Division of Endocrinology Progress Report 2008

Beth Israel Division of Endocrinology Progress Report 2008

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Table of Contents

Division of Endocrinology Activites Friedman Diabetes Institute Activites Summary and 2009 Goals

page 3 page 6 page 9

Copies of manuscripts and publications are available upon request.

Beth Israel Division of Endocrinology Progress Report 2008

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Divisional Activities
Clinical Educational Research

Educational Activities
Patients Gerald J. Friedman Diabetes Institute opened in Spring of 2007 (see full report on page 6) Physicians 2 conferences per week Medical Students Clinical and research rotations Fellowship Program From warning status to full accreditation; next site visit in 2009 Presentations at National Meetings by the fellows (13 in 2008) Boards passing rate increased from 33% to 100% for the last 8 years First PhD dissertation defended successfully by PhD exchange student Dimiter Avstanki House Staff Research rotation Clinical rotation Co-author abstracts and presentations Journal club

Clinical Activities
Inpatient and outpatient consultations and ongoing patient care within the Faculty Practice Plan (FPP) Diabetes Clinic Endocrine Clinic Insulin Pump Program Diabetes in Cardiac Surgery Program Diabetes in Pregnancy Program Diabetes Clinic - New York Downtown Hospital Thyroid Clinic - New York Eye and Ear Infirmary Endocrinology Clinic - HIP Center at East 23rd Street Gerald J. Friedman Diabetes Institute

Clinical Encounters
35,000 30,000 25,000 20,000 15,000 10,000 2007 and 2008 FPP Total
2007: GJ Friedman (1247); Clinics (1863); Off site (732); FPP (18267) 2008: GJ Friedman (4488); Clinics (1520); Off site (816); FPP (24684)

31511

24684 22109 16802 17060 17347 18267

Visits

15704 12504

Research Programs
Administration of vitamin D analog to new onset type 1 diabetes mellitus patients to restore pancreatic beta cell function. PI Dr. Agustin Busta
2005 2006 2007 2008

6014
5000 0

2976
2000 2001 2002 2003 2004
Years 2000-06 are FPP encounters only.

Year

FPP Collections ($)

$1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 $208,656 $342,672 $722,376 $801,773 $926,562 $994,758 $1,167,828 $1,591,444 $1,308,642

A Randomized, Double Blind, Parallel-Group, Multicenter, Multinational Study to Assess Glycemic Control with Rimonabant in Comparison with Glimepiride over 1 Year in Overweight/Obese Type 2 Diabetes Patients Not Adequately Controlled with metformin. PI Dr. Agustin Busta Vitamin D Supplementation in Patients with Type 2 Diabetes and Vitamin D Deficiency. PI Dr. Emilia P. Liao Paracalcitol in Patients with Type 2 Diabetes, Chronic Kidney Disease and Vitamin D Deficiency. PI Dr. Emilia P. Liao A pilot randomized controlled trial to evaluate the effects of an interactive website on clinical outcomes in patients with diabetes. PI Dr. Leonid Poretsky

2000

2001

2002

2003

2004

2005

2006

2006 2007

Year

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Research Programs continued

A Pilot nonrandomized study on the Effects of Diabetes Self Management Education on HBA1C in Deaf Patients. PIs Dr. Leonid Poretsky and Marina Krymskaya, NP, CDE A pilot randomized controlled trial to assess the Social Emotional Intelligence (ESI) levels and Confidence in Diabetes Self-Care (CIDS) scores of Insulin-Dependent Subjects with diabetes to determine whether higher ESI measures predict better self-efficacy outcomes and improved glycemic control. PIs Dr. Leonid Poretsky, Marina Krymskaya, NP, CDE and DArcy Yeager A 26-Week, Open-Label, Randomized, Active Comparator Study of Generex Oral-lyn Spray and Injected Human Insulin in Subjects with Type-1 Diabetes Mellitus: PIs Dr. Alina Gouller and Dr. Leonid Poretsky Gerald J. Friedman Diabetes Institute Database Retrospective and prospective Data Analysis; PIs Dr. Leonid Poretsky and Marina Krymskaya, NP, CDE A Randomized Trial Comparing Exenatide with Placebo in Patients with Type 2 Diabetes on Insulin Glargine With or Without Oral Antihyperglycemic Medications. PI Dr. Jerome Tolbert Receptor Mechanisms of Insulin and Insulin-Like Growth Factors (IGF) action in Human Ovary. PIs Dr. Leonid Poretsky & Dr. Donna Seto-Young Role of Thiazolidinediones in the Human Ovary. PIs Dr. Leonid Poretsky and Dr. Donna Seto-Young Role of Vitamin D in the Human Ovary. PI Dr. Donna Seto-Young Queens/South Asian Action For Diabetes Education Programs And Treatment: Funded by the New York State Health Foundation. PI Dr. Leonid Poretsky Comparison of the therapeutic effects of oral medications in women with polycystic ovary syndrome. PI Dr. Alina Gouller Role of pramlintide in patients with polycystic ovary syndrome. PI Dr. Leonid Poretsky

Research Funding
Note: Philanthropic Gifts from the Gerald J. and Dorothy Friedman Foundation support endowed chair and research in the Division of Endocrinology Research Laboratory.
$3,000,000 $2,580,514 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0 $24,201 $522,000 $623,000 $557,677 $1,005,627

$1,775,340 $1,790,529 $1,258,355

2000

2001

2002

2003

2004

2005

2006

2007 2008

Year

Sources of Funding Gerald J. Friedman Foundation Abbot Laboratories Aventis Pharmaceutical National Istitutes of Health Thanks to Scandinavia Foundation New York State Department of Health Glaxo SmithKline, Inc.

Holbrook Family Foundation Novo-Nordisk, Inc. Eli Lilly and Company Mr. Morgan Miller Mr. Jeffrey Soreff Ms. Mary DeBare Chinese American Medical Association

Pfizer BIASP Novolog Genzyme Corporation The Children Hearing Institute NY Health Foundation

2008 Original Peer-Reviewed Publications

Gurevich Y, Poretsky L. Possible prevention of hungry bone syndrome by preoperative use of pamidronate. Otolaryngology-Head and Neck Surgery 138:403404, 2008. Grover GJ, Marone PA, Koetzner L, Seto-Young D. Energetic signaling in the control of mitochondrial F 1F0-ATP synthase activity in health and disease. The International Journal of Biochemistry & Cell Biology 2008, 40:2698-2701. Poretsky L, Song L, Brillon DJ, Ferrando S, Chiu J, McElhiney M, Ferenczi A, Sison C, Haller I, Rabkin J. Metabolic and hormonal effects of oral DHEA in premenopausal women with HIV infection. Hormone and Metabolic Research. In press.

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Original Peer-Reviewed Publications continued

Alfonso B, Liao E, Busta A, Poretsky L. The role of vitamin d in diabetes mellitus-a new field of knowledge poised for D-velopment. Diabetes/Metabolism Research and Reviews. In press. Seto-Young D, Avtanski D, Parikh G, Strizhevsky M, Rosenwaks Z, Poretsky L. Thiazolidinediones inhibit aromatase activity in human granulosa cells by interfering with androgen binding to aromatase. Submitted, 2008.

2008 Presentations continued

Gurevich Y, Abelev Z, Gouller A. Rapid development of invasive Nelsons adenoma 40 years after adrenalectomy. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P2-784, San Francisco, CA, June 15-18, 2008. Patel PM, Parikh G, Fleckman AM. Hypoglycemia as the presentation of adrenal insufficiency secondary to epidural steroids in a patient with diabetes mellitus. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P3-299, San Francisco, CA, June 15-18, 2008. Alfonso B, Saliby A. Co-incidence of mature cystic teratoma and papillary thyroid carcinoma: diagnosis and treatment implications. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P3-340, San Francisco, CA, June 15-18, 2008. Patel PM, Parikh G, Fleckman. A unique clinical presentation of a woman with Kallmann syndrome and the phenotype of Turner syndrome. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P3804, San Francisco, CA, June 15-18,2008. Strizhevsky M, Abelev Z, Joshi P, Alfonso B, Fleckman A. Secondary hemochromatosis of the pituitary. AACE 17th Annual Meeting, #816, Orlando, FL, May 15-18, 2008. Strizhevsky M, Groh K, Feng Yun, Fleckman A. Hyperthyroid Graves disease and a simultaneous hot nodule (Marine-Lenhart Syndrome). AACE 17th Annual Meeting, #1018, Orlando, FL, May 15-18, 2008. Gurevich Y, Gouller A. Case Report : Simultaneous Occurrence of Papillary and Medullary Thyroid Carcinoma. AACE 17th Annual Meeting, Orlando, FL, May 15-18, 2008. 1st Annual Gerald J. Friedman Fellows Symposium. Topic: Thiazolidinediones inhibit aromatase activity in human granulosa cells by interfering with androgen binding to aromatase. New York, NY,November 14, 2008. Presented by Dr. Takako Araki 1st Annual Gerald J. Friedman Fellows Symposium. Topic: Vitamin D Receptor (VDR) is expressed in human ovarian cells, likely mediating the effects of Vitamin D on steroidogenesis. New York, NY, November 14, 2008. Presented by Dr. Grishma Parikh

2008 Presentations at National Meetings

Avtanski DB, Parikh G, Strizhevsky M, Feng Y, Pareek A, Singh J, Singh N, Polskaya M, Rosenwaks Z, SetoYoung D, Poretsky L. Thiazolidinediones inhibit estrogen synthesis by interfering with androgen binding to aromatase. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P2-44, San Francisco, CA, June 15-18, 2008. Parikh G, Chlamtac N, Rosenwaks Z, Poretsky L, Seto-Young D. Vitamin D receptor (VDR) is expressed in human ovarian cells, likely mediating the effects of Vitamin D on testosterone (T) and progesterone (P) production. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P2-468, San Francisco, CA, June 15-18, 2008. Poretsky L, DeJesus J, Lam A, Krymskaya M, Mantha K, Burke G. The effects of diabetes self-management education on HbA1`C in deaf patients. 68th Scientific Sessions of the American Diabetes Association, Abstract 861-P, San Francisco, CA, June 6-10, 2008. Abelev Z, Sharma N, Strizhevsky M, Fleckman AM. Fulminant type 1 diabetes mellitus in a Japanese patient residing in the United States 90th Annual Meeting of the Endocrine Society Meeting, Abstract P1-299, San Francisco, CA, June 15-18, 2008. Strizhevsky MA, Korman A, Gouller A. Recurrent parathyroid carcinoma. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P1-544, San Francisco, CA, June 15-18, 2008. Abelev Z, Sraow DS, Gouller A. Rapid progression and resolution of hypercalcemia in a HIV patient with mycobacterium avium intracellulare (MAI) infection. 90th Annual Meeting of the Endocrine Society Meeting, Abstract P1-549, San Francisco, CA, June 15-18, 2008.

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Gerald J. Friedman Diabetes Institute

Clinical Program Initial Results continued
Percentage of patients achieving HbA1C of 7% or less over time (p<0.001 by Cochran-Mantel-Haenszel test for trend analysis)
70% 60% All Patients Patients with Baseline HbA1C >7%

4488 office visits in 2008 First anniversary celebrated on November 14, 2008 with the First Annual Friedman Fellows Research Symposium Investigators from Tufts University, University of California, Los Angeles, Mt. Sinai Medical Center, New York, NY and Harvard University, Boston, MA delivered 18 presentations on a variety of nutritional, endocrine, metabolic and neuroendocrine topics. View the full program at: www.friedmandiabetesinstitute.com/whats_new

50% 40% 30% 20% 10% 0%

3 Months

Adult Program
Providing diabetes education to adults with diabetes. Working in collaboration with the patients primary care physician. Daily individual sessions Weekly classes available Monthly support groups for people with type 1 and type 2 DM

Clinical Program Initial Results (October 2008)

9.6 All Patients (n=289) 9.2 Patients with Baseline HbA1C >7% (n=183) p<0.001 by t-test 9.2%

HbA1C %

8.8 8.4 8.0 7.6 7.2 7.6% p<0.001 by t-test 8.1%

8.1%

Insulin Pump Program

Resources for people with diabetes interested in insulin pump therapy Weekly sessions on advanced pump features with the pump trainers (MiniMed) FDI Certified Diabetes Educators (CDEs) became certified pump trainers (Omni-Pod, Animas)

Baseline

Any follow-up

Baseline

Follow-up at 3 months

2.5 2.0

Changes in excess (over 7%) HbA1C

2.2% ~50%

New York Health Foundation South Asian Program

The Asian outreach program specifically targets the Asian community within NYC in an effort to understand their unique needs and to provide educational opportunities for them to lead healthier lives while living with diabetes. We provide diabetes education to the various Asian communities while building bridges between the Asian communities and the Friedman Diabetes Institute.

HbA1C %

1.5 1.1% 1.0 0.5 0

~50%
1.1% 0.6%

All Patients

Patients with baseline HbAic > 7%

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Pediatric Program
Program initiated on August 6, 2008 117 Visits in 2008 Curriculum developed Series of lectures for FDI providers started Dr. Gabrielle Grinstein Presentations by CDEs specialized in pediatrics. Topics include: Medications and insulin usage in pediatrics. Meters and insulin administration in pediatrics. Growth and development issues with school age and adolescents. Psychosocial support for parents and kids. BS goals and A1C goals in pediatrics. Complications associated with diabetes in pediatrics. DKA/Sick day guidelines. Nutrition and exercise. Insulin pump-Minimed, Animas Luxura pen or other pens/devices used in pediatrics. Olympian Celebrity Gary Hall Jr. spreads word about diabetes 3/12/08 Pediatric cooking demonstration 12/1/08 - Fox 5 American Idol Kevin Corvais sings at Pediatric Holiday Party 12/15/08 Miss New York Fei-Er Liu speaks to kids 12/15/08

Deaf Community Program

Individual and group diabetes education for the deaf (on-going) Developing culturally sensitive educational and didactic materials Grant from NYEEI Meeting with the deaf artist to develop educational booklets (on-going project) Collaborating with the Gallaudet University - the world leader in liberal education and career development for deaf and hard-of-hearing undergraduate students

Achilles Fitness Program Karpas Community Program

Community outreach program in collaboration with the Karpas Health Information Center. Series of lectures: Treating Pre-Diabetes Agustin Busta, MD Deaf Fair Collaboration with Karpas Diabetes Taking Care From Head to Toe Jenny DeJesus, RN Taking Charge of your Type 2 Diabetes Marina Krymskaya, NP, CDE Eating and Exercising for People with Diabetes Rosalia Doyle, RD, CDE BI Cares for You! Wellness programs for BIMC employees - Monique Welbeck, NP, William Craig, RD Howl Festival FDI Staff Running Your Life Keeping fit, focused and moving forward: Running Your Life is a program for people with diabetes that combines a motivational informational workshop with physical training. The program was designed in collaboration with the Achilles Track Club. Each week a different topic is presented in the workshop that will help individuals reach their goals. There are also two physical fitness classes every week at 6pm on Mondays and Wednesdays. Participants train for a predetermined walk/run, from walking a mile to running a marathon. Marathon team members: Jim Benson, Anthony DiCarlo, Lisa Galynker, Nell Hanks, Leonid Poretsky, Paula Ross and Veronica Thomas

High Risk OB/GYN Program

Providing diabetes education to pregnant women with diabetes Precept OB/GYN residents (Diabetes Education)

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Friedman Diabetes Institute Website www.friedmandiabetesinstitute.com

At the website you will find diabetes related information for: Families/Caregivers Kids/Teens Deaf/Hard of Hearing People with Diabetes Professionals Clinical Study Participants

Five Borough Outreach Program continued

Queens Queens/South Asian Action For Diabetes Education Programs And Treatment: Funded by the New York State Health Foundation to provide diabetes education to the South Asian Community and primary care providers. Manhattan NYU Geriatric Education Center - diabetes education for health care professionals Green Markets: at Union Square, Washington Heights and Poe Park, Bronx - provide diabetes awareness to public Young Womens Leadership Schools in East Harlem - provide diabetes management/prevention education Caring Community Senior Center - provided diabetes education via lecture series adapted from thr ADA curriculum Food Banks P.S. 154, P.S. 134, and food bank at 116th Street: participated in a 8 series of lectures on diabetes to patients with diabetes/pre-diabetes (adapted from the ADA curriculum). Also provided one-onone counseling Gaylord White Senior Center provided diabetes education via lecture series General Medical Associate (GMA @ PACC) provided one-on-one diabetes education from referrals of PCP offices Good Day New York Sugarless Sugar Cookies Cooking Demo by Randi Healthy Fair with Harlem Hospital Institute For Family Health Provide monthly education about diabetes basics and special HIV considerations Jackie Robinson Recreation Center Latino Health Initiative in collaboration with LHI staff, provide lectures to Latino community Los Vecinos provide monthly diabetes education following ADA curriculum Senior Event @ Hilton Hotel FDI presentation by Dr. Gerald Bernstain and Randi Levine St. Malachys Senior Meal provide written information to distribute on diabetes following the ADA curriculum. Provide on-on-one counseling Thomas Jefferson Recreation Center provided diabetes education via lecture series

Interactive Diabetes Education Website in Development

Five Borough Outreach Program

Brooklyn BI at Kings Highway: Provide diabetes education to patients and staff Staten Island Jewish Community Center: community diabetes education Bronx In collaboration with the New York City Department of Health (NYDOH); finalizing list of practice site/clinics to provide diabetes education Young Womens Leadership Schools in South Bronx: provides diabetes management/prevention education Davidson Senior Center

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2007-2008 FDI Media Appearances

Mens Health New York Daily News Sino Television Washington Square News Pharmawire Fox News Resident and Staff Physician MTV Education Update NewsRX D-life Staten Island Advance Health.com The Diabetes Voice NY Sun Newsday NBC TV Diabeteshealth.com Diabetesnet.com WINS Radio New York Times New York Metro Parents Food Bank Newsletter Cure-Diabetes.eu NYC Food and Fitness Partnership Newsletter Ability Magazine India Abroad Manhattan Times The Villager Town and Village (Stuyvesant Town) Prevention Magazine (Book on Diabetes) WorldDiabetesDay.org Diabetesstories.com

Summary and 2009 Goals

2008 Highlights Major Goal for 2009
45% growth in clinical encounter volume compared to Planning Interdisciplinary Diabetes Treatment Unit: 2007 with a total of 31,511 clinical encounters one-stop-shopping for patients with diabetes 4488 visits at Gerald J. Friedman Diabetes Institute in Adult Endo Neurology Podiatry/Ortho its 1st year Pediatric Endo Ophthalmology OB/GYN Initial results of the education program at Friedman Psychiatry Other Diabetes Institute demonstrate 50% reduction in excess Cardiology Nephrology Vascular HbA1C (>7%) 1st Annual Friedman Fellows Symposium featuring 19 presentations held on 11/14/08 at the Tribeca Grand Hotel. Participating institutions: BIMC, Tuft University, Directions for 2009 Rockefeller University, Harvard University, Mt.Sinai Interdisciplinary Diabetes Treatment Unit School of Medicine, UCLA Continued growth of Gerald J. Friedman Diabetes 15 research presentation at national meetings Institute 100% boards passing rate for graduate fellows 8th Continued growth of clinical activities year in a row Increase funding for research programs Maintain full accreditation of fellowship program Maintain full accreditation from the American Diabetes New Staff in 2008 Association for the education program Anto Ayinikal, RN South Asian Program Michael Goldman, MD Empire Clinical Research
Investigator Program Fellow

Randi Levine, RD FDI, Outreach Program Araki Takako, MD FDI Fellow Jerome Tolbert, MD Medical Director, FDI Outreach
Program

Miroslava Varadinova, MD Research Laboratory Fellow