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Clinical Briefing: Improving Glycemic Control - Comprehensive Diabetes Management

January/February 2008

The Penn Rodebaugh Diabetes Center at the Hospital of the University of Pennsylvania is a state-of-the-art facility dedicated to the treatment and prevention of diabetes. The Center, unique to the Philadelphia region, provides comprehensive care exclusively for patients with diabetes, pre-diabetes and other endocrine problems. As part of a world-class academic medical center, its patients have access to a multidisciplinary team of diabetes specialists and endocrinologists using advanced clinical therapies and the latest research.

Case Study
A.B., a 42-year-old male, has a 20-year history of type 1 diabetes complicated by neuropathy, microalbuminuria, retinopathy and persistent elevated glycosylated hemoglobin (HbA1c). His insulin regimen included twice daily injections of NPH and regular insulin. His physician referred him to the Penn Rodebaugh Diabetes Center for insulin pump therapy evaluation.

On initial assessment, downloaded data from the patient’s home glucose monitor revealed a one-month blood glucose testing average of 1.4 tests per day. Values indicated frequent hypoglycemic episodes; his HbA1c was 9.0.

The team determined A.B. needed to achieve improved control before starting pump therapy. He attended Rodebaugh’s Diabetes Self-Management course. The counseling session enabled him to more accurately predict his mealtime insulin needs by using an insulin-to-carbohydrate ratio and an insulin correction factor for elevated preprandial glucoses. He was switched to basal/bolus therapy, which entails a once daily basal insulin and rapid-acting insulin with meals.

After 4 weeks, his HbA1c improved marginally to 8.5. He was still not regularly monitoring his blood glucose, which hampered his ability to determine his insulin needs. Nevertheless, A.B. was encouraged by his minor improvement. He committed to the center’s recommendation of four blood glucose checks per day and was placed on insulin pump therapy. The center’s certified nurse practitioner, who manages the insulin pump therapy program, helped him select a suitable pump and provided detailed training on its use.

A.B.’s HbA1c improved to 8.1 six weeks later, but reached a plateau after three months. Infrequent blood glucose testing was again identified and therefore, continuous glucose monitoring (CGM) was recommended. CGM traces interstitial glucose sampled from under the skin of the abdomen and provides real-time glucose levels every five minutes. The device alarms when hypo- and hyperglycemic events occur. After two months of CGM, A.B’s HbA1c improved to 6.7 percent with no hypoglycemic events. He reports “feeling like a new man” and continues follow-up at three-month intervals.

Our Team of Faculty
The Penn Rodebaugh Diabetes Center team includes endocrinologists, advanced practice nurses, certified diabetes educators, nutritionists and a podiatrist all in one location. Our approach, as well as our standing as a predominant research center, enables us to provide patients with the latest pharmacologic therapy as well as other treatments and technology to deal with diabetes and its effects.

Medical Director

Mark H. Schutta, MD
Assistant Professor of Medicine

Diabetes

Seth Braunstein, MD, PhD
Associate Professor of Medicine

Carrie Burns, MD
Assistant Professor of Medicine

Serena Cardillo, MD
Assistant Professor of Clinical Medicine

Nayyar Iqbal, MD
Assistant Professor of Medicine

Vanessa Rein, MD
Assistant Professor of Medicine

Michael Rickels, MD
Assistant Professor of Medicine

Kia Morley Mellon, MSN, CRNP
Insulin Pump Program Coordinator

Barry G. Wolff, DPM

Diabetes Education

Kim Olson, RN, MSN, CNS
Frances Love, MSN, APRN, CDE, BC-ADM

Joan Metzner, RD, CDE, LDN
Linda Sartor, RD, MA, CDE, LDN

	Referring Physicians: To speak with a Penn physician or refer a patient, contact PennHealth through the secure online referral form or by calling 1-800-789-PENN (7366).