Rita Louard, MD, FACE
Joel Zonszein, MD
The Bronx is a unique borough, with a younger-than-average, economically poor, predominantly Black and Latino immigrant-intensive population. Nearly 12% of Bronx adult residents are affected by diabetes.
Albert Einstein College of Medicine and Montefiore Medical Center have targeted diabetes as a priority disease for strategic resources development. The Einstein Diabetes Research Center (DRC) and the Montefiore Clinical Diabetes Center (CDC), both established in 1977, have collaborated seamlessly to develop numerous successful community-centered diabetes management programs.
The DRC, established by the Diabetes Research and Education Act, is one of six centers supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Known throughout the world for its landmark studies on health disparities, the DRC collaborates with the Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities (Bronx CREED) and the Hispanic Center of Excellence to develop innovative approaches to advance diabetes care through education, professional training, and community outreach. The Montefiore CDC, one of New York City’s leading integrated diabetes treatment programs, is staffed by endocrinologists, registered nurses, and registered dietitians, all of whom are certified diabetes educators. The CDC strives to implement innovative methods to support patients with type 2 diabetes who are mainly treated by primary care physicians.
Collaborative Clinical Studies
Recently, the DRC and CDC have collaborated on a number of innovative diabetes clinical research studies, including the following:
- HbA1c Patient Registry
In partnership with the New York City Department of Health and Mental Hygiene and funded by a NIH grant, the DRC is currently developing a registry of patients who have undergone HbA1c (a test that measures glycated hemoglobin in the blood), and requiring all major laboratories to electronically report HbA1c results. Information from the registry will be used to evaluate the effectiveness of a patient-centered, bilingual telephone intervention study in which health educators regularly call patients with medication prompts and doctor visit reminders. This project will inform public health policies and practices in New York City and urban areas nationwide.
- BARI 2D
Montefiore was one of the major recruitment centers in the recently completed international Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D), a program that studied whether initial treatment with angioplasty or bypass surgery is better than initial treatment with a medical program for patients with type 2 diabetes. BARI 2D also compared two approaches to control blood sugar: insulin-stimulating medication vs. medication that sensitizes the body to the available insulin.
The study, sponsored by the NIH National Heart Lung and Blood Institute (NHLBI) attempted to elucidate best practices in the care of patients with type 2 diabetes and concomitant stable coronary artery disease. The outcomes will be released to the media in June 2009 during the American Diabetes Association National Meeting in New Orleans.
One of the CDC's initiatives, the Proactive Managed Intervention System for Education in Diabetes (PROMISED), serves more than 300 high-risk patients each year through group workshops on patient empowerment, diabetes self-management, and individual multidisciplinary consultative reports emphasizing cardiovascular disease outcomes. Over the past 5 years, Montefiore has successfully implemented successful diabetes management and care programs at each of its federally funded health centers.
Einstein-Montefiore recently received a National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA), joining an elite group of 38 academic health centers across the nation. The CTSA provides resources for clinical and research teams to refocus existing collaborative diabetes programs; further unifies Einstein and Montefiore in diabetes research; and strengthens partnerships with extramural institutions including the NYC Department of Health and its Bronx District Public Health Office, the NYC Health and Hospitals Corporation, and regional colleges and universities.
On every level, Einstein and Montefiore have opened the door to improve primary prevention and promotion, strengthen early and aggressive intervention, and expand leading-edge research and clinical treatment programs to control the diabetes epidemic throughout the Bronx, the nation, and the world.