The Director of the Young Adult Clinic is
Dr. Satish Garg, MD
The past few years have been filled with progress as the Young Adult Clinic continues to strive for excellence in diabetes care and research. The Young Adult Clinic provides care for approximately 3,000 patients ages 18-75. As we are growing, we were excited to welcome Registered Dietician, Angel Johnson, RD, CDE, and Registered Nurse, Brooke Huesman, RN, CDE, to the staff this year. We are also eagerly anticipating the addition of another physician to our staff in the near future.
Diabetes education is extremely vital to the Young Adult Clinic, whether the patient is newly diagnosed or has had diabetes for over 50 years. As knowledge of Type I Diabetes expands and changes, it is our commitment that our patients share in that knowledge also. Each of our patients is seen by at least one educator before he or she sees the doctor. We have found this approach to be of utmost importance as it allows the patient to voice concerns about hypoglycemia, medications or other issues, as well as learn about improved therapies for diabetes care. On staff, we are pleased to provide access to clinical social workers, a pharmacist, as well as dieticians. These professionals educate our patients on how to effectively self manage their diabetes and to troubleshoot obstacles they may face in their health. Also, the clinic has seen tremendous success with its newly implemented educational classes featuring carbohydrate counting instruction, insulin pump training, and continuous glucose monitor training.
With the introduction of Mary Voelmle as a Nurse Practitioner, we have established a pregnancy clinic where all of our expectant mothers are carefully monitored and seen every other week. This has proven to be very beneficial to our female patients who may have anxieties about pregnancy or patients who simply know that working in tandem with an experienced staff, is the best way to a happy, healthy pregnancy.
Dr. Satish K. Garg and his research staff have been busy with several clinical research studies which include investigating inhaled insulin, continuous glucose monitoring and insulin advising software. Conducting this research has not only allowed the clinic to be a part of bringing future treatments to real life, but it has also given our patients the opportunity be active research participants. By being a part of these clinical research trials at the Barbara Davis Center, we can be certain we are offering our patients the most up-to-date education, information and technology that is available in diabetic care.
For example, research with inhaled insulin has brought new devices and methods to the clinical studies led by Dr. Garg. One of the new investigational inhaled insulin devices comes from Novo Nordisk® with their AERx® inhalation device. The AERx® system allows patients to “dial in” any whole unit amount of rapid acting insulin to be inhaled before meals. In addition to eliminating the need for an injection of rapid acting insulin, the device records the doses and times of administration, which allow research staff to more accurately track diabetes management. To facilitate with this inhaled insulin study, the YAC has become involved in pulmonary function testing, which insures patient safety on this inhaled insulin study. The two year duration of the AERx® study will yield valuable insight to the benefits as well as the safety of Novo Nordisk’s device, which has been enthusiastically embraced by patient and clinical staff.
This past year also saw the completion of a long term device study involving insulin dosing software from Roche Diagnostics installed on a convenient Palm Pilot® hand held computer (PDA). The dosing software used the patient’s insulin dose prescription combined with past insulin doses and carbohydrate intake to guide the patient for dosing insulin on a daily basis. The software program also incorporated an alarm for glucose testing. The PDA study was highly effective and useful to patients who participated in the clinical trial.
In addition, the YAC has been involved a study evaluating the Navigator FreeStyle Continuous Glucose Monitoring System. A small sensor approximately ¼” long and the width of a hair, is inserted beneath the skin of the patient’s abdomen or arm. It is connected to a transmitter which sends glucose readings to a receiver and updates every minute. In addition, the system is equipped with numerous features including alarms to alert the patient of projected highs and lows, and a diary allowing the patient to log insulin doses and other events.
Dr. Peter A. Gottlieb and his research staff are also working on some very exciting projects which include extensive work with new onset patients. One of the research models supported by Dr. Gottlieb is the idea that new medications could suppress the immune system to potentially slow or alter the progression of Type 1 diabetes. To further explore this model, Dr. Gottlieb has two TOLERX sponsored trials (The RT4 and TTEDD studies) exploring the safety and efficacy of a drug called TRX4. This drug is given in the hospital over a serious of days and the patients are then followed intensively to see how TRX4 affects their immune system and pancreas function.
In addition, the BDC supports two local islet transplant protocols developed by Dr. Gottlieb and Dr. Wiseman. Both protocols are amended versions of the Edmonton model published in the New England Journal of Medicine in 2000. Patients who are at high risk for hypoglycemic complications from their diabetes due to their inability to sense their low blood sugars are individually selected for these trials. One trial provides islet cells to patients with Type 1 diabetes, and the other to patients with Type1 diabetes who have already received a kidney transplant. After transplant, patients are put on immunosuppressant medications and closely monitored to determine changes in their blood sugar control.
We have had a very exciting few years and look forward to providing excellent care to our adults with Type I diabetes. With a highly trained staff, intensive patient education, and clinical research, it is our hope that diabetes is a disease which anyone can successfully manage.
