to increase the number of these providers in our community.