Division of Endocrinology Progress Report 2007

Beth Israel Division of Endocrinology Progress Report 2007

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Table of Contents

Letter to Friedman Foundation Divisional Activities: - Friedman Diabetes Institute - Other Clinical, Educational and Research Activites

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Copies of manuscripts and publications are available upon request.

Beth Israel Division of Endocrinology Progress Report 2007

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April 2008 Ms. Jane Friedman President Gerald J. & Dorothy R. Friedman New York Foundation for Medical Research Paul, Weiss, Rifkind, Wharton & Garrison LLP 1285 Avenue of the Americas New York, NY 10019 Dear Ms. Friedman: Enclosed please find the 2007 progress report for the Friedman Diabetes Institute and the Division of Endocrinology at Beth Israel Medical Center. The following is a brief summary of our focal points in the past year. Opening of the Gerald J. Friedman Diabetes Institute on 11/14/07 (1st World Diabetes Day) Received American Diabetes Association (ADA) Recognition on 12/26/07. The clinical encounter volume in the division has continued to grow. Our fellowship program remains fully accredited by the Accreditation Council for Graduate Medical Education for the longest possible cycle 6 years (through 2009). The Fellows Board passing rate continued to be 100% during the seven years. Our research projects are progressing successfully. All residents rotating in the division express their excitement about the level of science in the laboratory directed by Dr. Seto-Young. Enclosed is a list of publications and research projects. We thank you for your support and are very excited about the opening of the Gerald J. Friedman Diabetes Institute.

cc: Lawrence S. Huntington, Chairman, Board of Trustees, Continuum Health Partners Stanley Brezenoff, President and Chief Executive Officer, Continuum Health Partners David Shulkin, President and Chief Executive Officer, Beth Israel Medical Center Henry Bodenheimer, MD, Interim Chairman, Department of Medicine, Beth Israel Medical Center Ms. Mary DeBare, Member, Board of Trustees, Continuum Health Partners Mr. Richard Netter, Member, Board of Trustees, Continuum Health Partners Ms. Andrea Halbrook Mr. Jeffrey Soref Deborah Visconi, Sr. Vice President, Operations, Beth Israel Medical Center Kathy McGovern, Sr. Vice President, Development and External Affairs, Continuum Health Partners Patricia Balsamini, Vice President, Development Department, Continuum Health Partners Sarah Berkson, Administrator Department of Medicine, Beth Israel Medical Center Jack J. ONeil, Esq., Partner, Paul, Weiss, Rifkind, Wharton & Garrison LLP

Leonid Poretsky
Sincerely, Leonid Poretsky, MD

Beth Israel Division of Endocrinology Progress Report 2007

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Gerald J. Friedman Diabetes Institute

Officially opened: Visits in 2007: 1247 ADA Recognition: Received December 26, 2007 Electronic Data Base Clinipro initiated: November 19, 2007 November 14, 2007

High Risk OB/GYN Program

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

The First World Diabetes Day sponsored by the UN

Insulin Pump Program

Resources for people with diabetes interested in insulin pump therapy

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

Weekly sessions on advanced pump features with the pump trainers (MiniMed) FDI Certified Diabetes Educators (CDEs) became certified pump trainers (Omni-Pod, Animas)

Karpas Community Program

Community outreach program in collaboration with the Karpas Health Information Center. Series of lectures: Nov.6 - Treating Pre-Diabetes Agustin Busta, MD Nov. 13 Taking Charge of your Type 2 Diabetes Marina Krymskaya, NP, CDE Nov. 20 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 Sept. 8-9 FDI Staff

Pediatric Program
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 and devices used in pediatrics.

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 at the end of March to develop educational booklets (on-going development) Collaborating with the Gallaudet University - the world leader in liberal education and career development for deaf and hard-of-hearing undergraduate students

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Energy Up! Wellness Program

Bi-weekly sessions for patients and FDI staff Weekly lectures for patients Diva-betic meetings School program in collaboration with FDI outreach team - providing nutrition, wellness, diabetes awareness/prevention presentations to the school population, and the parents.

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: Provide Diabetes Management/Prevention education 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 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.

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

Interactive Diabetes Education Website in Development

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Other Divisional Activities

Clinical Educational Research

Educational Activities
Patients Gerald J. Friedman Diabetes Institute opened in Spring of 2007 pump support group individual patient education groups for deaf patients 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 (11 in 2007) boards passing rate increased from 33% to 100% for the last 7 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 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 Opened Gerald J. Friedman Diabetes Institute

Clinical Encounters (FPP only)

24000 22000 20000 18000 16000 15704 12504 2007 FPP: 18267 Total: 22109
Includes GJ Friedman (1247), Clinics (1863) and Off site (732) volume in addition to FPP (18267)

22109

18267 17347 16802 17060

Visits

14000 12000 10000 8000 6000 4000 2000 0 2000 2001 2976 6014

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
2002 2003 2004 2005 2006 2007

Year
Years 2000-06 are FPP encounters only.

FPP Collections ($)

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

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 education programs, including an interactive web site, on clinical outcomes in patients with diabetes. PI Dr. Leonid Poretsky

2000

2001

2002

2003

2004

2005

2006

2006

Year

Beth Israel Division of Endocrinology Progress Report 2007

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Research Programs continued

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, continued

Current Research Funds Endocrinology Basic Science Lab Research Fund ADOPT Research Fund The Gerald J. Friedman Chair in Endocrinology Fund Gerald J. Friedman Diabetes Institute Fund Empire Clinical Research Fund Rosiglitazone in Diabetes Fund Clinical Trials Liao IIS Fund Lantus Plus Apidra MDI Versus Premixed Insulin Fund New York Health Foundation

Original Peer-Reviewed Publications: 2007

Seto-Young D, Avtanski D, Strizhevsky M, Parikh G, Patel P, Kaplun J, Holcomb K, Rosenwaks Z, Poretsky L. Interactions among peroxisome proliferator activated receptor-g, insulin signaling pathways, and sterodogenic acute regulatory protein in human ovarian cells. J Clin Endocrinol Metab 92:2232-2239, 2007. Martinez R, Poretsky L. Case study. Insulin 2:144-145, 2007. Martinez R, Poretsky L. Case study response. Insulin 2:190-191, 2007. Avgerinos DV, Leitman IM, Martinez RE, Liao EP. Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass surgery. J Am Coll Surg 205: 294-297, 2007.

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.
$1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 $24,201 $1,005,627 $1,258,355 $1,790,529 $1,775,340

$623,000 $557,677 $522,000

2000

2001

2002

2003

2004

2005

2006

2007

Year

Sources of Funding Gerald J. Friedman Foundation Abbot Laboratories Aventis Pharmaceutical National Istitutes of Health Holbrook Family Foundation Mr. Morgan Miller Mr. Jeffrey Soreff Ms. Mary DeBare Chinese American Medical Association Thanks to Scandinavia Foundation New York State Department of Health Glaxo SmithKline, Inc. Novo-Nordisk, Inc. Eli Lilly and Company Pfizer BIASP Novolog Genzyme Corporation The Children Hearing Institute

Rossman J, Bravo-Vera R, Sheikh A, Gouller A. Radiofrequency ablation of matastatic insulinoma in patients with coexisting a snchronous nesideioblastosis. J. Endocrinol Invest 30:521-524, 2007 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, submitted 2007. Seto-Young D, Avtanski D, Parikh G, Strizhevsky M, Rosenwaks Z, Poretsky L. Thiazolidinediones inhibit aromatase activity in human granulosa cell by interfering with androgen binding to aromatase. Manuscript in preparation.

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Presentations at National and International Meetings: 2007

Gurevich Y, Poretsky L. Can pamidronate prevent hungry bone syndrome after parathyroidectomy? 16th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists, Abstract #393, Seattle, WA, April 11-15, 2007. Avtanski DB, Strizhevsky M, Parikh G, Araki T, Rosen O, Demetri C, Goldman M, Cadaq S, Rosenwaks Z, Poretsky L, Seto-Young D. The effect of thiazolidinediones on estrogen production in human granulose cells. 89th Annual Meeting of the Endocrine Society, P1-317, Toronto, Canada, June 2-5, 2007. Song L, Seto-Young D, Liu L, Poretsky L. Lack of consistent effect of insulin-like growth factor I (IGF-1) on plasminogen activator inhibitor type 1 (PAI-1) production in cultured human aortic endothelial cells (HAEC). 89th Annual Meeting of the Endocrine Society, P-3-389, Toronto, Canada, June 2-5, 2007. Martinez RE, Poretsky L, Lam A, Krymskaya M, Burke G. Diabetes education for the deaf: unexplored territory. 16th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists, Abstract #272, Seattle, WA, April 11-15, 2007. Bernstein G, Poretsky L, Lam A, Krymskaya M, DeJesus J, Doyle R, Burke G, Towe M, Worthington B. Culturally Competent Diabetes Education Program for Deaf Patients. 34th Annual Meeting of the American Association of Diabetes Educators, Abstract CQ01, St. Louis, MO, August 1-4, 2007. Song L, Busta A. A case of benign symmetric lipomatosis can thiazolidinediones be of benefit. American Association of Clinical Endocrinologist Annual Meeting, Seattle, WA, April 11-15, 2007. Martinez RE, Rosen O, Saliby A. Pagets disease, pimary hyperparathyroidism, and osteoporisis: report of a case and therapeutic implications. 89th Annual Endocrine Society Meeting, Abstract #850265, Toronto, Canada, June 2-5, 2007. Martinez RE, Cadag A, Gouller A. Plasmapheresis: A life-saving therapy for thyroid storm. 89th Annual Endocrine Society Meeting, Abstract #851695, Toronto, Canada, June 2-5, 2007. Patel P, Gurevich Y, Liao E. Primary hyperaldosteronism with normal potassium and high renin levels in patient with chronic renal failure. Endocrine Society 89th Annual Meeting, Abstract P3-87, Toronto, Canada June 2-5, 2007. Patel P, Seto-Young D, Poretsky L, Liao E. Effefts of Vitamin D supplementation in type 2 diabetes mellitus. Osteoporosis Update, Santa Fe, New Mexico, August 2007. Seto-Young D, Poretsky L. The role of PPAR-g in human ovarian regulation. The 5th Anniversary Congress of International Drug Discovery Science and Technology, Xian, China, November 2007.

Major Goal for 2008

Interdisciplinary Diabetes Treatment Unit: one-stop-shopping for patients with diabetes Adult Endo Pediatric Endo Cardiology Nephrology Neurology Podiatry/Ortho Ophthalmology OB/GYN Psychiatry Other Vascular

New Staff in 2007

Diabetes Institute: Jenny De Jesus, RN Artee Srivastava, NP Monique Welbeck, NP Jennifer Regester, RD William Craig, RD Lisa Newman, MD Dorothy Perry, RN Natalie Morrow, LCSW High Voltage, Wellness Dir. Karina Ziskovich, Adm. Asst. Sandy Farrell, Adm. Asst.

Directions
Continued growth of Gerald J. Friedman Diabetes Institute Continued growth of clinical activities Increase funding for research programs Maintain full accreditation of fellowship program Maintain full accreditation from the American Diabetes Association for the education program