Welcome from the Chief!

It gives me great pleasure to present you with the first issue of the Mount Sinai Diabetes Center Newsletter. The mission of the Mount Sinai Diabetes Center is to provide the highest quality care to our patients, to improve the outcomes of patients with diabetes, to be at the forefront of cutting edge research in diabetes, to train future leaders and innovators in the field of diabetes and to serve our community through outreach programs and patient advocacy. As you will see in this newsletter, we are achieving success on all fronts. Our clinical program continues to grow and the number of patients we serve is increasing every year. Our recent research breakthroughs in areas such as beta cell regeneration, brain control of metabolism, and an artificial pancreas are leading the way to improving care and hopefully finding cures for diabetes, both type 1 and type 2. We have providers that provide outreach to our community with education, free seminars, and we continue to advocate for more government programs to stem the diabetes epidemic, such as our recently published op-ed advocating for a sugar tax. I hope you enjoy learning about our activities as you read this newsletter. We welcome any comments, suggestions, or questions.

Yaron Tomer, MD, FACP, FACE

Lillian and Henry M. Stratton Professor of Molecular Medicine

Chief, Division of Endocrinology, Diabetes and Bone Disease

Icahn School of Medicine at Mount Sinai

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Research Highlights from the Diabetes Obesity and Metabolism Institute (DOMI)

• Dr.Andrew Stewart, MD, the Irene and Dr. Arthur M. Fishberg Professor of Medicine and Director of Mount Sinai’s Diabetes, Obesity and Metabolism Institute led a team of scientists who discovered a novel mechanism that regulates the replication of insulin-producing beta cells in the pancreas. Their findings provide novel working models describing the control of cell cycle progression in the human beta cell. These discoveries offer new insights into possible therapeutic approaches to stimulate the regeneration of pancreatic beta cells in patients with type 1 and type 2 diabetes. To find out more about this discovery, click here.

• In a study published in Cell Metabolism, Christoph Buettner, MD, PhD, Associate Professor of Medicine, and Neuroscience and colleagues recently  reported that that impairment in insulin action in the brain may be one of the earliest defects that occurs in obese patients who eventually develop diabetes. To find out more about this discovery, click here.

• In a study published in the Journal of Autoimmunity, Dr. Yaron Tomer (Chief of the Division of Endocrinology, Diabetes and Bone Disease) and colleagues recently reported that epigenetic changes, which are changes in the way genes work when they are not mutated, play a key role in the development of type 1 diabetes. To find out more about this discovery, click here.

Diabetes Clinical Research Corner Update

Mount Sinai is dedicated to diabetes research.  Below are research studies that are currently underway, recruiting, or completed.  If you are interested in becoming a research volunteer reach out to Camilla Levister, NP at 212-241-5177 or our research coordinator at 212 241-9089:

• PERL (Prevention of Early Renal Loss in Diabetes): This is an exciting and landmark National Institutes of Health-sponsored study to explore if a pill that has commonly been used for other conditions can prevent the progression of kidney damage caused by type 1 diabetes.  .   Recruitment ends October 31^st.You can learn more by going to www.perl-study.org

• Artificial Pancreas Program:  If you are interested in participating in future Artificial Pancreas Studies, contact Camilla Levister, NP at 212-241-5177.

• TrialNet, Pathway to Prevention:  This is a study jointly funded by ADA, JDRF, NIDDK and others, being conducted at 18 Clinical Centers in 8 countries and studies those at increased risk for type 1 diabetes.  If you are 1-45 years old and the 1^st degree relative of a person with type 1 diabetes, you may be eligible to participate.  Second degree relatives (cousins, uncles, nieces, nephews, half siblings, or grandparents) of someone with type 1 diabetes between the ages of 1 and 20 years old may also be eligible.  This study is currently recruiting.  Contact our research coordinator for further information at 212 241-9089.

• Victoza (liraglutide) use in type 1 diabetes:  This study explored the efficacy of liraglutide in patients with type 1 diabetes in improving glycemic control, reducing total daily insulin requirements, and body weight loss.  This study is currently completed and we look forward to hearing about the results when the data from all sites is fully analyzed. 

• Faster acting insulin aspart (FIAsp):  This study is currently completed.  FIAsp is a new and faster formation of insulin aspart, a type of rapid acting insulin.  This trial explored the efficacy of FIAsp in diabetes management as measured by hemoglobin A1c and finger stick glucose values after meals.  We look forward to the results of data analysis for this multisite study. 

• Sotogaflozin use in type 1 diabetes: This is a study assessing the benefits of an SGLT 1/SGLT 2 inhibitor as adjunctive therapy in the management of type 1 diabetes; this study will likely be opening mid September 2015. 

Additional studies will soon be starting for type 1 and type 2 diabetes.  Please call 212 241-5177 or 212 241-9089 if you would like to additional information regarding current or  upcoming studies.

Artificial Pancreas Research Program

In a pioneering clinical study, Dr. Carol Levy and colleagues are examining whether an artificial pancreas (AP) can prevent blood sugar levels that are too low (hypoglycemia) from occurring in patients with type 1 diabetes (T1D) as they sleep. Nighttime hypoglycemia can cause seizures and coma or even death in rare cases, among the more than three million Americans with type 1 diabetes, making an artificial pancreas system potentially life altering for those living with diabetes.

This outpatient AP trial at Mount Sinai is the result of collaboration between Mount Sinai, the University of Virginia (UVA) and Mayo Clinic, and represents the first of its kind in New York City. The study began enrollment in October 2014 with a group of ten patients and measures the ability of an automated artificial pancreas (AP) system, developed by UVA, to normalize nighttime sugar levels in T1D patients (known as the Diabetes Assistant or DiA). By combining a smart phone app with a unique algorithm to help control blood sugar levels, a glucose sensor and an insulin pump, the AP system is designed to maintain sugar levels without requiring patients to frequently test their blood sugar levels or inject insulin themselves.

Mount Sinai Researchers Identify Drug with Potential to Drive Beta Cell Proliferation

In a screen of more than 100,000 potential drugs, only one, harmine, drove human insulin-producing beta cells to multiply, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai, published in Nature Medicine. Diabetes results from too few insulin-producing “beta cells” in the pancreas. Insulin is the hormone required to keep blood sugar levels in the normal range.  In a groundbreaking Mount Sinai study, researchers found that harmine drove the sustained division and multiplication of adult human beta cells in culture, a feat that had eluded the field for years.

Diabetes Education Classes - Class is now in session!

Free diabetes classes are now taking place at the Mount Sinai Diabetes Center! The first series of classes are open to those with pre-diabetes, Type 2 diabetes, and Type 1 diabetes.  Certified Diabetes Educators will lead classes covering the basics such as nutrition, carbohydrate counting, medications, and exercise.  Classes will meet at the Mount Sinai Diabetes Center at 5 East 98^th Street, 3^rd floor conference room.  For additional information, class schedule, and registration call 212-241-5177 or email Camilla.Levister@mssm.edu.

This post was written by Camilla Levister, NP, CDE, a Certified Adult Nurse Practitioner and Certified Diabetes Educator who has experience as an insulin pump and continuous glucose monitor trainer.  Ms. Levister is a co-investigator for several research studies in diabetes taking place at the Mount Sinai Diabetes Center.

Question Corner: Sharps Disposal

Dear Question Corner: How do I dispose of lancets and syringes used for my diabetes care?

Dear Patient: 

Many patients ask me what they should do with their used sharps. First, let’s discuss what the term “sharps” means. Needles, lancets, syringes, and insulin pens are considered sharps and must be disposed of properly. Needles, syringes and lancets are intended for one time use. Once used, they still contain blood that can infect another person; this why it is so important to dispose of them properly.

            Sharps disposal containers can be purchased at your local pharmacy. You can also your own sharps container using a thick plastic, puncture proof container with a twist-top (such as:  a detergent or shampoo bottle). Once filled, tape it closed and clearly mark it “CONTAINS SHARPS.”

            Disposal laws are different in every region, so check with your local sanitation laws. New York City Department of Sanitation allows you to throw the sealed and marked container in the garbage. DO NOT RECYCLE.

            You can also bring your container to any hospital or nursing home in New York State for disposal.

            For more information, click on these links:  

• NYC Department of Sanitation - Household medical Waste
• New York State Dept. Of Health - Safe Sharps Disposal
• Diabetes Forecast - Making your own sharps container
• Diabetes Forecast -  How to trash your sharps

This post was written by Cara Blackhall, BSN, RN, CDE, who is certified by the American Nurses Credentialing Center in Medical-Surgical Nursing and is a Certified Diabetes Educator. Ms. Blackhall specializes in educating patients on lifestyle and health management, diabetes medication administration and use, insulin infusion pumps, and continuous glucose monitoring at the Mount Sinai Diabetes Center.

Recipe Corner: A friend of mine has diabetes and is coming over for dinner, can you suggest a salad we’ll all enjoy?

Grilled Chicken Salad with Strawberry Vinaigrette

This recipe is low carb and tastes great for a wonderful summer lunch.  

Serves 4

Ingredients: 

• 1/2 shallot, finely chopped
• 2 tablespoons raspberry or champagne vinegar
• 2 tablespoons extra-virgin olive oil
• 8 ounces baby spinach
• 1 cup strawberries, thinly sliced
• 1/2 cup almonds, toasted and chopped
• 2 ounces fresh goat cheese, crumbled
• 1 lb grilled chicken breast, sliced

Directions:

In a large bowl, whisk together shallot and vinegar. While whisking constantly, drizzle in oil to make a vinaigrette. Add spinach, sliced grilled chicken, strawberries, almonds and goat cheese and gently toss to combine. Serve immediately.

Nutritional Info: 

Per Serving (includes 4 oz. grilled chicken): 290 calories (120 from fat), 14g total fat, 3.5g saturated fat, 5mg cholesterol, 140mg sodium, 11g carbohydrate (4g dietary fiber, 2g sugar), 32g protein

This post was written by Shelley Wishnick RD, CDN, CDE, a registered dietitian with the Academy of Nutrition and Dietetics, a NYS Certified Nutritionist, and Certified Diabetes Educator with the National Certification Board for Diabetes Educators who provides counseling to those with type 1, type 2, pre-diabetes and gestational diabetes at the Mount Sinai Diabetes Center.