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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
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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
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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.
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MESSAGE FROM THE DIRECTOR
JEFFREY PESSIN, Ph.D.
Judy R. and Alfred A. Rosenberg Endowed Professorial Chair in Diabetes Research Director, Diabetes Research Center
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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
[email protected]
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.
