Download NEWS W Diabetes

IN THIS ISSUE
Foster care and type 1 – page 3
2 Message from the Director
3 Discoveries
4 Our Supporters
Science at the heart of medicine
NEWS
Diabetes Research Center
Power to the
Patients
W
Newsletter of the Albert Einstein
Diabetes Research Center
Elevated Risk in the Bronx
Dr. Zonszein notes that change is especially difficult in underserved areas
such as the Bronx, where the prevalence of diabetes among the borough’s
disadvantaged minorities is among the highest in the nation. Yet these
I S S U E 8 • S U M M E R / FA L L 2 0 1 3
hen Joel Zonszein, M.D., above, arrived at Einstein more
than 20 years ago, most patients with type 2 diabetes—
then called “adult-onset diabetes”—were elderly. Today,
this disease is more common, more aggressive and
more likely to affect the young. It is associated with obesity, insulin
resistance, dyslipidemia and early heart disease and death.
“When diabetes is diagnosed and treated early, we can prevent complications, but that’s not happening,” says Dr. Zonszein, a professor of clinical
medicine in the department of medicine (endocrinology) at Einstein. The
incidence of the disease is skyrocketing, mainly among minorities, and it
remains underdiagnosed and undertreated. One third of patients with type
2 diabetes don’t know they have it; many of those who know they have
it are not treated, and those who are treated are rarely treated optimally.
“We should be doing a much better job,” adds Dr. Zonszein, an attending
physician in medicine at Montefiore, the University Hospital and academic
medical center for Einstein.
continued on page 2
MESSAGE FROM THE
DIRECTOR
JEFFREY PESSIN, Ph.D.
Judy R. and Alfred A.
Rosenberg Endowed
Professorial Chair in
Diabetes Research
Director, Diabetes Research
Center
T
his issue of the Albert Einstein
Diabetes Research Center (DRC)
newsletter highlights our efforts
to promote healthy lifestyles
and reduce the burden of type 2 diabetes and its complications.
Most cases of type 2 diabetes stem
from too many calories plus not enough
exercise—which leads to obesity or
overweight. Even a small weight loss (5
to 10 percent of body weight) can markedly improve metabolism and reduce
the risk of developing diabetic complications. The Einstein/Montefiore Diabetes
Self-Management Education Program
helps patients take control of their own
lives by setting and attaining reasonable
goals for managing their food intake and
for exercising in ways they enjoy.
One of the keys to preventing type 2
diabetes is understanding the challenges
that confront people who are trying to
lose weight. Dr. Natania Ostrovsky and
her colleagues have found that social
anxiety contributes to overeating. By
helping overweight people overcome
social anxiety, she and other DRC members are making significant progress in
reducing the personal and public health
costs of diabetes.
DRC programs are funded by a
variety of resources. We’re especially
grateful for philanthropic gifts that provide critical support for our faculty. The
recent investiture of three DRC faculty
members (see page 4) will ensure that
their research programs remain vibrant—
and that Einstein will continue to make
progress in treating and preventing
diabetes.
Power to the Patients (continued)
patients have poor access to
healthcare, struggle to afford medications and must hurdle language
and cultural barriers. “It’s frustrating, in this country, not being able
to better prevent and treat such a
common disease,” he says.
Dr. Zonszein adds that inertia among patients—and among
their doctors, too—prevents early
and aggressive treatment. “We’re
working hard to improve healthcare
delivery for this devastating disorder,” he says.
Empowering Patients
“We’ve developed programs at
Montefiore that give patients the
power to manage their disease,”
Dr. Zonszein continues. In the Diabetes Self-Management Education
Program, a registered nurse and a
registered dietitian—both certified
diabetes educators—teach type
2 patients to monitor their own
weight, cholesterol, blood pressure
and blood sugar; improve their
diet; exercise more; and take their
medicine.
Patients don’t just “go on a
diet” and sign on for exercise
boot camp. “It’s a matter of getting patients motivated,” says
Dr. Zonszein. “It’s about healthier
lifestyles for the entire family.” Out
with giant servings, sugary drinks,
saturated fat and fried food; in with
“slow food”—eating healthier, with
less stress, and at a table, with family and friends.
Weight-loss goals in the program are realistic. As Sharon
diabetes
Movsas, R.D., C.D.E., the program
coordinator, puts it, “The focus is on
the plate and not the weight.” The
exercise plan involves setting equally
reasonable goals: walking with a dog,
going to a gym, starting an enjoyable
sport. Most people leave the program
healthier and happier.
These initiatives rest solidly on
landmark trials emphasizing lifestyle
change in which Dr. Zonszein has
participated during his career. As a
co-investigator in the Diabetes Prevention Program, a National Institutes
of Health trial, he found that modest
weight loss through diet and exercise
was actually more effective than medication at reducing the risk for type 2
diabetes—confirming the power of
the patient. Add early treatment to
these already potent lifestyle changes
and you really can help prevent the
disease and its complications.
From Too High to Too Low
The hallmark of diabetes is hyperglycemia, or elevated blood-sugar
levels. But abnormally low blood
sugar, known as hypoglycemia, can
be dangerous as well. Hypoglycemia
is common in hospitalized patients—
especially the elderly, frail and
severely ill. In a recent study among
hospitalized patients with and without diabetes, Dr. Zonszein found that
spontaneous cases of hypoglycemia
are more dangerous than falls in blood
sugar caused by medications given to
patients with diabetes. Spontaneous
hypoglycemia appears to be a biomarker of serious illness and carries a
poor prognosis.
QA
Q: How does economic disadvantage increase the risk
for type 2 diabetes?
A: Economically disadvantaged people live in areas where controlling diabetes is a challenge. These areas typically lack stores that sell fresh produce;
parks and other safe places to exercise are also in short supply. As a result,
residents commonly are stuck with convenience stores and fast-food restaurants selling foods high in calories, fat and sugar. Poor diets and lack of
exercise cause weight gain, increasing the risk of type 2 diabetes.
discoveries
Social Anxiety and
Disordered Eating
Foster Care and Type 1
Aging and Adipokines
Natania W. Ostrovsky, Ph.D.
Rubina A. Heptulla, M.B.B.S.
Meredith A. Hawkins, M.D.
Two out of three adults
in the United States are
obese or overweight,
and obesity-related
health conditions
have become a major
public health burden.
Obesity is now regarded as a serious
and complex health condition caused
by a combination of environmental,
genetic and social factors.
A team of researchers led by Dr.
Ostrovsky conducted an Internetbased survey to evaluate the relationship between social anxiety and binge
eating and emotional eating in obese
and overweight individuals. They
found that social anxiety was indeed
significantly associated with these
types of disordered eating in the
study group. The authors concluded
that weight-loss plans should address
social anxiety and other psychosocial
factors when relevant, because those
factors could impede effective weight
loss. The study was published in a
2013 issue of Eating Behaviors.
Managing childhood
type 1 diabetes mellitus (T1DM) is a challenge for any family;
the smallest break in
care or watchfulness
can bring on potentially life-threatening complications
such as diabetic ketoacidosis or
severe hypoglycemia. It follows that
when a child’s family life is unstable
and leads to foster-care placement,
the risk for neglected or fragmented
disease management increases.
Senior author Dr. Heptulla and
colleagues at The Children’s Hospital
at Montefiore conducted a retrospective case study on six children
with T1DM in foster care and found
that all showed signs of poor bloodsugar control. The authors call for
identifying at-risk children and their
families early on and providing the
support services they need. The
study was published in a 2012 issue
of the Journal of Pediatric Endocrinology and Metabolism.
Our susceptibility to
obesity and cardiovascular disease increases
as we get older—in
large part due to the
interplay among diet,
insulin action and inflammation in adipose tissue (fat).
Senior author Dr. Hawkins and
Class of 2014 M.D./M.S. student
Yonah Esterson examined plasminogen activator inhibitor-1 (PAI-1), a
hormone secreted by inflammatory
immune cells called macrophages,
which contributes to atherosclerosis,
insulin resistance and obesity. They
compared PAI-1 levels in adipose
tissue and adipose macrophages in
middle-aged people (44–68 years)
and younger adults (19–32 years) in
response to fat intake. Those who
were middle-aged showed increases
in PAI-1 plasma levels that were more
dramatic than those in their younger
counterparts. This higher adipose
inflammatory response to fat intake
may contribute to age-related insulin
resistance, obesity and cardiovascular
disease. The study appeared in a 2012
issue of the Journals of Gerontology.
Instructor
Department of Epidemiology &
Population Health
Albert Einstein College of Medicine
Professor of Medicine
Professor of Pediatrics (Endocrinology)
Albert Einstein College of Medicine
Chief, Division of Pediatric Endocrinology
Montefiore Medical Center
ON THE WEB
To learn more about the Diabetes Research Center,
please visit www.einstein.yu.edu/diabetes
Professor of Medicine (Endocrinology)
Harold and Muriel Block Chair in Medicine
Director, Global Diabetes Institute
Albert Einstein College of Medicine
Attending Physician in Medicine
(Endocrinology)
Montefiore Medical Center
The Honorable Sonia Sotomayor, Survivor
“ [My doctor] discovered that Albert Einstein College of Medicine, a leader
in juvenile diabetes research, ran a clinic at Jacobi Medical Center, a public
hospital, which by luck happened to be located in the Bronx... With a strong
focus on patient education, the clinic was pioneering much that is now standard practice: child-friendly lessons on how to live with diabetes, on nutrition
and on what’s going on in your body.”
— Bronx native and Supreme Court Justice Sonia Sotomayor
in My Beloved World (Knopf, 2013)
Justice Sotomayor has successfully
managed her type 1 diabetes for
more than 50 years.
our supporters
The Albert Einstein Diabetes Research Center (DRC) gratefully acknowledges the generosity of the individuals and
organizations whose support is critical to advancing its mission.
CONGRATULATIONS!
Three members of the Diabetes Research
Center were invested with endowed
academic positions at the 2013 Einstein
Academic Convocation, held during the
“Campaign to Transform Einstein” event
at New York’s Plaza Hotel on April 15.
Inspired by her belief in translational
medicine’s potential to heal the world,
the late Muriel L. Block, a longtime leading Einstein Benefactor and friend, made
a remarkable bequest that resulted in a
gift of more than $160 million to benefit
research at the College of Medicine. Part
of this historic gift will endow a series of
chairs that will support the work of outstanding Einstein faculty members
in a variety of disciplines. At the
Convocation,
Meredith A.
Hawkins, M.D., a
professor of medicine (endocrinology)
at Einstein and an
attending physician
in medicine (endocrinology) at Montefiore Medical Center,
was invested as the Harold and Muriel
Block Chair in Medicine. (She was also
formally installed as the first director of
Einstein’s Global Diabetes Institute.)
Dr. Hawkins’ research interests include
the effects of nutrient deficiency and
excess on insulin resistance; nutritional
regulation of adipose tissue inflammation; and the regulation of hepatic glucose production in diabetes mellitus.
Judith
Wylie-Rosett, Ed.D.,
was invested as the
Atran Foundation
Chair in Social Medicine. Her research
focuses on the
role of nutrition in
chronic disease prevention and control.
Dr. Wylie-Rosett is also a professor of
epidemiology & population health and
of medicine (endocrinology) and head of
the department of epidemiology & population health’s division of health promotion and nutrition research. The Atran
Foundation and Einstein have shared a
long and fruitful partnership, including
the Atran Foundation Exchange Scientist Program, which facilitates research
collaborations between Einstein faculty members and their colleagues at
renowned medical institutions in Israel.
Teresa P.
DiLorenzo, Ph.D.,
was invested as the
first Diane Belfer,
Cypres & Endelson
Families Faculty
Scholar in Diabetes
Research. The goals
of her work are to better understand the
underlying immunopathogenesis of
type 1 diabetes and to develop
improved tools to monitor and manipulate pathogenic T cells that destroy
beta cells in the pancreas. This research
may lead to therapies that halt the
progression of early diabetes or prevent
the disease entirely. Dr. DiLorenzo is also
a professor of microbiology & immunology and of medicine (endocrinology). Dr.
DiLorenzo’s endowed position was made
possible by the generosity of Einstein
Overseer Diane Belfer and her children,
Sheryl and Kenneth Endelson and Kathi
and Gary Cypres. Mrs. Belfer is a longtime Einstein Benefactor. Together with
her late husband, Arthur B. Belfer, she
has been a distinguished supporter of
biomedical and translational research at
the College of Medicine.
To learn more about supporting
the work of the DRC, please contact:
IRA LIPSON
Interim Associate Dean
for Institutional Advancement
Albert Einstein College of Medicine
Jack and Pearl Resnick Campus
1300 Morris Park Avenue
Harold and Muriel Block Bldg., Rm. 725
Bronx, NY 10461
718.430.2371
ira.lipson@einstein.yu.edu
DIABETES RESEARCH CENTER
Our mission:
• To support and conduct basic and clinical
research related to diabetes and its causes,
treatment and complications
• To encourage research that will rapidly lead to
diabetes therapies, especially in minority and
underserved populations
ADMINISTRATION
Director
Jeffrey Pessin, Ph.D.
Co-director
Norman Fleischer, M.D.
Associate Directors
Michael Brownlee, M.D.
Streamson Chua, M.D., Ph.D.
Gary Schwartz, Ph.D.
Elizabeth Walker, Ph.D., R.N.
Administrator
Aneleen Dizon, M.P.A.