About Us

Welcome.

In the USC Westside Center for Diabetes, we change lives —  daily. Led by internationally respected diabetes expert Anne L. Peters, MD, we specialize in treatment of diabetes in adolescents and adults.

As part of a leading research Univesrsity and supported by our philanthropic partners, we offer:

• Intensive diabetes management for type 1 and type 2 diabetes

• Cutting-edge insulin pump therapy and continuous glucose monitoring

• Bilingual diabetes education and nutritional counseling

• Access to the latest research studies

Our involvement in cutting-edge clinical trials and technologies is changing how diabetes is treated, and our community outreach is bringing new tools to residents of underserved areas.

Anne Peters, MD

Director, USC Westside Center for Diabetes

Professor, Keck School of Medicine of USC

Director, USC Clinical Diabetes Programs

Anne L. Peters, MD, is one of the world’s leading diabetes clinicians and clinical researchers and an influential advocate and policy advisor for new diabetes treatment guidelines and increased access to care. Dr. Peters is dedicated to bringing cutting-edge diabetes care to all walks of life, including an underserved lower-literacy population.

She works with the L.A. County Department of Health Services on a county-wide diabetes program, and she established the Community Diabetes Initiatives Research Center (CDI) with Children’s Hospital Los Angeles (CHLA). Dr. Peters received the American Diabetes Association (ADA) Outstanding Physician Clinician Award and the Bernardo Houssay Award from the National Minority Quality Forum for her work with the underserved.

She earned her MD from Pritzker School of Medicine, University of Chicago, and completed an internal medicine residency at Stanford University and an endocrinology fellowship at Cedars-Sinai Medical Center.

Dr. Peters has been a Principal Investigator on multiple clinical trials, including two current grants supported by the National Institutes of Health (NIH), and several active foundation-funded grants. She also serves as special consultant to the U.S. Food & Drug Administration on the development of devices for diabetes treatment.

A sought-after speaker and thought leader, she plays a central role in developing national guidelines for diabetes care, serving on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) Guidelines Committee for Management of Type 1 Diabetes. She also participates on the ADA Guidelines Committee for Management of Type 1 Diabetes and the EASD/ADA Committee on Device Safety, and chairs the Endocrine Society Committee on the Use of Devices in Treatment of Diabetes.

Dr. Peters has authored more than 200 articles, reviews and abstracts in peer-reviewed medical journals, as well as three books on diabetes. These include the patient-centered Conquering Diabetes: A Cutting-Edge, Comprehensive Program for Prevention and Treatment and the ADA/JDRF Type 1 Diabetes Sourcebook for health professionals. On track for 2017 is The Type 1 Diabetes Self-Care Manual: A Complete Guide Across the Lifespan for People with Diabetes, Parents, and Caregivers.

In addition, Dr. Peters is a regular contributor to Medscape (the professional side of WebMD) with her video series “Peters on Diabetes.

 

Dina Block, MD

General Endocrinology,
Diabetes & Metabolism

Assistant Professor,
USC Keck School of Medicine

Dina Block, MD is an endocrinologist who treats patients with diabetes and expands our services to encompass the full range of endocrine disorders including Hashimoto's disease, Graves' disease, hyperthyroidism, and thyroid cancer. She also treats a wide variety of conditions including PCOS, prediabetes, osteoporosis, adrenal disorders, disorders of calcium metabolism, and parathyroid disease.

 

Dr. Block received her medical degree from the Sackler School of Medicine in Tel Aviv, Israel. She performed her residency in internal medicine at Mt. Sinai Beth Israel Hospital and completed her endocrinology fellowship at NYU Medical Center. She remained at NYU as an assistant professor and left to join the faculty at UCLA Medical Center in 2015.

 

She believes in "fostering an environment based on trust and communication,” where she can more effectively treat patients after “establishing a strong relationship where we tackle everything as a team."

Donna Miller, MSN, FNP-C, CDE

Nurse Practitioner/Certified Diabetes Educator

Donna Miller is dedicated to teaching her patients at the USC Westside Center for Diabetes the self-management skills they need to live successfully with diabetes. Born in Hollywood, Donna grew up in Hawthorne. Prior to joining us as Nurse Practitioner and Certified Diabetes Educator, she gained invaluable experience in heart health (and its links with diabetes). She established and managed the Congestive Heart Failure/Hypertension Center at Daniel Freeman Memorial Hospital.

Her current clinical interests include the physiology and treatment of type 1 and type 2 diabetes across the lifespan. Donna sees a wide range of patients, from pre-teens to geriatric patients and every age in between. One of her areas of expertise is working with women who have type 1 diabetes throughout their pregnancies, from pre-conception on.

“My No. 1 goal is to keep people healthy,” says Donna, “and enjoying the best possible quality of life.”

Valerie Ruelas, MSW, LCSW

Director, Community Diabetes Initiative (CDI),

Children’s Hospital Los Angeles and USC Keck School of Medicine

 

Valerie Ruelas manages research grants and projects for the Community Diabetes Initiative and the Westside Center for Diabetes. She’s an expert in community participation research, assessing local needs to reduce obesity and related chronic conditions like diabetes, primarily among low-income Latinos.

Valerie earned her Masters of Social Work at California State University, Fresno, and is a licensed clinical social worker. Prior to joining WCD, she worked at the L.A. County Department of Health Services, including for LAC+USC Medical Center, the Office of AIDS Programs and Policy and the Maternal, Child and Adolescent Health Programs.

In her community work, Valerie has helped to open a farmer’s market in Watts, teach nutrition and healthy cooking in East L.A., and develop bilingual, low-literacy educational materials about diabetes. She says, “With powerful community-based research, we can reduce obesity and diabetes and improve quality of life.”

Mark Harmel earned his Master of Public Health at the Keck School of Medicine of USC. His roles at the USC Westside Center for Diabetes are to provide diabetes education and is the  coordinatore new of research studies from at the Westside office. He also manages the ongoing TrialNet and T1D Exchange Registry and TrialNet studies.

Mark has a BA in Social Sciences (and studied photography) from Thomas Jefferson College at Grand Valley State University in Michigan, where he grew up. He started his career in 1985 as a photojournalist for newspapers and magazines and evolved to being aprofessional  healthcare photographer.

Of his work at the WCD, he says, “I get to help patients with their current diabetes management and work on research that can change policies and move the science forward to improve care.”

Mark Harmel, MPH, CDE

Certified Diabetes Educator

Research Coordinator

 

Meg Werner Moreta,

MS, RD, CDE

Registered Dietitian/Certified Diabetes Educator

 

Meg Werner Moreta has guided people toward healthy choices for more than two decades. She earned her MS in Human Nutrition at the University of New Haven and a BS in Nutritional Science from California Polytechnic State University, San Luis Obispo. She completed a Dietetic Internship at the University of Medicine and Dentistry of New Jersey.

At WCD, she is responsible for nutritional counseling, pre-pregnancy planning, behavioral therapy and insulin therapy. Meg, who grew up in Manhattan Beach, first joined the WCD staff from 2001-2005, then returned to us several years ago. She has also worked in the Cedars-Sinai Medical Center Diabetes Center and served as a nutritional consultant for TV shows, restaurants and in private practice.

“After working in a hospital environment for five years,’ she says, “I wanted to leave acute care and change direction to outpatient diabetes, where I could make a difference in people’s lives.”

Mary Rose Deraco, RN, BSN, CDE

Certified Diabetes Educator

 

Mary Rose Deraco RN, BSN, CDE is a certified diabetes educator (CDE) with 31 years of experience in the field of diabetes and she is thrilled to be back with her “family” of previous patients and colleagues at USC. She lives with her two teenage sons and is a working artist in her spare time.

A graduate of Hahnemann University in Philadelphia, PA, she recently returned to USC Westside Center for Diabetes after spending the last decade working in diabetes industry and outpatient clinical settings.

Mary Rose has a diverse background in both clinical diabetes, nutrition, fitness, medical device and pharmaceutical industry clinical education programs. She began her carrier in diabetes at Los Angeles Children’s Hospital where she worked in a special unit for children with diabetes. Early in her career, Dr. Peters hired and trained her to be a diabetes nurse specialist, she has continued to be a mentor and friend for the past 27 years.

She co-authored several publications with Dr. Peters on insulin management, algorithms for clinical care of diabetes and books on diabetes for both patients and medical providers. She went on to complete UCLA extension’s certification program for health and fitness training in order to develop expertise in coaching patients with diabetes on safe and effective fitness programs. During the early years with Dr. Peters, she developed a special interest in insulin pumps and soon the practice had the largest population of insulin pump patients in the Los Angeles basin.

 

Research and Advocacy

Academic Publications

We work on several fronts to change the future of diabetes care, from testing innovative medications and devices to developing preventive strategies that stop diabetes from developing.

Backed by the National Institutes of Health (NIH), we are a study site on the benefits of Vitamin D on diabetes prevention. In addition, we are in our 12th year in the LookAHEAD study, an Intensive Lifestyle Intervention focused on weight loss achieved through healthy eating and increased physical activity in overweight and obese individuals with type 2 diabetes. We have been able to contrubute contribute to these major national studies by enrolling residents from the Latino resident population we serve at Roybal Comprehensive Health Center in East Los Angeles.

Access  Other studies give our patients early access to new solutions. These include the T1D Exchange Network, which is testing a closed-loop insulin delivery system, along with clinical trials that are analyzing a continuous glucose monitor (CGM) in seniors and in family members without diabetes. We are one of the first centers to test the new Dexcom G6 CGM sensor, and we’re part of TrialNet, an international network exploring how type 1 diabetes can be prevented. We are also currently conducting a study on a potentially better way of using inhaled and a study using a closed-loop CGM/insulin pump system is scheduled for next year.

Advocacy   Dr. Peters is leading an effort to change the Centers for Medicare & Medicaid Services (CMS) policy for insulin pump approval for seniors and has lobbied to convince CMS to fund CGMs for seniors and people with Medicaid.

Prevention   We are committed to studying how lifestyle approaches —  diet, exercise and weight loss —  may improve long-term health outcomes. Our team conducts on-the-ground research to help whole neighborhoods become healthier, including establishing and studying the impact of farmer’s markets.

 

Dear Friends,

Slowly but surely our expansion plan is becoming realized. Dina Block, MD our newest endocrinologist is now seeing patients in the clinic for all general endocrinology, diabetes and prediabetes concerns. She also authored an overview of Hashimoto's disease in this month's newsletter.  This autoimmune condition occurs in 30-40% of our type 1 diabetes patients and Dr. Block increases our ability to treat these patients.  Next, we need to find donors to help us expand into a new space, since we are rapidly outgrowing the space we have.

We have also expanded our diabetes education offering by adding Learning Sessions. We have hosted four sessions already and have more planned for next year. If you haven't attended one yet, read more about these offerings and send your suggestions for session times and topic ideas to Mary Rose.

The major highlight in diabetes news has been the continuing announcements of the heart health and kidney benefits of medications approved for use in people with type 2 diabetes. There are early hints of benefits from a third drug in the injectable GLP-1 class of medications. More details will be released at the 2019 ADA meeting in June.

The SGLT2-inhibitor Invokana also joined Jardiance in having FDA approval for reducing cardiac and heart failure events.  In the first quarter of 2019 the FDA will hear evidence on the benefit of this class of medication, including a new agent known as an SGLT-1,2-inhibitor (sotagliflozin), in people with type 1 diabetes.

It is great to have an expanded choice in continuous glucose monitoring; the flash Abbott Libre is extending to 14-day wear and the Dexcom G6 is expected to be available for Medicare patients next year. We are even seeing TV ads for these systems. We welcome the competition in CGM devices and applaud the expansion of using these options to provide patients with much better outcomes than previously possible.

Tandem has added a predictive low glucose suspend feature to their X2 insulin pump and expects to have a software update next year to offer additional automation features. This will join the Medtronic 670G system in providing an FDA approved hybrid closed-loop option. There is active development in this field and additional systems are expected in the coming years.  Meanwhile many of our patients are not waiting for the FDA and are very successfully using their own “Do-It-Yourself” (DIY) systems.

Once again, our wonderful patients who have donated to our clinic have provided to funds to launch our own pilot research trial using a system we developed using remote daily CGM monitoring with telemedicine towards the goal of prevention hypoglycemia in our older type 1 diabetes participants. The pilot data will be used for an NIH grant application to expand the approach to a larger trial. Your continuing support allow us to self-fund this cutting-edge research and expand our community programs on the Eastside of town.

In my own professional life my claim to fame is in the world of diabetes technology.  I chair the Endocrine Society Technology Committee, the ADA Diabetes Technology Interest group, and the JDRF Provider Device Education Initiative.  I was recently asked to be a member of the ADA Professional Practice Committee, which generates all of the ADA guidelines.  At this point in my life my goal is to use any accumulated wisdom I have to help guide policy and to mentor and train young physicians to lead us forward into the future.  I am fortunate to have an amazing group of young mentees (both at CHLA and USC) who are thriving, getting grants, publishing articles, running programs and giving me hope for the future of diabetes care.

I wish for all to have a healthy, safe holiday season.  I am exceedingly lucky to have the best patients anywhere, who make all the hard work worth it.

 

Sincerely,

Anne

To read past messages from Anne, please see our archive.

 

Message from the Director

 

News of the Center

We have initiated a series of learning sessions led by Mary Rose Deraco, RN BSN CDE and a rotating cast of featured guest speakers. Some of the initial sessions were geared to our type 1 diabetes patients, and in 2018 we will offer a series of workshops for type 2 diabetes.

Our original type 1 session focused on Looking Beyond A1c to Time in Range and using a CGM to spend more time in target glucose range, this was followed by ways to eat healthier and with T1D with tips on carb-counting and insulin timing. These sessions can be repeated according to demand and we have other sessions on the way for all patients.

These sessions are small groups of 5-15 participants. Most sessions will be billed to your insurance as an education visit. The sessions are held at 9033 Wilshire, check-in and pre tests are required before the session. Registration starts 30 min prior to the session in the clinic and the session is help upstairs in the 5th floor conference room.

If you can't make the sessions, some of the content will be available on our website. A preview of the Time in Range Session was featured in the summer edition of the newsletter and this issue reports on information covered in the Vaccinations for Adults with Diabetes Learning Session.

These sessions are small groups of 5-15 participants. Most sessions will be billed to your insurance as an education visit. The sessions are held at 9033 Wilshire, check-in and pre tests are required before the session. Registration starts 30 min prior to the session in the clinic and the session is help upstairs in the 5th floor conference room. The next session Year-end Celebrations are No Diabetes Holiday will be held on Dec. 6th at 10am.

More sessions are being planned for next year and we want to hear topic suggestions from you. We also want to know the best time and days to meet. These classes are for you and we can prepare sessions based on interest. Keep an eye on our Facebook page and Twitter feed for announcements. For more information contact Mary Rose Deraco maryrose.deraco@med.usc.edu or 310-272-8204 select 0.

 

 

 

Many of our type 1 diabetes patients also have Hashimoto’s thyroiditis - which is also called Hashimoto's disease. This is another autoimmune disorder where antibodies cause inflammation of the thyroid, a small butterfly shaped gland at the base of the neck. Although small, the thyroid is quite powerful and is responsible for regulating many of our body’s functions.

About 30-40% of people with type 1 diabetes and 10-30% percent of the general population have Hashimoto’s thyroiditis. It is 7 times more likely to occur in woman than men. Over time, the inflammation from Hashimoto's disease may lead to the thyroid working less effectively, otherwise known as hypothyroidism.

Again, like type 1 diabetes, the antibodies for Hashimoto's disease can be detected many years prior to the development of hypothyroidism and annual monitoring of thyroid functions is important. This can be done with a simple blood test. Symptoms of hypothyroidism are very vague but may include fatigue, forgetfulness, weight gain, hair loss, irregular periods, and depression. Treatment for most people typically involves synthetic thyroid hormone once a day. It is usually lifelong and finding the right treatment option and dosage to help you feel your best can take some experimentation and patience.

Special care needs to be taken either during time of pregnancy, or when considering pregnancy. Close monitoring of thyroid levels during this time is important and some woman in the early stage of Hashimoto's disease may need to start replacement therapy even with normal thyroid functions.

I'm often asked, “What can I do to prevent becoming hypothyroid?” Unfortunately, there is no good answer beyond our normal advice to promote a healthy lifestyle. These include eating a health-promoting diet, with fewer processed foods, lower amounts of sugar and carbohydrates, staying physically active, getting plenty of sleep, and reducing stress in your life.

Having too little or too much thyroid hormone can lead to other complications. When I meet with a Hashimoto's patient I consider all of their symptoms, perform a thorough exam, and draw monitoring blood tests. I believe that it is important to focus on the whole person to provide excellent care for my patients.

Dina Block, MD is our new endocrinologist, you can learn more about Dr. Block in her team profile and you can schedule an appointment with her to help manage your thyroid or other endocrine condition.

By Sharon Orrange, MD, MHS, FACP

We hear a lot about vaccination shots for children, but it turns out that adults also need immunizations. People with diabetes need to pay special attention to being up-to-date because they are more likely to be infected and get complications from the flu and pneumonia. The CDC recommends that adults with diabetes should be current with five different types of vaccinations.

The most important vaccination is the annual flu shot. Since the flu virus changes from year to year it is good to get into the ritual of getting a shot in September or October. Getting a bad case of the flu can lead to a lung infection called pneumonia.

To protect against the most common cause of bacterial pneumonia, you should receive the vaccines against the pneumococcal infection that causes pneumonia. You can do this based on age. Everyone with diabetes between 19 and 64 should have the PCV13/Prevnar 13 vaccination, those who are 65 and older should have both the PCV13 and the PPSV23/Pneumovax shots. The two type of vaccinations should be taken a year apart. If you are 65 and older and don't have the pneumococcal vaccination yet, start with the PCV13 and follow it a year later with the PPSV23.

Diabetes patients also have a higher risk of getting hepatitis B due to their exposure to needles and blood. Vaccination can prevent the potential liver disease and liver cancer that can result from contracting HEP B. Vaccination for HEP B is recommended for people with diabetes who are under age 60.

There is a new, highly effective vaccine against the painful shingles for people 50 and over. The brand name is Shingrix and it requires two doses 6-months apart. Lastly there is the Tdap (tetanus, diphtheria, and pertussis) shot to protect again whooping cough. This protects both the adult and prevents the transmission to younger children.

Taking these preventative steps can help prevent the complications dealing with your diabetes during sick days and it may seem like a lot of shots, but only the flu shot is needed every year and the other are spread out over your long adult life.

Many of these vaccinations are available in the clinic as well as your primary care office. The flu and other shots are also widely available at pharmacies. Not every primary care physician is current on the vaccination needs of people with diabetes and it is hard for your diabetes doc to cover all of your diabetes concerns is a normal visit, so it is good for patients to keep a vaccination record and ask for your recommended vaccinations. For more information visit:
https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/diabetes.html

Results from using a CGM in people without diabetes

A week of CGM tracing in a person without diabetes shows glucose values clustering around 100 mg/dL with short variations above and below.

We asked for our patient's friends and family members who didn't have diabetes to wear a blinded Dexcom G6 and a Fitbit activity monitor to update our current knowledge of what glucose levels are in healthy children and adults without diabetes. The average glucose levels were less than 104 mg/dL with a peak after meals of 129 mg/dL. It was not uncommon to see glucose levels above 120 and below 70 mg/dL across all age groups but sensor values above 180 mg/dL were rarely observed except in participants who were 60 and older. Sensor levels less than 54 mg/dL were rarely seen. Glucose levels improved slightly following exercise, but not enough to be considered significant.

What does this mean for our patients with diabetes? As we start to look beyond using A1c to the amount of time spent in a target range of sensor glucose values, we learned that glucose levels either above 180 and less than 54 mg/dL were uncommon which supports using these limits of high and low glucose levels in patients with diabetes. As diabetes technology and medications develop the target range could be tightened by lower the high range from 180 to 160 mg/dL.

To hear the experience of an "almost normal" person wearing a Dexcom G6. Listen to the Podcast of our patient Craig Stubing as he lends his new G6 to a co-worker who was just diagnosed with prediabetes. It includes a Frappuccino surprise.

 

Taking a post-meal "Touch-Up Dose" Using Inhaled Insulin—
The STAT Study

The fast on and off action of inhaled insulin allowed for a post-meal "touch-up" dose if needed. Use of this technique increased the time-in-range of STAT study participants.

 

The inhaled insulin Afrezza works much faster than injected insulin and since most of glucose lowering action is finished by the end of an hour there is less concern about insulin stacking. Would it be possible to take a touch-up dose of inhaled insulin and hour or two hours after eating to reduce the post-meal spike?

The answer from the STAT Trial was yes. There were three main findings, the participants who followed the system of taking an additional dose of inhaled insulin after a post-meal spike spent an additional two hours a day in the target range between 70 - 180 mg/dL. Their post-meal excursions were also much flatter than the group who used Novolog as their fast-acting insulin. And then there was less time spent where their glucose less than 60 mg/dL. That occurred 3 minutes a day in the inhaled insulin group compared to 12 minutes a day in the Novolog group.

We were one of five study sites in this pilot trial in patients with type 1 diabetes. All the participants were using a Dexcom continuous glucose monitor that they could use to guide their treatment.

This was a short 4-week study and we discovered that there is a learning curve to using Afrezza. You have to learn how to inhale instead of injecting insulin and the dosing is different. Some participants struggled to change their eating pattern to match the 4, 8 & 12-unit dosing options but it was a great new tool for others. After the trial some wanted to stay on Afrezza, others were happy to go back to injecting and there was a third group who were interested in the occasional use of inhaled insulin for certain meals or corrections.

If you are interested in trying Afrezza, talk with your provider about the option and ask for a sample to see how it works for you.

 

Early Results from a Tele-Monitoring Study of older T1Ds

Older adults with type 1 diabetes (T1D) are still an understudied population and we know that they are more likely to have episodes of hypoglycemia than younger T1Ds. Would it be possible to monitor a group of older T1D's to see if low glucose levels could be prevented?

We conducted a short 14-week pilot study with a group of ten participants who were using a Dexcom CGM and owned a smartphone capable of transmitting data. A morning review of glucose readings from the prior day could trigger either a technical support call or an educational intervention if a hypo event was noted. Our study was funded by the money given to us by our greatly-appreciated donors.

The trial has just completed, and we are analyzing the data, but we have a few observations. Initially the challenge was simply creating a stable connection to the smartphone followed by testing ways to transmit the data with a three-hour delay. We developed an app with Tidepool that provides an automated alert dashboard to identify participants with connection or low glucose issues. Then we reach out to patients who have an alert with a telemedicine connection and follow troubleshooting protocols to help them improve their care.  The data we obtained from our pilot study is being used to apply for an NIH grant to determine if we can make a difference in a larger population. If this is true we will be the first group to show this sort of automated diabetes dashboard can improve the health of our patients.  We certainly know that remote monitoring can help people with heart disease, so why not diabetes?

 

Simple Language Pen & Pump Guides

Work continues on the simple language guides for insulin pumps and pens. They are being updated to include pediatric patients as well. Funding has been secured for additional guides to cover continuous glucose monitoring, preliminary work on those guides has begun.

This work is funded by the Helmsley Trust and the guides are geared to a fifth-grade reading level. The current guides are available now and are free to use by any individual or organization to promote diabetes education and educate patients on the use of insulin pens and pumps.

 

 

Opportunities for newer diabetes treatment suddenly expanded for our type 1 diabetes patients in East Los Angeles in 2014. After the implementation of the Affordable Care Act and the expansion of MediCal, insulin pens and pumps became available to more patients through the new coverage options these plan provided.

 

But insurance coverage wasn’t enough, there was still a barrier to learning how to use new devices because all of the training guides were written at an 11th grade reading level. For our patients in East LA to take advantage of these new tools they needed instructions that were geared to simpler 5th grade English or Spanish reading level.

 

With the help of a grant from the Leona M. and Harry B. Helmsley Charitable Trust and advice from our patient and community advisors, we were able to develop a series of simple language guides that introduced the basics of how insulin pens and pump work and described how they could improve their diabetes treatment. A second series of books provided non-branded instructions on the details of using an insulin pump.

 

To help lower the language barrier, the guides are written in a question and answer conversation format between patients and diabetes care team providers and used over 100 illustrations to break up the text. This series of guidebooks were recently recognized by the American Diabetes Association and will be distributed in their 78th Scientific Session Abstract Book as the supplement to the journal Diabetes.

 

To help lower the language barrier, the guides are written in a question and answer conversation format between patients and diabetes care team providers and used over 100 illustrations to break up the text. This series of guidebooks were recently recognized by the American Diabetes Association and were distributed in their 78th Scientific Session Abstract Book as the supplement to the journal Diabetes.

 

With future funding, we hope to add a guide about CGM, updates guides as new devices and technology are developed and create pediatric friendly versions of all guides.

 

While working with our patient and community advisors, it soon became clear that there also was a need to provide better basic type 1 diabetes care education. So, a “How Can I Manage My Type 1 Diabetes Better?” was created to give nutrition education on carb counting reading nutrition labels. Introductions on the skills on using insulin to carb ratios and insulin correction factors was also provided with tips on how to prevent lows and high glucose numbers.

 

All of the guides are free to use by any individual or organization to promote diabetes education and educate patients on the use of insulin pens and pumps.

 

The PDF versions are all open-source and freely available by clicking on the links below. They can either be printed or hosted on a website for distribution to a wider audience.

 

• How Can I Manage My Type 1 Diabetes Better?

• ¿Cómo puedo controlar mejor mi diabetes tipo 1?

 

• Is the Insulin Pen Right for Me?

• ¿La pluma de insulina es adecuada para mí?

 

• Is the Insulin Pump Right for Me?

• ¿La bomba de insulina es adecuada para mí?

 

• How Do I Use an Insulin Pump?

• ¿Cómo se usa la bomba de insulina?

 

Our Children’s Hospital Los Angeles (CHLA) partner continues to evolve the Kids N Fitness (KNF) program to meet the needs of young people at risk for or with diabetes. The CHLA staff now provides training for professionals, lay educators and licensed organizations to conduct regular KNF events. KNF has also developed new targeted lesson plans including, KNF JR. (for children 2-9), KNF for ALL (for children with developmental disabilities), Teens N Fitness (for adolescents), KNF in the camp setting and KNF Nuggets (KNF broken into 10-minute educational segments) to add to any curriculum.

 

Most KNF programs run for 6 weeks and includes parents, but the different versions of the program can be adapted to be delivered in one weekend, consecutive days, or spread out over a longer period of time.

 

The KNF staff just completed the “Teens N Fitness: Wellness Agents of Change” in Huntington Park. Funded by AltaMed, this program was delivered in partnership with the after-school program, “just keep livin” Foundation and Huntington Park Senior High. Teens N Fitness staff led students living in this low-income community through games, interactive activities and discussions that reinforced lessons about nutrition. They also stressed the connection between mental and physical health while promoting physical activity.

 

A highlight of the program was the nutrition portion that allowed students to make and eat delicious, healthy food. Goals of the program are personal change and teaching teen graduates to became agents of change by bringing messages of health and wellness to their peers.

 

 

 

Once again, we will be attending the JDRF Family Picnic to screen family members of people with type 1 diabetes to detect the early stages of T1D. Family members are 15 times more likely to develop type 1 diabetes and a simple screening test is accurate at detecting the early warning signs for developing diabetes and provide access to prevention studies.

 

This screening is performed as part of the Type 1 Diabetes TrialNet – an NIH funded research group working on Type 1 Diabetes prevention.

 

Who can be screened?

• People between the age of 1 and 45 with a parent, brother, sister, or child with T1D

• People between the age of 1 and 20 with a grandparent, aunt/uncle, cousin, niece/nephew, or half-sibling with type 1 diabetes

 

We will be doing the screening and will be available to talk about other research trials – but you can also just come out for the free family event, have fun and connect with other families with type 1 diabetes.

 

When & Where:

Sunday, July 15, from noon to 3pm.

Crystal Springs Picnic Area at Griffith Park

4659 Crystal Springs Drive, Los Angeles, CA, 90027

 

For more information contact Mark Harmel at mark.harmel@med.usc.edu or 310-646-6509.

 

As continuous glucose monitoring (CGM) becomes the new standard of care for type 1 diabetes patients, experts are focusing more on “time in (target) range” as a tool for measuring diabetes control. For most people a CGM improves the time people with diabetes spend in the target range. Target range is usually defined as between 70 - 180 mg/dL. The goal is to spend less time below 70 mg/dL or above 180 mg/dL.

Different versions of the Ambulatory Glucose Profile (AGP) are available from our meters, CGMs and insulin pumps. These reports may have the target range and show the shows the percentage of time spent in target range and time spent above and below target range.

You don’t need to be on CGM to focus on improving your time in range. People who are using blood glucose meters can see the distribution of their blood glucose readings, but not everyone on insulin needs a CGM.

AGP also give an average glucose and some measures of how much you are cycling from high to low and back again. And many of the reports show this as a cloud-like graph to help you spot the times of your day where you tend to be high or low. It can also and show the individual day to day ranges that can reveal days that might be learning experiences or worth celebrating!

The A1c is still the best validated tool for predicting outcomes. The however it can also be skewed by wide swings with periods of time in dangerously low glucose levels and can mask the existence of high glucose spikes that may be contributing to the risk of complications.

 

Looking at the individual days above, the wider glucose swings on the 17th and moderate variations on the 22nd can produce similar A1c reports although the person with the mild ups and downs in the target time in range will feel much better. This why time in range can more useful than A1c in determining day to day diabetes control.

Tips from Mary Rose Deraco RN, BSN, Certified Diabetes Educator at USC Westside Center for Diabetes, for improving your time in range:

·   Ask your diabetes practitioner for your personal target glucose range. The lowest premeal target and the highest post meal number are used to set your glucose range. Most CGM reports come with a preset range target of 70-180 but your doctor might adjust your range depending on your age and other health conditions. It is normal to hit the top number of your range up to 2 hours after eating and to return to the mid to lower levels of your range in between meals and overnight. If you are not on CGM test your 2-hour post meal glucose levels to get a better picture of your highest glucose levels after meals.

·   Stay in range as often as you can without causing additional low blood sugars. Make slow and gradual improvements such as increasing your time in range by 10% over a 1 to 2-week period of time.

·   Match your insulin peak to your carbohydrate glucose rise. Time your bolus 15-20 min prior to eating. Most rapid acting insulins work at their greatest intensity peak 60-90 min after injecting. Carbohydrates peak as sugar in the blood 15-90 minutes after eating them.

·   Know how foods effect your glucose. When you combine high fiber complex carbohydrates with vegetables, protein and fat, the glucose peak matches up better with the insulin peak for improved post meal blood sugar control. Accurate carbohydrate counting is key to keeping glucose levels in range. There are great mobile apps such as MyFitnessPal and Calorie King or use Siri to look up your carbs before dosing. Make an appointment to see the diabetes educator if you feel you need carb ratios adjusted or a review of carb counting.

·   If blousing 15-20 minutes before eating is a challenge for you, ask your practitioner if you are a candidate for Fiasp or Afrezza which are faster acting insulins that launched this year.

·   If you see up arrows 30-90 min after a meal, it is normal. If you went beyond your target range, it is most likely that your food reached the blood stream quicker than the insulin peak or you didn’t get enough insulin to match your intake. Try not to stack multiple insulin doses top of each other, it can cause hypoglycemia and knock you out of range. Ask your healthcare team when and how to safely correct highs.

·   Look at your CGM 10-20 times per day. Before meals, 2 hours after meals, when you have symptoms, before driving and during times of increased activity or stress. Make observations at first and try to change behaviors like walking after meals, administering insulin earlier and choosing more complex carbohydrates instead of changing insulin doses.

·   Learn how to use trend arrows, temporary basal rates and correction dosing. Your diabetes team will give you individualized instruction for using trend arrows.

·   Learn how to read you CGM reports. The time is range value is found in the AGP report. You can’t manage data that you don’t see, so be sure to learn how to read your data. Seeing improvements will really motivate you to focus a little bit more time on diabetes management and achieve much more “time in range”.

If you feel you need more instruction on “time in range”, CGM or advanced insulin management, Mary Rose is available for individual diabetes instruction at USC Westside Center for Diabetes contact her at Maryrose.deraco@med.usc.edu for an appointment

Mark also recorded a video of Richard Berganstal, MD, one of the creators of the AGP report at the 79th ADA Scientific Sessions. Watch our Facebook page and Twitter stream for a link to the video on Medscape to hear his tips as well.

 

We have another study for seniors with Type 1 diabetes (T1D) and one for people starting on the MiniMed 670G system.

We initiated a pilot study for Dexcom users with T1D who are 65 and older and have an iPhone. We are testing if we can create an automated daily remote monitoring system of patient's Dexcom data to see if we can identify people who might be having hypoglycemia episodes to reduce the low glucose events. Currently seniors have higher rates of hypoglycemia and low use of continuous glucose monitoring technology and the study will assess the time using the technology, measure the impact on quality of life and evaluate costs for care.

The study is called: Telemedicine Monitoring of Nocturnal Incidents of Treatment-Requiring Hypoglycemia in Older Adults with T1DM - A Feasibility Study, or "Tele-Monitor T1DM" and we are enrolling up to 10 participants now.

We also want to enroll patients who are starting on the Mini-Med 670G system to have an independent evaluation of the system and to gather insights on starting closed loop systems.

This is known as Hybrid Closed Loop Insulin Delivery System Data Collection or HYCLO and we are in active enrollment. Please contact us if you are getting ready to start on the system; we need to collect data before you start on any training on the 670G system.

Our patient's participation in studies has contributed to diabetes treatment and created major policy changes. The participants in the ReplaceBG Study help to lead the way to making insulin dosing decisions off the Dexcom, which led to Medicare approval and the new no-calibration Dexcom G6 and Freestyle Libre systems.

Your contributions are vital in giving us the support we need to conduct studies like Tele-Monitor T1dm, the community Kids-N-Fitness  or low literacy teaching guides for insulin pens, pumps and CGM devices. Please consider contributing what you can.

If you are interested in either of the trials, please contact Mark Harmel at mark.harmel@med.usc.edu or 310-646-6509.

UPDATE: My new book is now available in both print and e-book editions. I highly recommend getting the electronic version for the best reading experience.

My newest book is a consumer version of the textbook on type 1 diabetes that I wrote for health care providers several years ago and is co-authored with Pediatric Endocrinology Jamie Wood, MD. Some of you may know from her service at Children’s Hospital Los Angeles, she is now at the University Hospital Rainbow Babies and Children’s Hospital in Cleveland, Ohio.

The Type 1 Diabetes Self-Care Manual: A Complete Guide to Type 1 Diabetes Across the Lifespan is a guide for all ages, from infants to 90 year olds. We talk about childhood and adult onset diabetes, transitioning youth, exercise and nutrition, technology, and new and improved treatments. There will be an accompanying website hosted by the American Diabetes Association that will be updated as the evidence and treatments change. The site will be launching soon in conjunction with the November start of Diabetes Awareness Month and a link will be posted as soon as the site is live.

Since Jamie and I learn so much about how to live with diabetes from our patients, we wanted to share their wisdom directly with our readers from those who inspired us to get better every day. I truly have the greatest patients a doctor could ever ask for. I am grateful to all who contributed; it was truly a labor of love.

Here is a sample of the stories that are dear to my heart that you will find in the book.

All the Things I Teach My Children Because I Have Type 1 Diabetes

1. It’s not an excuse for anything. I can do anything. Except the things I can’t do because I’m not 20 anymore - like a cartwheel.

2. My children know not to distract me in the morning when I take my insulin; otherwise, I might not remember later that I took my insulin, and then I might take it accidentally twice. That was a sucky day, and I couldn’t drink enough juice to catch up.

3. You really do use math when you grow up.

4. Exercise is really the best medicine - it treats everything!

5. Health insurance is a good perk of employment.

6. Be nice to the smart kids in school. They might cure diabetes when they grow up.

Leslie Kraft, 47 is a physical therapist and mother of two.

I’m Not Diabetes!

After three years of going to camp and meeting others who don’t mind walking around with a pump connected to their waist and their site in their arm or leg, it has shown me that I don’t have to worry about what others possibly think.

Everyone with diabetes probably has something that they hate about it. Probably for me on of my biggest pet peeves is when someone comes up to me and says, “I feel so bad for you, since you have a DISEASE and have to give yourselves shots all the time.” I HATE getting defined that I have a disease! I’m not diabetes, I’m ME!

Ayla Oceanna Kanow, 13 is a competitive soccer player who has had diabetes since age 9.

There Is No Way to Be “Perfect”

Running with type 1 diabetes is always a complicated challenge. Since every run is different, your blood sugar will never act exactly the same each time. The key is knowing you won’t get it right every time and to keep checking your blood sugar to stay on top of any changes. A continuous glucose monitor makes running so much easier I can’t imagine not running without one.

For me, there is always a strong desire to eliminate as many variables as possible: waking up at the same time every day, eating the same thing for breakfast, working out at the same intensity. And while it will make parts of type 1 diabetes less complicated, you’ll never be able to eliminate all the variables and because of that, you’ll never be able to eliminate all of the high and low blood sugars. Once I realized that there was no way to be “perfect,” it let me stop feeling like that was something I had to strive towards. I could live my life the way I wanted to live it without letting type 1 diabetes dictate what I did or didn’t do.

Craig Stubing, 30 is the founder of Type One Run

 

 

UPDATE: We are starting to write prescriptions for the Freestye Libre system. The sensor will last 10-days and have a 12-hour warm-up period and are expected to cost less than existing sensors. The reader also doubles as a meter that will accept FreeStyle Precision Neo blood glucose test strips. The system will be available at many local pharmacies and insurance coverage is not expected to be available until sometime next year.

 

The Libre

The first fully fingerstick replacement sensor has been approved by the FDA in September. The Abbott Libre is expected to be available in the US by the end of the year. It was launched in Europe and for the past few years it has been hard to keep up with the demand. Patients love it, but is it right for you?

What it is?

1.  A continuous glucose sensor that is worn on the arm or abdomen.

2.  The user can see what the blood sugar level is by swiping a reader over it.

3. It is factory calibrated - NO fingersticks are required.

4.  The reader shows you a blood sugar level and whether your sugars are rising, falling or staying flat.

5.  It does NOT provide any alarms or alerts when the blood sugar is rising or falling, so the Dexcom or Medtronic sensors may be a better choice for people already on a sensor or who need alerts to low blood sugar levels.

We have experience using the blinded pro-version of the Libre and have been working with patients who have picked up the European version in their travels. For those of you not on a continuous glucose monitor or who dislike doing fingersticks this will be a wonderful option.

Want to know more? Watch the video by Dr. Peters on Medscape:

Faster Acting Insulin

The FDA recently approved Fiasp, a faster acting version of insulin aspart - or Novolog. This insulin starts working more rapidly than Humalog or Novolog, so that it better matches the absorption of food. It also wears off a little more quickly, avoiding some of the low blood sugars seen with the older insulins. It is best suited for patients who use a continuous glucose monitors and are on pre-meal injections or a pump. Although it is not yet approved for pump use, it will be available in either a pen or a vial. It will help with the frustration of being “stuck high” after eating or having to give an insulin injection 15 – 30 minutes before a meal. It can be given immediately before eating or even during the meal. It should be available in the US in January and is priced similar to Novolog.

Want to know more? Watch the video by Dr. Peters on Medscape:

 

 

 

 

 

 

 

 

Thanks to our wonderful patients and study participants, we have just completed two clinical trials. One explored a new dosing schedule when using inhaled insulin and the other tested the Dexcom G6 continuous glucose monitor in people without diabetes. We look forward to the results of the studies early next year.

But I can now share that the Dexcom G6 is an improvement that patients will love, they will appreciate the improved accuracy and once a day calibration after warm-up and a smaller transmitter. A big upgrade can also be found in the insertion device. It is a painless, one-button application that will make placement on the arm as easy as the abdomen.

Closed Loop:

We are still scheduled to host a trial of the BigFoot closed-loop system once they finish testing using the Freestyle Libre system as their sensor. We are also being considered for testing other systems as well.

Eastside:

The NIH funded trial using vitamin D to prevent type 2 diabetes is continuing, as is the development of lower literacy English and Spanish training guides for insulin pumps and CGMs.

 

 

 

 

For women with type 1 diabetes (T1D) planning a family, the best time to see your endocrinology team is before you get pregnant, not after — at least three to six months before, says Donna Miller, MSN, FNP-C, CDE, Nurse Practitioner and Certified Diabetes Educator at the Westside Center for Diabetes.

One of Donna’s specialties is working with women who have T1D throughout their pregnancies, from pre-conception on. For many years, women with T1D were advised not to get pregnant, she notes. Although it represents more challenges for women with T1D, a healthy pregnancy is entirely possible with careful preparation. “It’s important to create a plan to minimize the risk of complications and maximize the health of the mother and the baby,” says Donna.

High blood glucose at conception and throughout pregnancy can spell added dangers for the baby, including miscarriage and potential birth defects. However, these complications can largely be avoided by intensive glucose management.  “The mothers we see are able to do an amazing job at controlling their blood sugar levels in order to have a successful pregnancy.  We consider it a joy to be able to help mothers bring healthy infants into the world.”

Donna advises her patients to use a continuous glucose monitor (CGM) and insulin pump to get the most accurate, convenient monitoring and delivery of insulin. “Using these devices, the woman can make insulin decisions based on the trending blood glucose,” she says. For women who decide against CGM and a pump, Donna offers other options for managing their pregnancy.

She also works with her patients to develop a nutritional plan, critical for managing the demands of pregnancy. “In some cases, meals you’ve always eaten might not work during pregnancy because they tend to raise your glucose too high.” Exercise — walking and yoga, for example — also are important.

Each pregnancy plan is highly individualized. But one recommendation Donna makes applies to all, she says: interview your potential OB/GYN and perinatologist. “Find out their comfort level and understanding of type 1 diabetes.” The WCD maintains referral lists and can help you find one that works for you.

To begin planning for your healthy pregnancy, contact Donna at the WCD.

New developments in diabetes happen slowly, yet at this year’s annual American Diabetes Association 77th Scientific Sessions there were many glimmers of hope, particularly in the area of new technologies and medications.

Oral, faster, smarter and all-around better insulins were discussed and positive data came out on the safety of the long acting insulin known as degludec (Tresiba) in the DEVOTE Trial.

The biggest news was on the cardiovascular benefits of a medication known as canagliflozin (Invokana) which showed benefit in terms of reducing heart disease risk.  This supports the previous findings for empagliflozin (Jardiance) suggesting that all the medications in this class known as “SGLT-2 inhibitors” may have cardiovascular benefit.

Dr. Peters presented on four topics; updating the diabetes guidelines, continuous glucose monitoring safety, the new diabetes medication known as sotagliflozin (for people with both type 1 and type 2 diabetes) and the restrictive nature of current CMS rules regarding insulin pump therapy. Reporting for Medscape, Mark covered the news from the ADA and his videos can be found on-line.

Our WCD team, led by Dr. Peters, is grateful to be able to play a role in the process of advancing treatment for diabetes. We remain hopeful to develop new methods of care and establish higher levels of education for this underrepresented, life-threatening condition.

We lost one of our very special patients recently—Don Rickles —who was a beloved patient, friend and benefactor. Although he was known as an “insult” comic he was the singularly kindest man I have ever known.  Off stage, he made me laugh and always feel loved and valued.  He would, however, admonish me to “leave the jokes to him” if I joked back. I miss him very much. We send our heartfelt condolences to his family and friends. If you would like to donate in honor of Don Rickles and his memory here at WCD, please fill out the envelope and write “Don Rickles” on the in memory line. We will share your gift by sending a notification letter to his wife Barbara and family in your honor.

— Anne

 

The first version of the House ACHA health bill just stalled and the Presidential budget with major cuts in health research funding was released right before Mark made his first trip joining the American Diabetes Association’s Call to Congress lobbying event in Washington D. C. The agenda in March was filled with pressing topics from rising insulin prices to increasing concerns about insurance coverage for people with preexisting conditions, and the risk of major cuts in funding for medical research and diabetes prevention.

Attending with our patient Doris Gilbert and other ADA Los Angeles advocates, we were joined by over 180 other patient advocates and researchers from 33 states. Our LA group met with staff members from the offices of Senators Harris and Feinstein, plus Representatives Bass, Cardenas, and Barragan to ask for policy changes to prevent diabetes and to improve the lives of our patients.

A highlight happened during one of our policy talks, with a policy staffer from Rep. Cardenas’ office who seemed to be distracted by series of text messages on his phone. We shortly discovered that he was texting his girlfriend – a newly diagnosed type 1 diabetes staffer working in another office who had never met another person with T1D. Policy questions melted in face of personal concerns about living with T1D, but in the process we created two new diabetes advocates.

 

Give a Gift

MAKE A DONATION

Led by Dr. Peters, we have had a successful track record in helping to push the boundaries of diabetes care as we increase access to care through community outreach, education, telemedicine and telehealth. People with diabetes live healthier lives because of the advances in research, treatment and education.  Please join our team. Together, we will improve diabetes care and prevention now and set the stage for future breakthroughs by clicking on the Donate button to provide your tax-deductible gift.

For more information contact Valerie Ruelas: 323-361-8416 I vruelas@usc.edu.

 

Support for diabetes treatment and prevention is precarious. Funding goes disproportionately to cancer and heart disease. Yet uncontrolled diabetes is a leading cause of heart disease, stroke, kidney disease, blindness, and early death.

In Los Angeles, people in the poorest parts of town have the highest rates of diabetes, obesity and heart disease, as well as fewer doctors and a life expectancy 12 years less (73 vs. 85 years) than those in the wealthiest parts of L.A. These disparities are largely due to diabetes and its related complications.

As our philanthropic partner, you can help improve diabetes care and prevention now and set the stage for future breakthroughs. No gift is too small.

We are currently seeking support for these priority programs:

• Continued development, testing and dissemination of culturally sensitive, lower-literacy diabetes educational tools

• Innovative pilot projects in the communities of East and South L.A. aimed at reducing rates obesity and diabetes

• Development of a training program for nurses, nurse practitioners, and physician fellows to treat patients with diabetes — vitally important given a growing shortage of expert practitioners

• Research into an artificial pancreas for type 1 diabetes, which has the potential to free patients from the roller-coaster cycle of high and low blood sugar

• Advocacy work to:
1) convince health insurers (including Medicare) to pay for needed diabetes tools and treatments,
2) persuade the FDA to adopt more realistic outcome goals for developing diabetes medications, and
3) meet with Congressional Representatives to influence research and healthcare policy

“We hope that those who can afford it will pay it forward to help us in our efforts to improve outcomes for all.”  
— Anne Peters, MD

 

Make an on-line donation at: www.keck.usc.edu/donatewcd
or send a check to: USC Westside Center for Diabetes
150 N. Robertson Blvd.
Suite 210
Beverly Hills, CA 90211

Valerie Ruelas,

Program Director, 323-361-8416

Thank you for your interest and your support.

Our Funding Goals

$10,000,000

endows the program and continues

our work indefinitely

$1,500,000

trains 5 physician fellows in

diabetes over 10 years

$500,000

supports our programs for

families and youth for three years

$200,000

develops and disseminates

our type 1 diabetes tools

Donate to Diabetes Research and Receive a Fine-Art Photo as a Thank You Gift

This is a great way to support diabetes research and receive a gift of art in return. Just make a tax-deductible contribution to the USC Westside Center for Diabetes and select a thank you print from Mark Harmel’s Iceland collection.

Mark and Anne were wowed by the sights of glaciers, waterfalls and puffins on their recent trip and now you are able to share in the island’s wonders.

Just make a donation and choose which photo or set of photos you would like to add to your collection. Give more money and get a larger print, or more prints in the size you like.

Many of you know Mark either from his new roles as a diabetes educator or managing our clinical trials, while others know that he is married to Dr. Peters and was a professional photographer. He thinks photography is even better as a hobby and is pleased to share his vision to support diabetes research.

Add the USC Westside Center for Diabetes to your end of the year contribution list a get rewarded by a gift of fine art. Make you selection from the gallery and let Mark know your choice at 310-546-6509 or mark@markharmel.com

Signed, archival prints are available from 11x17” up to 60x80” and beyond. Matting and framing is not included and larger prints or custom sized prints are available upon request.

These are ink jet prints made with a state of the art Epson printer with 7-color UltraChrome inks that have a life rating of 90 years.

 

Donation $300
Signed 11"x17" (9”x13.5" image size) museum parchment print. This is a coated, textured watercolor style paper.

 

Edition limited to 20.

 

Donation $400
Signed 13"x19" (11.5”x17" image size) smooth surface.

 

Edition limited to 20.

Donation $550

Signed 21"x29" (15"x22.5" image size) printed on heavy fine art paper by the icon, a premier digital printer.

 

Edition limited to 20.

Donation $700

Signed 30"x40" (22.5"x34" image size) printed on heavy fine art paper by the icon, a premier digital printer.

 

Edition limited to 20.

Donation $1,000
Signed 60 x 70 (39.5" x 59.25" image size) printed on heavy fine art paper by the icon, a premier digital printer.

 

Edition limited to 20.

Donation $1,400
Signed 60 x 80 (48" x 72" image size printed on heavy fine art paper by the icon, a premier digital printer.

 

Edition limited to 20.

 

We want to hear from you.

If you have any questions or want to make an appointment, please use this form.
Or simply call us at 310-272-8222 or email us.

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USC Westside Center for Diabetes

9033 Wilshire Blvd., Suite 406

Beverly Hills, CA 90211

tel. 310-272-8222 ext. 0

fax. 310-272-8206

SUMMER 2018

Dear Friends,

First, I want to reassure you that our lives at the USC Diabetes Programs are not particularly impacted by all the issues facing USC. We continue to enjoy the freedom we have to pursue our research and programs in East and West Los Angeles. One of the strengths of being funded through grants and donations is that we can control what happens in our own little universe. However, if you are uncomfortable donating directly to USC please contact us for additional options.

This year the annual American Diabetes Association meeting had no major diabetes advances. But revealed many small steps in terms of improving care for people with diabetes There were plenty of details on improvements in CGMs and the movement towards closed-loop insulin pump systems. As well as updates on the safety of a wide variety of medications that we use for treating type 2 diabetes.

There was an odd statement from a researcher named Denise Faustman that she had found a cure for type 1 diabetes. Sadly, this isn’t true. But it brought a lot of media attention.

In terms of own Center, two new providers have joined/are joining our group!!!

You may have already met Mary Rose Deraco, RN, CDE who is rejoining our team to provide diabetes education for our patients. She allows us to expand our clinical services, treat more patients and ensure that there is always someone available should you need help. I encourage you to get to know her, you can start by visiting her web profile. She will be starting diabetes classes soon. If you are interested, send her an email.

On September 1 we will add Dina Block, MD, who will take care of patients with diabetes as well as all endocrine disorders. This includes thyroid disease, osteoporosis, PCOS, adrenal issues, pituitary, prediabetes, and everything else endocrine. Dr. Block received her medical degree from the Sackler School of Medicine in Tel Aviv, Israel. She continued her training in Internal Medicine at Mt. Sinai Beth Israel Hospital and completed her training as an endocrinology fellow at NYU Medical Center. She remained at NYU as an Assistant Professor before moving to UCLA in 2015. Dr. Block will be a great addition to our team and allows us to expand the range of endocrine services we can offer.

In addition to our routine in-clinic services we are working on developing a telemedicine program. In California there are entire counties without an endocrinologist. Dr. Block and Mary Rose will lead this initiative, to expand our care and make it easier for our patients to access our services.

Our research continues in both sides of town. We are continuing our STEPP-UP Project to create much-needed lower literacy teaching tools for underserved patients using diabetes devices, but still seek funding to finish our work. We are fully enrolled in the WISDM Trial (looking at the use of continuous glucose monitoring in older adults) and are starting a project known as “Tele-Monitor” on combining continuous glucose monitoring with daily evaluation from our clinic and feedback through a telemedicine process. This should create a level of safety and follow-up not currently available for patients using insulin. Your research support allows us to conduct this pilot study and use the results to apply for NIH funding to conduct a larger trial in the under researched population of seniors with type 1 diabetes.

Your support allows us to expand our staff and our research programs. Please consider making a donation so that we can do even more next year. Change may seem slow, but there continues to be steady progress for our patients. We are incredibly grateful to have you on our team to improve the care and understanding of diabetes.

P.S. We are still offering Iceland photo prints by Mark as a thank you gift for donations. Pick out your favorite one now and place an order.

 

FALL 2017

Dear Friends,

This officially marks the six-year anniversary of the USC Westside Center for Diabetes (WCD) bi-annual newsletter. If you made it this far, you know that we have made the move to publishing the newsletter on the clinic website. This also allows you to view the content from the summer newsletter and quickly find links to my Medscape videos and academic papers. Let us know how this works for you, as this is a service we provide for your benefit.

November is National Diabetes Month and it is a time to reassess one’s own diabetes status. As I reflect both on all that we have done to improve the lives of people with diabetes, as well as how far we have yet to go; I promise to not give up on pushing the envelope for research and support in this area, and I ask that you do the same. The importance of proper insulin management, overall wellness, educational programs, research studies, and adequate health coverage for this disease is what I fight for every day. I thank all of you who have donated to the cause over the years as you have gifted me the opportunity to make medical advancements in ways others cannot. Our work is far from being done; we must never give up!

We don’t have a donation envelop tucked inside of a physical newsletter, but you can still mail in a check or use a credit card to make an online donation.

I’m proud to announce the launch of my new book, The Type 1 Diabetes Self-Care Manual: A Complete Guide to Type 1 Diabetes Across the Lifespan. This is an in-depth look into the newest methods and tools for living well with Type 1 diabetes that is available for pre-ordering on Amazon and should be available on the ADA site soon as well. It may also make a great holiday gift for someone in your life living with Type 1 Diabetes or for the people who support them. We also have a preview of the book with patient stories.

The most exciting recent news is the FDA approval of the personal Libre continuous glucose monitor and Fiasp, the fastest acting insulin yet. I encourage you to read our updates (and watch the videos) on these developments to learn how they may benefit you or your loved one with diabetes.

On another note, I feel it necessary to comment on the disappointing “elephant in the room”news—the fact that the two former USC deans (Puliafito) and his replacement (Varma) were both forced to resign due to serious issues, including sexual harassment. I was not surprised by the behavior of Dr. Puliafito, but I had higher expectations of Dr. Varma. As a female, it is discouraging to see that the “old boys club” was alive and well, but I believe these events have prompted change. Our interim dean is now an eminently qualified woman, and our search for a new dean should be long and thorough. We women faculty have created a working group to help facilitate change.

I am optimistic that we will continue to advance the culture at the Keck School of Medicine of USC.  USC is still the best place in Los Angeles to develop and implement diabetes programs—we service patients from all socioeconomic situations.  Any donations I receive go directly to helping our research programs in underserved communities. I think now is the time to grow, not shrink what we’ve created over the past 17 years. In this moment of change, we may have more of a voice than ever before—After all, I am the longest serving female faculty member in the medical school. If nothing else, this shows I am persistent.

My heart is full as I enter this holiday season. I am thrilled with how much we have accomplished and I look forward to achieving more goals in 2018. I wish you and your family a big, happy, healthy and beautiful fall season.  Thank you in advance for your holiday charitable gift, it means so much!

 

SUMMER 2017

Dear Friends,

When it comes to treating, managing, and researching diabetes, my team and I are leading the movement. In the last two decades we have jumped over many hurdles to advance the quality of diabetes care and increase the availability of much needed medications, pumps and pre-screenings. Our constant and consistent commitment to this cause has undoubtedly saved many lives. The reality of this underrepresented disease is:

• Diabetes is one of the most common diseases in the US; far more so than breast and prostate cancer combined

• Early diagnosis and treatment is the key to living well with diabetes

• The majority of diabetes deaths occur in the lower and middle class communities

• Diabetes is inadequately treated in over half of the people who have it

We have been working hard to provide care to people with diabetes and gain them access to the treatments and the devices they need to live well. Trips to DC to lobby Congress and work with California state legislators and judges have yielded some benefit. However, we have much more to do, as diabetes is one of the largest health threats facing our world today.

Ongoing progress is made possible through research and education. We have multiple new research studies starting up (see box on next page), and are proud to announce that our summer camp nutrition model has been adopted by the ADA and will be piloted in 5 other cities around the country.

None of this progress would exist without your support. We depend on philanthropic gifts to fund our efforts that range from community-based interventions to complex artificial pancreas research. Donations also help provide services in underserved areas that are hardest hit by impending changes in healthcare. In addition to maintaining all of this, my goal is to fundraise a much larger gift of $1.5 million, to launch a program to train nurses and doctors to care for people with diabetes.

Fewer healthcare professionals than ever choose to train in our field of work, and the future of diabetes care is looking grim. I want future generations to have treatment available to them by training and educating professionals to mange this disease with the same care, compassion, knowledge, and respect that we do.

Please help put diabetes prevention and treatment on the map and contribute today. Your gift is tax deductable and will help in a multitude of ways. Thank you for being one of our heroes.

 

 

Mary Rose Deraco,

$10,000,000

endows the program and continues

our work indefinitely

$1,500,000

trains 5 physician fellows in

diabetes over 10 years

$500,000

supports our programs for

families and youth for three years

$200,000

develops and disseminates

our type 1 diabetes tools

You may have already met Mary Rose Deraco, RN, CDE who is rejoining our team to provide diabetes education for our patients. She allows us to expand our clinical services, treat more patients and ensure that there is always someone available should you need help. I encourage you to get to know her, you can start by visiting her web profile. She will be starting diabetes classes soon. If you are interested, send her an email.

On September 1 we will add Dina Block, MD, who will take care of patients with diabetes as well as all endocrine disorders. This includes thyroid disease, osteoporosis, PCOS, adrenal issues, pituitary, prediabetes, and everything else endocrine. Dr. Block received her medical degree from the Sackler School of Medicine in Tel Aviv, Israel. She continued her training in Internal Medicine at Mt. Sinai Beth Israel Hospital and completed her training as an endocrinology fellow at NYU Medical Center. She remained at NYU as an Assistant Professor before moving to UCLA in 2015. Dr. Block will be a great addition to our team and allows us to expand the range of endocrine services we can offer.

P.S. We are still offering Iceland photo prints by Mark as a thank you gift for donations. Pick out your favorite one now and place an order.

I’m proud to announce the launch of my new book, The Type 1 Diabetes Self-Care Manual: A Complete Guide to Type 1 Diabetes Across the Lifespan. This is an in-depth look into the newest methods and tools for living well with Type 1 diabetes that is available for pre-ordering on Amazon and should be available on the ADA site soon as well. It may also make a great holiday gift for someone in your life living with Type 1 Diabetes or for the people who support them. We also have a preview of the book with patient stories.

The most exciting recent news is the FDA approval of the personal Libre continuous glucose monitor and Fiasp, the fastest acting insulin yet. I encourage you to read our updates (and watch the videos) on these developments to learn how they may benefit you or your loved one with diabetes.

News of the Center

$10,000,000

endows the program and continues

our work indefinitely

$1,500,000

trains 5 physician fellows in

diabetes over 10 years

$500,000

supports our programs for

families and youth for three years

$200,000

develops and disseminates

our type 1 diabetes tools

Signed 11"x17" (9”x13.5" image size) museum parchment print. This is a coated, textured watercolor style paper.

Signed 60 x 70 (39.5" x 59.25" image size) printed on heavy fine art paper by the icon, a premier digital printer.

Signed 60 x 80 (48" x 72" image size printed on heavy fine art paper by the icon, a premier digital printer.

Anne Peters, MD

Director, USC Westside Center for Diabetes

Professor, Keck School of Medicine of USC

Director, USC Clinical Diabetes Programs

Anne L. Peters, MD, is one of the world’s leading diabetes clinicians and clinical researchers and an influential advocate and policy advisor for new diabetes treatment guidelines and increased access to care. Dr. Peters is dedicated to bringing cutting-edge diabetes care to all walks of life, including an underserved lower-literacy population.

She works with the L.A. County Department of Health Services on a county-wide diabetes program, and she established the Community Diabetes Initiatives Research Center (CDI) with Children’s Hospital Los Angeles (CHLA). Dr. Peters received the American Diabetes Association (ADA) Outstanding Physician Clinician Award and the Bernardo Houssay Award from the National Minority Quality Forum for her work with the underserved.

She earned her MD from Pritzker School of Medicine, University of Chicago, and completed an internal medicine residency at Stanford University and an endocrinology fellowship at Cedars-Sinai Medical Center.

Dr. Peters has been a Principal Investigator on multiple clinical trials, including two current grants supported by the National Institutes of Health (NIH), and several active foundation-funded grants. She also serves as special consultant to the U.S. Food & Drug Administration on the development of devices for diabetes treatment.

A sought-after speaker and thought leader, she plays a central role in developing national guidelines for diabetes care, serving on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) Guidelines Committee for Management of Type 1 Diabetes. She also participates on the ADA Guidelines Committee for Management of Type 1 Diabetes and the EASD/ADA Committee on Device Safety, and chairs the Endocrine Society Committee on the Use of Devices in Treatment of Diabetes.

Dr. Peters has authored more than 200 articles, reviews and abstracts in peer-reviewed medical journals, as well as three books on diabetes. These include the patient-centered Conquering Diabetes: A Cutting-Edge, Comprehensive Program for Prevention and Treatment and the ADA/JDRF Type 1 Diabetes Sourcebook for health professionals. On track for 2017 is The Type 1 Diabetes Self-Care Manual: A Complete Guide Across the Lifespan for People with Diabetes, Parents, and Caregivers.

In addition, Dr. Peters is a regular contributor to Medscape (the professional side of WebMD) with her video series “Peters on Diabetes.

 

Donna Miller, MSN, FNP-C, CDE

Nurse Practitioner/Certified Diabetes Educator

Donna Miller is dedicated to teaching her patients at the USC Westside Center for Diabetes the self-management skills they need to live successfully with diabetes. Born in Hollywood, Donna grew up in Hawthorne. Prior to joining us as Nurse Practitioner and Certified Diabetes Educator, she gained invaluable experience in heart health (and its links with diabetes). She established and managed the Congestive Heart Failure/Hypertension Center at Daniel Freeman Memorial Hospital.

Her current clinical interests include the physiology and treatment of type 1 and type 2 diabetes across the lifespan. Donna sees a wide range of patients, from pre-teens to geriatric patients and every age in between. One of her areas of expertise is working with women who have type 1 diabetes throughout their pregnancies, from pre-conception on.

“My No. 1 goal is to keep people healthy,” says Donna, “and enjoying the best possible quality of life.”

Valerie Ruelas, MSW, LCSW

Director, Community Diabetes Initiative (CDI),

Children’s Hospital Los Angeles and USC Keck School of Medicine

 

Valerie Ruelas manages research grants and projects for the Community Diabetes Initiative and the Westside Center for Diabetes. She’s an expert in community participation research, assessing local needs to reduce obesity and related chronic conditions like diabetes, primarily among low-income Latinos.

Valerie earned her Masters of Social Work at California State University, Fresno, and is a licensed clinical social worker. Prior to joining WCD, she worked at the L.A. County Department of Health Services, including for LAC+USC Medical Center, the Office of AIDS Programs and Policy and the Maternal, Child and Adolescent Health Programs.

In her community work, Valerie has helped to open a farmer’s market in Watts, teach nutrition and healthy cooking in East L.A., and develop bilingual, low-literacy educational materials about diabetes. She says, “With powerful community-based research, we can reduce obesity and diabetes and improve quality of life.”

Mark Harmel, MPH, CDE

Certified Diabetes Educator

Research Coordinator

Mark Harmel earned his Master of Public Health at the Keck School of Medicine of USC. His roles at the USC Westside Center for Diabetes are to provide diabetes education and is the  coordinatore new of research studies from at the Westside office. He also manages the ongoing TrialNet and T1D Exchange Registry and TrialNet studies.

Mark has a BA in Social Sciences (and studied photography) from Thomas Jefferson College at Grand Valley State University in Michigan, where he grew up. He started his career in 1985 as a photojournalist for newspapers and magazines and evolved to being aprofessional  healthcare photographer.

Of his work at the WCD, he says, “I get to help patients with their current diabetes management and work on research that can change policies and move the science forward to improve care.”

Meg Werner Moreta, MS, RD, CDE

Registered Dietitian/Certified Diabetes Educator

 

Meg Werner Moreta has guided people toward healthy choices for more than two decades. She earned her MS in Human Nutrition at the University of New Haven and a BS in Nutritional Science from California Polytechnic State University, San Luis Obispo. She completed a Dietetic Internship at the University of Medicine and Dentistry of New Jersey.

At WCD, she is responsible for nutritional counseling, pre-pregnancy planning, behavioral therapy and insulin therapy. Meg, who grew up in Manhattan Beach, first joined the WCD staff from 2001-2005, then returned to us several years ago. She has also worked in the Cedars-Sinai Medical Center Diabetes Center and served as a nutritional consultant for TV shows, restaurants and in private practice.

“After working in a hospital environment for five years,’ she says, “I wanted to leave acute care and change direction to outpatient diabetes, where I could make a difference in people’s lives.”

Meg Werner Moreta, MS, RD, CDE

Registered Dietitian/Certified Diabetes Educator

 

Meg Werner Moreta has guided people toward healthy choices for more than two decades. She earned her MS in Human Nutrition at the University of New Haven and a BS in Nutritional Science from California Polytechnic State University, San Luis Obispo. She completed a Dietetic Internship at the University of Medicine and Dentistry of New Jersey.

At WCD, she is responsible for nutritional counseling, pre-pregnancy planning, behavioral therapy and insulin therapy. Meg, who grew up in Manhattan Beach, first joined the WCD staff from 2001-2005, then returned to us several years ago. She has also worked in the Cedars-Sinai Medical Center Diabetes Center and served as a nutritional consultant for TV shows, restaurants and in private practice.

“After working in a hospital environment for five years,’ she says, “I wanted to leave acute care and change direction to outpatient diabetes, where I could make a difference in people’s lives.”

Mary Rose Deraco, RN, BSN, CDE

Certified Diabetes Educator

 

Mary Rose Deraco RN, BSN, CDE is a certified diabetes educator (CDE) with 31 years of experience in the field of diabetes and she is thrilled to be back with her "family" of previous patients and colleagues at USC.  She lives with her two teenage sons and is a working artist in her spare time. A graduate of Hahnemann University in Philadelphia California, she recently returned to USC Westside Center for Diabetes after spending the last decade working in diabetes industry and outpatient clinical settings.

Mary Rose has a diverse background in both clinical diabetes, nutrition, fitness, medical device and pharmaceutical industry clinical education programs. She began her carrier in diabetes at Los Angeles Children's Hospital where she worked in a special unit for children with diabetes. Early in her career, Dr. Peters hired and trained her to be a diabetes nurse specialist, she has continued to be a mentor and friend for the past 27 years.

She co-authored several publications with Dr. Peters on insulin management, algorithms for clinical care of diabetes and books on diabetes for both patients and medical providers. She went on to complete UCLA extension’s certification program for health and fitness training in order to develop expertise in coaching patients with diabetes on safe and effective fitness programs. During the early years with Dr. Peters, she developed a special interest in insulin pumps and soon the practice had the largest population of insulin pump patients in the Los Angeles basin.

In 2006, she was recruited by Medtronic Diabetes to assist in the global launch of the first sensor augmented insulin pump. As Global Education Manager, she developed and implemented education and training programs for sales professionals, patients, CDE device trainers and providers and was project lead for the first digital online insulin pump training portal. She worked for five years at Quintiles Corporation, where she covered the Los Angeles and Long Beach territory for a national diabetes education program. For the last 3 years, she has been working as an outpatient CDE at UCLA Santa Monica Diabetes Center.

What sets her aside from most experts in diabetes is her expertise and passion for the use of innovative approaches to managing diabetes using fitness, nutrition, technology and medical devices.

 

About Us

 

 

 

 

 

 

 

 

 

 

 

Welcome.

In the USC Westside Center for Diabetes, we change lives —  daily. Led by internationally respected diabetes expert Anne L. Peters, MD, we specialize in treatment of diabetes in adolescents and adults.

As part of a leading research Univesrsity and supported by our philanthropic partners, we offer:

• Intensive diabetes management for type 1 and type 2 diabetes

• Cutting-edge insulin pump therapy and continuous glucose monitoring

• Bilingual diabetes education and nutritional counseling

• Access to the latest research studies

Our involvement in cutting-edge clinical trials and technologies is changing how diabetes is treated, and our community outreach is bringing new tools to residents of underserved areas.

Message from the Director