Impact - Joslin Diabetes Center

ALLIANCES
CATALYST
COLLABORATION
JOSLIN
INNOVATION
IMPACT
INGENUITY
CAPACITY
JENESIS
CONFIDENCE OUTCOMES
AGILITY
TY
G
GLOBAL ACCELERATION BIG DATA
TRANSLATIONAL
DIGITAL
Contents
2
Partnering for impact
4
Solutions for the nation
6
Innovative medicine
8
Big data
10
Accelerating progress
12
Digital healthcare
14
Empowering stakeholders
16
Solutions for the world
18
Discovery cycle
Joslin Diabetes Center is the world's
preeminent diabetes research and clinical
care organization. Joslin is dedicated to
ensuring that people with diabetes live
long, healthy lives and offers real hope and
progress toward diabetes prevention and
a cure. Founded in 1898 by Elliott P. Joslin,
M.D., Joslin is an independent, nonprofit
institution academically affiliated with
Harvard Medical School.
www.joslin.org
Joslin Innovation is produced by the
Communications Department at
Joslin Diabetes Center.
director
Jeffrey Bright
writer & editor
Christine Paul
design
Richard Chiarella, Innovative Resource Group
photography
John Soares
Stephanie M. McPherson
Arthur Pollock
Call to Action
Imagine coupling the expertise of the world’s preeminent
diabetes center with the energy of a start-up business.
At Joslin Diabetes Center, we are leveraging our 116-year
record of discovery and care with an all-out effort to shape
new medical innovations and global health solutions.
We are witnessing a worldwide diabetes pandemic, driven
by genetic risks, poor lifestyle choices, and inadequate
awareness, education and care. We cannot stand by, allowing
this human devastation and economic pain to continue.
As is our longstanding privilege, Joslin wears the mantle
of leadership—to be the international catalyst for change—
searching for new ways to prevent, treat and cure diabetes.
In our labs, clinics, offices and boardroom, we are connecting
the power of big data, outcomes research, molecular biology,
digital communications and lifestyle medicine. In the nation and
world, we are exporting creative solutions to help healthcare
practitioners everywhere expand their skills and reach more
people. To accelerate new diabetes therapies, we are forging
entrepreneurial partnerships with industry. It is a vibrant time
at Joslin. We invite you to join this unparalleled call to action.
John L. Brooks III
President and Chief Executive Officer
Joslin Diabetes Center
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Joslin Innovation
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Partnering f
Joslin is teaming up with pharmaceutical, medical device, food
and software companies to convert discovery into action. Together, we
are pursuing an ocean of ideas, creating new treatments and solutions.
Why partner?
“At Joslin, we have a
strategic business model —
we discover, they apply
and everyone gains.”
— Dr. Nandan Padukone
Innovation alliances
“Joslin is the world’s preeminent institution dedicated to building a
future without diabetes and its complications, but we can’t do it alone,”
says Nandan Padukone, Ph.D., M.B.A., who heads Global Business
Development and Ventures at Joslin. “To have a major impact, we are
creating business relationships that will expand our expertise and reach.”
Now in Joslin’s portfolio are more than 25 formal partnerships with
pharmaceutical, medical device, food and software companies, focused on
getting new products and services into the pipeline and out the door to
patients. Many are springing from Joslin findings that are ready for
“spin-out.” Others are emerging from a unique accelerator called
Jenesis Biosciences. “This is start-up central—an initiative in which
internal and external scientists work together, sharing a wealth of ideas,”
says Dr. Padukone. “In that ocean, we determine where we’re going to
swim, guiding our partners to address key problems and accelerate new
products and services into the marketplace.”
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for Impact
Simplifying
nutrition
Six years ago
ago, when Elle Shaheen (center)
r was new to making food
choices as a way to help manage her type 1 diabetes, she exclaimed,
“Mom, why does this have to be so hard?” Her mother, Stefany
Shaheen (left), stepped up to address the challenge. Together with
George Bennett, Ph.D., the pair launched Good Measures. Working
with a Joslin team, led by Catherine Carver, M.S., A.N.P., C.D.E., Vice
President of Clinical Innovation, Good Measures incorporated Joslin’s
nutritional guidelines, meal plans and exercise recommendations
into a state-of-the-art digital platform. By combining this technology
with the know-how of registered dietitian nutritionists and certified
diabetes educators, including Amanda Kirpitch, R.D., M.A., C.S.S.D.,
L.D.N., C.D.E. (right), Good Measures and Joslin can now provide
patients with re
real-time support via phone, e-mail or even in person.
Steeped in Joslin’s nutritional guidelines, dietitians are helping
patients better manage eating and exercise habits to achieve better
health. When on the go and trying to juggle personal preferences,
nutritional needs and medical conditions, people have support
where and when they need it—at the grocery store, work, school
or in a restaurant. Elle, now 15 and still receiving her care at Joslin,
is benefitting from this breakthrough approach every day. She is
working with a registered dietitian periodically and refers to her
Good Measures smartphone app several times daily. “It takes out the
guesswork,” she says. “I can mix and match meals, and track my food
choices. It’s given me a lot of confidence.”
Off to a good start
“The risk of developing type 2 diabetes can be handed down to babies in ways not based
simply on copying the parents’ DNA,” says Joslin scientist Mary-Elizabeth Patti, M.D.
“A pregnant woman with poor nutrition or other health issues such as a poorly functioning
placenta or cigarette smoking is at risk for giving birth to a low-birth-weight infant. These
babies go through a catch-up growth period, so that their body weight is normalized. Shortly
thereafter, we can see elevated glucose levels, reduced muscle mass and an increase in fat
tissue. Later in life, these problems often lead to obesity and type 2 diabetes.” The father’s
health also is key. If he has poor metabolism, it can change how the sperm’s double strand of
DNA is unwound and read, affecting the baby’s embryonic development and risk of obesity.
“There’s an important public health message here about parental nutrition and fitness,”
Dr. Patti says. “We know that obesity begets obesity. If you are planning to become pregnant,
you and your partner really want to try to improve your health as much as possible before
the pregnancy, so your developing baby is exposed to a healthy metabolic environment.”
In the lab, she is working to identify and reprogram the molecular signals involved in order
to identify potential drug therapies to interrupt vicious cycles of risk for diabetes.
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Solutions for
Joslin is not standing by. With more than 24 million people
nationwide afflicted by diabetes, our array of programs is
designed to help healthcare providers meet the challenge.
Why go national?
“Diabetes is a pandemic
that all U.S. providers
need to address.
We can equip them with
the skills to do that.”
— Dr. Robert Gabbay
Bundling diabetes care
“With more than 90 percent of diabetes patients receiving care through primary care
providers, it makes sense to assist these practices in a creative way,” says Robert
Gabbay, M.D., Ph.D., F.A.C.P., Chief Medical Officer and Senior Vice President at
Joslin. “These are exciting times, as we work to integrate a successful affiliate program
with many of the clinical, research and educational activities here at Joslin Diabetes
Center in Boston. As healthcare continues to evolve, we all need to harness new tools
and approaches to better serve our patients with diabetes. In this spirit, we have
undertaken a concerted effort to reorganize and better align our organization to meet
these new challenges. Healthcare is clearly moving toward population management
and the need to provide cost-effective solutions to improve the lives of those with
diabetes. As rates of diabetes soar, along with its associated costs, we all have an
opportunity to dramatically impact how care is delivered. We have a great deal of
expertise here at Joslin and have been developing new, innovative approaches for
high-value diabetes care. Our approaches include a focus on inpatient care and the
reduction of readmissions. We also are working in the outpatient arena with primary
care providers to transform their practice models to Patient-Centered Medical Homes
and engaging diabetes teams to coordinate care in the Medical Neighborhood.”
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the Nation
‘A quality net’
“Using Joslin’s tracking tools, we are seeing a transformational sea
change in diabetes care provided by our primary care physicians,” says
Mark McPhee, M.D., M.H.C.M. (right), Executive Vice President for
Clinical Coordination for Truman Medical Centers in Kansas City, MO.
“Many of our patients are impoverished, needing both a safety net and
a quality net. We believe the Joslin program will have a high impact on
our population, whose diabetes often must be managed with other
chronic conditions.” The hospital, which recently implemented the
Joslin Clinical Audit Tool (JCAT), is tracking providers’ progress in
five data areas—glycemic control (A1C values), blood pressure, lipids,
renal function and smoking—to improve their patients’ outcomes
At Truman, JCAT is managed among primary care doctors by Willy
Pegues, Director of Primary Medicine Clinics (left), who regularly
consults with JCAT’s medical director, Richard A. Jackson, M.D.
Joslin care alliances
• Inpatient Diabetes Quality Initiative: Insights on effective
management of hospitalized diabetes patients
Diabetes is everywhere, and so is Joslin. We are in the care-delivery
business, establishing comprehensive care and operational programs
nationwide that focus on managing diabetes and its complications,
including specialty care for blood vessels, eyes, nerves, kidneys
and other diabetes-related conditions. Our alliances include
hospitals, networks and practices, and we also offer the following
suite of services:
• Pediatric Program: Team approach to care for the increasing
number of children with type 1 diabetes
• Primary Care Provider Certification: Training primary care doctors
to effectively manage diabetes and its complications
• Joslin Clinical Audit Tool (JCAT): Analytical tools that track
providers’ progress in treating diabetes (see story above)
• Skilled Nursing, Long-Term Care, Assisted Living: Optimal care
solutions for residents with diabetes
• Behavioral Health: Training clinicians to help patients deal with
behavioral dimensions of diabetes
• Community Health: Guiding non-clinicians who provide diabetes
education in underserved communities
• Weight Management: Weight-loss programs including Why WAIT,
a 12-week course, and You-Turn, a seven-day program
• Consulting: Analysis of an organization’s diabetes programs and
recommendations for programs of excellence
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Innovative
At Joslin, we are integrating the entire spectrum of medicine—
how genes and cells communicate, what goes wrong in diabetes,
and how to promote and restore health.
What is innovation?
Microbiome
holds big clues
With bacteria numbering in the trillions, the microbiome comprises
more than 1,000 different bacterial species that live in our gut.
At Joslin, researchers are striving to unmask their role in obesity,
inflammation and diabetes. Suzanne Devkota, Ph.D. (right), focuses
on how various diets alter the balance of gut bacteria. “High-fat
diets have a profound impact on the microbiome, often leading to
inflammation,” she says. Among other questions: Does the overuse
of bacteria-killing sanitizers or antibiotics in children set the stage
for autoimmune diseases? In these conditions, the immune system
is poorly educated and can attack itself. An imbalance in the gut
bacteria may be triggering the immune response that destroys the
insulin-producing cells in the pancreas, leading to type 1 diabetes.
“The microbiome also might be a big contributor to type 2 diabetes,”
says C. Ronald Kahn, M.D. (left), Chief Academic Officer, who focuses
on how alterations in insulin receptors cause insulin resistance.
“By using different strains of mice, we’re seeing that genetic
background interacts with the microbiome and diet to produce
obesity and diabetes. This is exactly what happens in humans where
these gut bacteria may grow and work differently in different
people and are influenced by diet. Gut bacteria not only can lead
to inflammation but also modify metabolism, changing how and
what nutrients are absorbed and creating signals throughout the
body. Once we determine which bacteria are harmful and which are
helpful, we can look for ways to fix it.”
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“It’s about combining
something in one area
with something in
another area, resulting
in a new advantage
previously unknown.”
— Dr. C. Ronald Kahn
Medicine
Exercise
generates
signals
“Society needs to embrace exercise as medicine,” says
Laurie Goodyear, Ph.D. (left). In Joslin’s new fitness
facility, she discusses the benefits of exercise with patient
David Dekker, who periodically comes to Joslin from
Canada for DO-IT, a four-day refresher course, to update
his diabetes skills. The new Biodex system, operated by
exercise physiologist Jeffrey Richard, M.S., R.C.E.P. (right), measures
strength, endurance and range of motion, providing precise data
to gauge whether patients are gaining strength. Dr. Goodyear, who
helped design the facility, is primarily a lab scientist who focuses
on the molecular mechanisms underlying the beneficial effects of
exercise. She’s found that when muscles contract, signals become
activated, leading to glucose being cleared from the blood and into
the muscles. New research also suggests that contracting muscles
secrete proteins into the circulation that improve glucose tolerance,
insulin sensitivity and lipid levels. One goal is to design drugs that
imitate signals generated by exercise or speed up the process.
Another question: Can fat tissue be made healthier? “When we
transplanted subcutaneous fat tissue from exercise-trained mice into
untrained mice, the ‘trained’ fat imparted the benefits of exercise
to the untrained mice, working to prevent the harmful effects of a
high-fat diet,” she says. “This suggests the trained fat is secreting
something beneficial. These findings—including a signal that regulates
glucose uptake in skeletal muscle—have led to a partnership with
Janssen Pharmaceuticals, a Johnson & Johnson company. We need to
identify those factors and study their benefits in humans, including
tissues such as the heart, liver and blood vessels.”
Prescription for health and wellness
“We need to do more to help people with or without diabetes realize they can live a healthy lifestyle,
even if they have chronic medical issues like diabetes,” says Martin Abrahamson, M.D., F.A.C.P., who
has launched Joslin’s new Center for Integrative Health and Wellness. “This is a center without walls.
In collaboration with others at Joslin and elsewhere, our goal is to bring innovative solutions to
patients at Joslin and beyond, leveraging our leading expertise in clinical care, research, education
and technology. We aim to help people make changes to their lifestyle by providing innovative
prescriptions for health and wellness, tailored to the individual.” Among key approaches:
• Study new products: Advance new exercise models (above), ways to reduce stress, meal supplements,
pathways for healthy eating (p. 3) and diabetes care apps (p. 12)
• Provide innovative care: Enhance existing programs, develop new programs, target new populations,
provide education and leverage technology to access more people (p. 13)
• Educate healthcare professionals: Continue to expand training of physicians, medical students,
and other healthcare clinicians on national and international levels through the Institute of Lifestyle
Medicine and other programs conducted by Joslin (pp. 14–17)
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BIG Data
Joslin’s scientists are developing big databases to capture,
store and process huge amounts of information on diabetes
and its complications, shaping new questions and solutions.
Why big data?
Mining for medical gold
Among his many accomplishments, Elliott P. Joslin, M.D.,
our founder, was the world’s first diabetes epidemiologist.
In 1898, he began recording patient data in log books
that he maintained throughout his long career. He insisted
that his staff follow suit, and that practice never stopped.
Today, Joslin serves more than 25,000 diabetes
patients each year and has developed a rich repository
of data. “We’ve developed a uniform way to enter data
into the patient’s electronic health record (EHR),” says
Sanjeev Mehta, M.D., M.P.H., Director of Quality.
“This allows us to collect and analyze a tremendous
amount of information, which can be used to understand
the effectiveness of our care models and design new
studies. Future linkages to clinical trial data and external
databases will enhance our understanding of the data
stored in our EHR database.” For example, a search of the
databases may illuminate the relationship between Joslin
care delivery and patients’ health outcomes in reducing
the risk of diabetes-related complications. Additionally,
data can be used to design weight-loss programs that
work more effectively in different populations, based on
specific demographic and clinical characteristics detailed
in the Joslin EHR database. Dr. Mehta is working on
several initiatives to support the development of national
registries for type 1 and type 2 diabetes with the goal
of translating our local expertise to a broader audience
and ensuring that the best clinical care is always being
delivered at Joslin.
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“There is no one-size-fitsall solution to diabetes.
Big data combined with
patient-centered clinical
care can provide the
insights we need to tailor
care to the diverse group of
individuals seen at Joslin.”
— Dr. Sanjeev Mehta
Pursuing a
kidney clue
The research idea sprang from data. “Our data revealed type 1
diabetes patients with moderately high serum uric acid levels
are at high risk of losing kidney function,” says Joslin researcher
Alessandro Doria, M.D., Ph.D., M.P.H. (right). “But we didn’t know
if this is due to uric acid itself or to something else going together
with it. We need to find out if uric acid is the culprit or not.”
To find the answer, he is heading a new study in collaboration with
Andrzej Krolewski, Ph.D. (left), head of Genetics and Epidemiology,
and other key Joslin investigators including Allison Goldfine, M.D.,
Director of Clinical Research, and renal specialist Robert C. Stanton,
M.D. In 2013, the National Institutes of Health awarded Joslin
$24.3 million to lead a five-year clinical trial titled Preventing Early
Renal Function Loss in Diabetes, or PERL. The aim is to determine if
allopurinol—an FDA-approved drug that lowers uric acid—will help
Racing toward
health
prevent or slow the loss of kidney function in people with type 1
diabetes. Working with 10 other clinical centers in the United States,
Canada and Denmark, the study will enroll approximately 500
patients. Half will receive allopurinol, the others a placebo,
and their kidney function will be compared after three years.
This research offers potential hope to people with type 1 diabetes,
10 to 15 percent of whom will develop end-stage renal disease,
meaning they will need dialysis or a renal transplant to survive.
Dr. Doria is eager to see the results: “If we see a robust effect from
this study, we will have a new therapy for kidney complications.”
“I’m no athlete, but exercise is a tremendous help in managing my
diabetes,” says Danielle Panetta. “If you do the best you can, your
body knows it and responds.” This indomitable spirit got her
through a major health crisis. Weighing 350 pounds, for nine years
she struggled with diabetes misdiagnosed elsewhere as type 2.
Trying to get it under control, she lost 190 pounds while dealing with
the rigors of college and law school. Eight years ago, she experienced
excruciating foot pain and was referred to Joslin, where clinicians
diagnosed her diabetes as type 1 and provided expert care for
Charcot foot, in which nerve damage can lead to foot deformities.
Other complications also had begun, which she is determined to get
under control. “I really want to be healthy, and I can do that with
or without diabetes,” she says. Equipped with an insulin pump, a
continuous glucose monitor and skills to manage type 1 diabetes,
she has regained the feeling of hot and cold in her feet, rebuilt her
leg muscles, and today trains for half-marathons and other races
nationwide, often running with people who have diabetes.
Concerned about her kidneys, she has volunteered for the PERL
study, headed by Joslin, which is investigating the potential of a drug
therapy to stem kidney disease (see above).
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Joslin Innovation
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Accelerating
Joslin’s new Translational Center for the Cure of Diabetes
expands our capacity to translate lab and clinical discoveries
into improved diabetes therapies and possible cures.
What does the Center do?
“This state-of-the-art clinical
center positions Joslin to more
rapidly test and pilot ideas to
solve the problem of diabetes.”
— John L. Brooks III, Joslin President and CEO
THE GRAND TOUR
Joslin President and CEO
John L. Brooks III leads
Governor Deval Patrick on a
tour of the new clinical research
center. It is the cornerstone of
Joslin’s Translational Center
for the Cure of Diabetes,
which also will include an
exercise physiology lab,
biobank expansion, nutritional
research, and a new lab for
next-generation sequencing,
a valuable tool for studying
genes and their functions.
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COMMITMENT TO INNOVATION
Governor Patrick was thrilled to see
the results—a premier clinical center
designed to advance new therapies for
diabetes and its complications.
FUNDING SUPPORT
Dr. Susan Windham-Bannister was at the helm
of the Massachusetts Life Sciences Center when
Joslin was awarded a $5 million grant for the
Translational Center for the Cure of Diabetes,
matched by $5.8 million from private donors—
the largest capital infusion in Joslin’s history.
Progress
CELEBRATING PROGRESS. Attending the 2014 ribbon-cutting ceremony for Joslin’s new Translational Center for the Cure of Diabetes (from left):
George King, M.D., Joslin’s Chief Scientific Officer; Sharon Harpel, Vice President of Sponsored Research; Susan Windham-Bannister, Ph.D., first
President and CEO of the Massachusetts Life Sciences Center, which provided key funding; Allison Goldfine, M.D., Joslin’s Director of Clinical Research;
Massachusetts Governor Deval Patrick; Boston City Councilor Josh Zakim; and Joslin President and CEO John L. Brooks III.
PATIENT-CENTERED CARE
On behalf of the 25,000
diabetes patients who come
to Joslin each year, a pediatric
patient thanks Joslin for
adding new treatments and
working toward a cure.
EXERCISE MATTERS
Governor Patrick visits Joslin’s new exercise facility, where exercise physiologist
Jacqueline Shahar, M.Ed., R.C.E.P., C.D.E., and a Joslin patient demonstrate
high-tech equipment designed to capture data on strength, range of motion
and other physical factors. When fully developed, the exercise physiology lab,
the first of its kind east of the Mississippi, will allow investigators to explore
the key role of exercise in managing and preventing diabetes.
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Joslin Innovation
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Digital
Blending the best of diabetes care with the digital age,
Joslin is making it easier for patients to gain access to their
healthcare team from afar, without having to come to the clinic.
Why go digital?
“Diabetes care is data-driven, making
digital technology an ideal format for
enhancing the patient experience.”
— Harry Mitchell
Smart tools to manage diabetes
“As the world’s largest diabetes center, Joslin is uniquely positioned to provide clinical
insight to impact the effectiveness of devices, technologies and strategies to improve
diabetes care,” says Harry Mitchell, C.P.A. (above left), Executive Director of the newly
launched Joslin Institute for Technology Translation (JITT). Pairing Joslin’s clinical
expertise with industry, JITT focuses on the following:
• Create physician-designed, patient-tested decision support tools for improved
solutions in glucose and insulin management
• Be a powerful voice in moving digital health to improve diabetes care in a
cost-effective approach
• Create individualized collaborations with technology partners, providing new
solutions to advance monitoring and treatment of diabetes
• Pioneer educational innovations to optimize decision-making processes and adoption
of best-in-class technologies for healthcare professionals and patients worldwide
Serving as JITT Director is Howard Wolpert, M.D. (above center), senior
physician at Joslin, whose team is developing the decision-support
systems programmed into various technology platforms. Among
several new partners is Dexcom, Inc., the first founding JITT member,
which is developing advanced continuous glucose monitoring systems
for patients and healthcare providers. In a system developed with
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Glooko, Inc., patients can download data from their glucose monitor
to an app for mobile devices called the Joslin HypoMap, which tracks
patient symptoms, causes and treatment of hypoglycemic events.
The device also allows actionable data to be uploaded into the
patient’s electronic health record, which aids clinicians in making
decisions and engaging patients in teachable moments.
Visits..
Virtual
Healthcare
...are here
A new online program for Joslin patients to “virtually”
visit their clinicians makes it easier to manage
appointments from anywhere in the world—home,
work, school and while traveling. “I now can visit my
diabetes team from my seasonal home in California,”
says patient Arthur Hersh (right), participating in a
video conference with nutritionist Gillian Arathuzik,
R.D., L.D.N., C.D.E. (left). The program stems from Joslin
initiatives to provide the latest in Web-based care.
Paul Penta (opposite page, right), among Joslin’s
Information Technology specialists, explains the
benefits: “Given the nature of both type 1 and type 2
diabetes, self-management technologies can have a
huge impact, giving people more control over their
lives. The Virtual Visit Program is a great way to provide
follow-up care.” To use this technology, patients first
install software on their computer. This software has
been specially developed to provide the level of privacy
required by HIPAA. Then the patient schedules an
appointment for a virtual visit, which follows a flow
similar to an in-person visit. At the appointed time,
the patient connects online with a front-desk staff
member, who transfers the patient to the clinician’s
queue, or “waiting room,” where the provider picks
up the patient’s video call. The patient and clinician
simultaneously view each other on screen, and the
clinician also uses a second monitor to access and
discuss test results and the patient’s electronic health
record. Currently, virtual visits are being offered as
follow-up appointments for Joslin patients who are
being seen in person at least once a year.
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Joslin Innovation
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Empowering
Joslin sponsors a wide range of initiatives designed to
educate everyone with a stake in improving diabetes
outcomes and embracing a healthy lifestyle.
Who needs to know?
“The number of cases is so
great…that their care must
rest in the hands of the
general practitioner. It is
ridiculous to expect that the
treatment of (all) diabetics
should be under the
supervision of a specialist.”
— Dr. Elliott P. Joslin
Corporations gain understanding
“This is the best program I’ve ever attended, either in diabetes
or in the industry,” a participant wrote about Joslin’s Corporate
Education Program. It is among several ways that Joslin trains
stakeholders beyond those involved in patient care, including
executives and sales representatives of companies that market
diabetes drugs or devices. “It’s not about their product,” says
program director Anne Gregory. “It’s about understanding the
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disease.” She oversees more than 30 live corporate programs held
annually, either at the company’s location or at Joslin, educating
more than 2,000 sales representatives in 2014. Participants often
are challenged to use a glucose monitor and syringe overnight,
giving them a sense of how it feels to have diabetes. Joslin also
offers webcasts to companies both domestically and abroad.
Stakeholders
Digital tools to
train clinicians
“The explosive power of the information age is transforming the way
Joslin educates healthcare professionals,” says Enrique Caballero,
M.D. (left), who directs Joslin’s international initiatives in professional
education. “Our innovative programs can now reach diabetes care
teams across the globe and through them, favorably touch the lives
of many patients with diabetes.” At live conferences for clinicians,
Joslin often uses electronic audience-response systems, allowing
each member of the assembly to answer polling questions and
discuss patient cases. Doctors also can take online courses to earn
continuing medical education credits, available through Joslin’s
Web-based portal. “We have successfully integrated our educational
activities with periodic examination of patient metrics from the
electronic medical records of selected practices around the country,
and have been able to demonstrate real improvement in patient
care,” says Richard S. Beaser, M.D. (center), who has led professional
education for 20 years and also served as editor of Joslin’s Diabetes
Deskbook, 3rd edition: A Guide for Primary Care Providers, published in
2014. The team, which includes Assistant Director Karen Kuc (right),
also trains inpatient specialists, primary care office staff and
home-care professionals.
Healthcare professionals should ‘live the life’
“We need to transform the medical profession to embrace lifestyle factors as medicine,”
says Edward Phillips, M.D., founding director of the Institute of Lifestyle Medicine at Joslin.
“We’re asking healthcare professionals to live the life—embrace good nutrition, exercise, sleep,
stress reduction and other beneficial behaviors. Once they commit to their own lifestyle changes,
it’s easier to share the benefits with others.” Designed to improve every aspect of health, including
treating and lowering the risk of diabetes, this potent message is relayed through four main channels:
• Teach medical students about the value of a healthful lifestyle, regarding it as medicine
• Retrofit physicians with knowledge and skills they didn’t receive in medical school
• Modify healthcare professionals’ own behaviors, helping to inspire their staff and
patients to adopt new behaviors
• Train doctors and other healthcare professionals to coach patients to embrace the
ideals of lifestyle medicine and personal health
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Solutions for
As the world’s leading center in all aspects of diabetes—
research, care and education—Joslin is implementing
quality diabetes care in all corners of the globe.
Why go international?
Reaching the world
“Of the nearly 400 million people worldwide with
diabetes, most live outside the United States,”
says endocrinologist William C. Hsu, M.D., Senior
Director of Joslin’s International Programs.
“We need to reach them too.” For years, Joslin
has offered robust international programs in
professional education and culturally based diabetes
care. This new program, formally launched in 2013,
takes Joslin’s capabilities to the next level—to be
directly involved in shaping systems of diabetes
care in countries around the world. Invited by
entities involved in healthcare delivery such as
ministries of health, medical schools or healthcare
providers, Joslin’s experts visit and assess specific
systems of diabetes care, then shape strategies
for improvement, implementation and ongoing
performance evaluation. “Our approach is nimble,”
says Dr. Hsu. “We look for creative ways to work
within a country’s existing system—how best to
train its healthcare providers, educate patients
and the general public, and improve access and
quality of diabetes care.” In photo at right, he
presents at a symposium in Tokyo sponsored by
the global company Sunstar. The multi-year
Joslin-Sunstar Diabetes Educational Initiative brings
together dental and medical professionals in cities
throughout the world to focus on the link between
oral and systemic diseases such as diabetes.
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“The need is compelling and
clear. In 116 years of Joslin’s
history, we’ve never before
been so international.
Our phone is ringing off the
hook, and we are responding
to calls for innovative solutions
from all over the world.”
— Dr. William C. Hsu
theWorld
Where and
Why
To address the growing problem of diabetes,
Joslin is forging relationships worldwide.
Below is just a sampling of our global initiatives.
UNITED ARAB EMIRATES
VENEZUELA
RUSSIA
Helmut M. Schühsler, Ph.D., Chairman and
CEO of TVM Capital Healthcare Partners (left),
and John L. Brooks III (right), President and
CEO of Joslin, celebrate an alliance centered on
developing healthcare systems of excellence to
meet the growing need for diabetes services
across the care continuum in the United Arab
Emirates, which has twice the incidence of
diabetes as the United States.
With young patients in her home country
of Venezuela, Morella de Grossmann
(center right), a member of Joslin’s Board
of Directors, is a key supporter of the
Joslin Vision Network, a technology that
takes images of the back of the eye, which
are transmitted to Joslin experts for
evaluation and treatment planning.
Osama Hamdy, M.D., Ph.D., founder of
Joslin’s acclaimed Why WAIT program
for losing weight and gaining control of
diabetes, recently presented this program
to healthcare professionals in Russia.
Novartis Russia has licensed the use of the
program throughout the Russian federation.
The program’s manual is being translated
into Russian and other languages.
SAUDI ARABIA
Receiving Joslin certificates are three pharmacists,
among more than 1,500 who have completed a
course training pharmacists to educate patients
about diabetes and self-care at the pharmacy’s
point of service. The program is sponsored
by Nahdi Medical Company, which has more
than 800 pharmacy outlets in Saudi Arabia, as
represented by Sarah Turkistani, Senior Health
and Community Service Manager (second from
left), with Haleh Armian, Associate Director of
Joslin’s International Programs (second from right),
and Patricia Bonsignore, M.S., R.N., C.D.E.,
Joslin’s Manager for Clinical Education (far right).
CHINA
In another initiative, Joslin and Jazan University
in Saudi Arabia are creating opportunities
for advanced diabetes training and student
exchanges, a partnership shaped by Jazan
faculty Ibrahim Bani, M.D., Ph.D., Associate
Dean (left), and Hussein Ageely, M.D.,
Dean of the Faculty of Medicine (right),
Joslin endocrinologists Edward Horton, M.D.,
and William Hsu, M.D. (center left and right),
and Nuha El Sayed, M.D. (not pictured).
Dr. Hsu stands with Dr. Yan, of the
Sunshine Harmony Hospital, which Joslin
is helping to design a comprehensive
diabetes Center of Excellence in the
Shandong province in China. More than 114
million Chinese nationals live with diabetes,
and Joslin continues to build on its Asian
population expertise to help improve
treatments and reduce complications.
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Joslin Innovation
17
Discovery
Discoveries in Joslin’s laboratories lead to clinical studies, which
generate treatment results that prompt ideas for further investigation,
more research and continually improving patient outcomes. Our eye
research is a great example of Joslin’s distinguished discovery cycle.
What is Joslin’s impact on eye care?
1930s
Targeting
complications
With the 1921
discovery of insulin,
everyone hoped
diabetes would
be cured. But as
people with diabetes
lived longer, new
health problems
began to emerge—
complications involving blood vessels,
nerves, kidneys and eyes. Elliott P.
Joslin, M.D., founder of Joslin Clinic,
staunchly advocates that intensive
control of diabetes is key to reducing
complications, originally a hotly
debated medical issue. Thirtyrtyone years after his death,
the 1993 landmark Diabetess
Control and Complications
Trial proves he was right.
“Blindness from diabetes complications
once was common. Today, the average
vision for Joslin patients is 20/20.”
— Dr. Lloyd P. Aiello
1968
Ruby laser
William P. Beetham, M.D. (left), who
joined the Joslin team in 1932, rises
to international stature in diabetic
eye disease. In 1968, with his son-inlaw Lloyd M. Aiello, M.D. (right), he
introduces ruby laser technology for
diabetic retinopathy, a revolutionary
treatment for this visually devastating complication in which blood vessels
in the eye leak or proliferate where they should not. Joslin leads the national
clinical trials for this procedure, which remains the primary treatment for
diabetic retinopathy. The original laser equipment is now displayed at Joslin in
the Beetham Eye Institute, named in Dr. Beetham’s honor.
1985
85
Pivotal cell findings
George L. King, M.D., who has pioneered cell-culture models to study diabetes complications,,
shows in 1985 lab findings that insulin is critical for maintaining blood-vessel integrity.
Today as Chief Scientific Officer, he directs Joslin’s research program. He also heads the
50-Year Medalist Study, which he initiated to study people who have lived with type 1 diabetess
for 50 years or longer, seeking to discover genetic, protein and other factors that protect
against damage to the heart, kidney, nerve tissue and eyes.
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Joslin
50-Year Medal
y Cycle
Today
On the horizon
Molecular
pathways
Up to half of diabetic macular
edema may be caused by a nonVEGF pathway, as proved by
Joslin proteomics scientist Edward
Feener, Ph.D. (photo below, left),
who discovers that a protein called
plasma kallikrein is involved.
With Dr. Lloyd P. Aiello, he launches
KalVista Pharmaceuticals, which
is developing a kallikrein inhibitor,
now in clinical trials led by Jennifer
Sun, M.D., M.P.H. (right), and
supported by JDRF, the nation’s
largest charitable supporter of
type 1 diabetes research. In other
lab studies, Drs. Sun, Feener and
Aiello also are seeking ways to
identify key molecules and pathways
that protect diabetes patients from
developing eye disease.
Treating other eye conditions
In the lab, Lloyd P. Aiello, M.D., Ph.D. (right), who today heads Joslin’s eye program, and others
show that VEGF, the molecule that causes blood-vessel proliferation in diabetes, also is
associated with damage from non-diabetes eye conditions. Herbert Gramm, M.D. (left),
a retired radiologist, has been successfully treated with a VEGF inhibitor to reduce macular
swelling associated with occlusion of a retinal vein.
1990s
1998
Inhibitor is key
Joslin Vision Network
In the 1990s, Drs. George King and
Lloyd P. Aiello demonstrate in lab studies
that vascular endothelial growth factor
(VEGF) causes blood-vessel growth and
leakage, leading to severe diabetic eye
disease. Taking these findings to clinical
trials, Dr. Aiello helps lead studies of a
VEGF inhibitor, which when injected into
the eye is effective in treating diabetic
macular edema, a condition where leaking
blood vessels cause macular swelling
(in image, before and after treatment).
Today, the drug also is used to treat numerous blinding eye conditions.
For this pioneering work, in 2014 Drs. King and Aiello receive the
prestigious António Champalimaud Vision Award from the
Champalimaud Foundation in Portugal, the highest honor in
ophthalmology and vision research.
In 1998, Dr. Lloyd M. Aiello
co-launches the Joslin Vision
Network, in which a retina
camera takes detailed pictures
of the back of the eye. Coupled
with telemedicine technologies,
these cameras can be installed
in nearly any clinical setting
worldwide, with images
transmitted back to Joslin’s
eye experts for evaluation.
Currently, JVN cameras are
installed in a number of locations across the nation and other
countries worldwide. Since 1999, more than 50,000 patients
have been cared for with the Joslin Vision Network.
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Joslin Innovation
19
Joslin is ready to make an impact
on the global diabetes epidemic
56 M
37 M
32 M
72 M
138 M
Number of
Diagnosed Cases
20 M
(millions)
24 M
36%
27%
48% 49%
Estimated
Undiagnosed
Cases
54%
62%
(percent of total estimated cases)
Top 5 Countries
Number of cases per country (2013)
China
98,407,000
India
65,076,000
United States
24,402,000
Brazil
11,934,000
Russia
10,924,000
24%
Total Global
Expenditure
$548
Billion
(USD)
Data: International Diabetes Federation, IDF Diabetes Atlas, 6th ed. (2013)
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Projected
Case Growth
Cases are expected
to increase
55% by 2035
381
Million
(2013)
591
Million
(2035)
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