Division of EndocrinologyProgress Report 2007

Beth Israel Division of Endocrinology • Progress Report 2007 page 2

Table of Contents

Letter to Friedman Foundation page 3

Divisional Activities:

- Friedman Diabetes Institute page 4

- Other Clinical, Educational and Research Activites page 6

Copies of manuscripts and publications are available upon request.

Beth Israel Division of Endocrinology • Progress Report 2007 page 3

April 2008

Ms. Jane FriedmanPresidentGerald J. & Dorothy R. Friedman New York Foundation for Medical ResearchPaul, Weiss, Rifkind, Wharton & Garrison LLP1285 Avenue of the AmericasNew York, NY 10019

Dear Ms. Friedman:

Enclosed please find the 2007 progress report for the Friedman Diabetes Institute and the Division of Endocrinology at Beth Israel Medical Center. The following is a brief summary of our “focal points” in the past year.

• Opening of the Gerald J. Friedman Diabetes Institute on 11/14/07 (1st World Diabetes Day)

• Received American Diabetes Association (ADA) Recognition on 12/26/07.

• The clinical encounter volume in the division has continued to grow.

• Our fellowship program remains fully accredited by the Accreditation Council for Graduate Medi-cal Education for the longest possible cycle – 6 years (through 2009). The Fellows’ Board passing rate continued to be 100% during the seven years.

• Our research projects are progressing successfully. All residents rotating in the division express their excitement about the level of science in the laboratory directed by Dr. Seto-Young. Enclosed is a list of publications and research projects.

We thank you for your support and are very excited about the opening of the Gerald J. Friedman Diabetes Institute.

Sincerely,

Leonid Poretsky Leonid Poretsky, MD

cc:Lawrence S. Huntington, Chairman, Board of Trustees, Continuum Health PartnersStanley Brezenoff, President and Chief Executive Officer, Continuum Health PartnersDavid Shulkin, President and Chief Executive Officer, Beth Israel Medical CenterHenry Bodenheimer, MD, Interim Chairman, Department of Medicine, Beth Israel Medical CenterMs. Mary DeBare, Member, Board of Trustees, Continuum Health PartnersMr. Richard Netter, Member, Board of Trustees, Continuum Health PartnersMs. Andrea HalbrookMr. Jeffrey SorefDeborah Visconi, Sr. Vice President, Operations, Beth Israel Medical CenterKathy McGovern, Sr. Vice President, Development and External Affairs, Continuum Health PartnersPatricia Balsamini, Vice President, Development Department, Continuum Health PartnersSarah Berkson, Administrator – Department of Medicine, Beth Israel Medical CenterJack J. O’Neil, Esq., Partner, Paul, Weiss, Rifkind, Wharton & Garrison LLP

• Officially opened: November 14, 2007

The First World Diabetes Day sponsored by the UN

• Visits in 2007: 1247

• ADA Recognition: Received December 26, 2007

• Electronic Data Base “Clinipro” initiated: November 19, 2007

Adult Program

Providing diabetes education to adults with diabetes. Working in collaboration with the patient’s primary care physician.• Daily individual sessions • Weekly classes available• Monthly support groups for people with type 1 and

type 2 DM

Pediatric Program

• Curriculum developed• Series of lectures for FDI providers started –

Dr. Gabrielle Grinstein• Presentations by CDEs specialized in pediatrics• Topics include:

• Medications and insulin usage in pediatrics.• Meters and insulin administration in pediatrics.• Growth and development issues with school age

and adolescents.• Psychosocial support for parents and kids.• BS goals and A1C goals in pediatrics.• Complications associated with diabetes in

pediatrics.• DKA/Sick day guidelines.• Nutrition and exercise.• Insulin pump-Minimed, Animas• Luxura pen or other pens and devices used in pedi-

atrics.

High Risk OB/GYN Program

• Providing diabetes education to pregnant women with diabetes

• Precept OB/GYN residents (Diabetes Education)

Insulin Pump Program

• Resources for people with diabetes interested in insulin pump therapy

• Weekly sessions on advanced pump features with the pump trainers (MiniMed)

• FDI Certified Diabetes Educators (CDEs) became certi-fied pump trainers (Omni-Pod, Animas)

Karpas Community Program

Community outreach program in collaboration with the Karpas Health Information Center.

• Series of lectures: Nov.6 - “Treating Pre-Diabetes” – Agustin Busta, MD

• Nov. 13– “Taking Charge of your Type 2 Diabetes” – Marina Krymskaya, NP, CDE

• Nov. 20– “Eating and Exercising for People with Diabetes” – Rosalia Doyle, RD, CDE

• “BI Cares for You!” Wellness programs for BIMC employees - Monique Welbeck, NP, William Craig, RD

• Howl Festival – Sept. 8-9 – FDI Staff

Deaf Community Program

• Individual and group diabetes education for the deaf (on-going)

• Developing culturally sensitive educational and didac-tic materials

• Grant from NYEEI

• Meeting with the deaf artist at the end of March to develop educational booklets (on-going development)

• Collaborating with the Gallaudet University - the world leader in liberal education and career development for deaf and hard-of-hearing undergraduate students

Beth Israel Division of Endocrinology • Progress Report 2007 page 4

Gerald J. Friedman Diabetes Institute

“Energy Up!” Wellness Program

• Bi-weekly sessions for patients and FDI staff• Weekly lectures for patients• “Diva-betic” meetings• School program in collaboration with FDI outreach

team - providing nutrition, wellness, diabetes aware-ness/prevention presentations to the school popula-tion, and the parents.

Friedman Diabetes Institute Website

www.friedmandiabetesinstitute.com

At the website you will find diabetes related information for:

• Families/Caregivers

• Kids/Teens

• Deaf/Hard of Hearing

• People with Diabetes

• Professionals

• Clinical Study Participants

Interactive Diabetes Education Website in Development

Beth Israel Division of Endocrinology • Progress Report 2007 page 5

Five Borough Outreach Program

Brooklyn• BI at Kings Highway: Provide diabetes education to

patients and staff

Staten Island• Jewish Community Center: community diabetes

education

Bronx• In collaboration with the New York City Department of

Health (NYDOH); finalizing list of practice site/clinics to provide diabetes education

• Young Women’s Leadership Schools in South Bronx: Provide Diabetes Management/Prevention education

Manhattan• NYU Geriatric Education Center: diabetes education

for health care professionals• Green Markets at Union Square, Washington Heights

and Poe Park, Bronx: Provide diabetes awareness to public

• Young Women’s Leadership Schools in East Harlem: Provide Diabetes Management/Prevention education

Queens• Queens/South Asian Action For Diabetes Education

Programs And Treatment: Funded by the New York State Health Foundation to provide diabetes educa-tion to the South Asian Community and primary care providers.

Beth Israel Division of Endocrinology • Progress Report 2007 page 6

Clinical•Educational•Research•

Clinical Activities

Inpatient and outpatient consultations and ongoing • patient care within the Faculty Practice PlanDiabetes Clinic• Endocrine Clinic• Insulin Pump Program• Diabetes in Cardiac Surgery Program• Diabetes in Pregnancy Program• Diabetes Clinic - New York Downtown Hospital• Thyroid Clinic - New York Eye and Ear Infirmary• Endocrinology Clinic - HIP Center at East 23rd Street• Opened Gerald J. Friedman Diabetes Institute•

Clinical Encounters (FPP only)

17347170601680215704

2976

6014

12504

2000

Years 2000-06 are FPP encounters only.

2001 2002 2003 2004 2005 2006

22109

18267

2007Year

Vis

its

24000

22000

20000

18000

16000

14000

12000

10000

8000

6000

4000

2000

0

2007 FPP: 18267 Total: 22109 Includes GJ Friedman (1247), Clinics (1863) and Off site (732) volume in addition to FPP (18267)

FPP Collections ($)

$1,167,828

$994,758

$208,656

$801,773$722,376

$342,672

$926,562

$1,400,000

$1,200,000

$1,000,000

$800,000

$600,000

$400,000

$200,000

$02000 2001 2002 2003 2004 2005 2006

$1,308,642

2006

Year

Educational Activities

Patients • Gerald J. Friedman Diabetes Institute opened in

Spring of 2007• pump support group• individual patient education• groups for deaf patients

Physicians• 2 conferences per week

Medical Students• clinical and research rotations

Fellowship Program• from “warning” status to full accreditation; next site

visit in 2009• presentations at National Meetings by the fellows (11

in 2007)• boards passing rate increased from 33% to 100% for

the last 7 years• first PhD dissertation defended successfully by PhD

exchange student Dimiter Avstanki

House Staff• research rotation• clinical rotation• co-author abstracts and presentations• journal club

Research Programs

• Administration of Vitamin D Analog to new onset Type 1 Diabetes Mellitus patients to restore Pancreatic Beta Cell Function. PI – Dr. Agustin Busta

• A Randomized, Double Blind, Parallel-Group, Multi-center, Multinational Study to Assess Glycemic Control with Rimonabant in Comparison with Glimepiride over 1 Year in Overweight/Obese Type 2 Diabetes Patients Not Adequately Controlled with metformin. PI – Dr. Agustin Busta

• Vitamin D Supplementation in Patients with Type 2 Diabetes and Vitamin D Deficiency. PI – Dr. Emilia P. Liao

• Paracalcitol in Patients with Type 2 Diabetes, Chronic Kidney Disease and Vitamin D Deficiency. PI – Dr. Emilia P. Liao

• A pilot randomized controlled trial to evaluate the ef-fects of education programs, including an interactive web site, on clinical outcomes in patients with diabe-tes. PI –Dr. Leonid Poretsky

Other Divisional Activities

Research Programs continued

• Receptor Mechanisms of Insulin and Insulin-Like Growth Factors (IGF) action in Human Ovary. PIs – Dr. Leonid Poretsky & Dr. Donna Seto-Young

• Role of Thiazolidinediones in the Human Ovary. PIs – Dr. Leonid Poretsky and Dr. Donna Seto-Young

• Role of Vitamin D in the Human Ovary. PI – Dr. Donna Seto-Young

• Queens/South Asian Action For Diabetes Education Programs And Treatment: Funded by the New York State Health Foundation. PI – Dr. Leonid Poretsky

• Comparison of the therapeutic effects of oral medica-tions in women with polycystic ovary syndrome. PI – Dr. Alina Gouller

• Role of pramlintide in patients with polycystic ovary syndrome. PI – Dr. Leonid Poretsky

Research FundingNote: Philanthropic Gifts from the Gerald J. and Dorothy Friedman Foundation support endowed chair and research in the Division of Endocrinology Research Laboratory.

$1,258,355

$24,201

$557,677$623,000

$522,000

$1,005,627

2000 2001 2002 2003 2004 2005 2006

$1,775,340

2006

$1,790,529

2007

Year

$1,800,000

$1,600,000

$1,400,000

$1,200,000

$1,000,000

$800,000

$600,000

$400,000

$200,000

$0

Sources of Funding

Gerald J. Friedman FoundationAbbot LaboratoriesAventis PharmaceuticalNational Istitutes of HealthHolbrook Family FoundationMr. Morgan MillerMr. Jeffrey SoreffMs. Mary DeBareChinese American Medical Association

Thanks to Scandinavia FoundationNew York State Department of HealthGlaxo SmithKline, Inc.Novo-Nordisk, Inc.Eli Lilly and CompanyPfizer – BIASP NovologGenzyme CorporationThe Children Hearing Institute

Research Funding, continued

Current Research Funds • Endocrinology Basic Science Lab Research Fund• ADOPT Research Fund• The Gerald J. Friedman Chair in Endocrinology Fund• Gerald J. Friedman Diabetes Institute Fund• Empire Clinical Research Fund• Rosiglitazone in Diabetes Fund• Clinical Trials – Liao IIS Fund• Lantus Plus Apidra MDI Versus Premixed Insulin Fund• New York Health Foundation

Original Peer-Reviewed Publications: 2007

• Seto-Young D, Avtanski D, Strizhevsky M, Parikh G, Patel P, Kaplun J, Holcomb K, Rosenwaks Z, Poretsky L. Interactions among peroxisome proliferator activat-ed receptor-g, insulin signaling pathways, and sterodo-genic acute regulatory protein in human ovarian cells. J Clin Endocrinol Metab 92:2232-2239, 2007.

• Martinez R, Poretsky L. Case study. Insulin 2:144-145, 2007.

• Martinez R, Poretsky L. Case study response. Insulin 2:190-191, 2007.

• Avgerinos DV, Leitman IM, Martinez RE, Liao EP. Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass surgery. J Am Coll Surg 205: 294-297, 2007.

• Rossman J, Bravo-Vera R, Sheikh A, Gouller A. Ra-diofrequency ablation of matastatic insulinoma in pa-tients with coexisting a snchronous nesideioblastosis. J. Endocrinol Invest 30:521-524, 2007

• Poretsky L, Song L, Brillon DJ, Ferrando S, Chiu J, McElhiney M, Ferenczi A, Sison C, Haller I, Rabkin J. Metabolic and hormonal effects of oral DHEA in pre-menopausal women with HIV infection. Hormone and Metabolic Research, submitted 2007.

• Seto-Young D, Avtanski D, Parikh G, Strizhevsky M, Rosenwaks Z, Poretsky L. Thiazolidinediones inhibit aromatase activity in human granulosa cell by interfer-ing with androgen binding to aromatase. Manuscript in preparation.

Beth Israel Division of Endocrinology • Progress Report 2007 page 7

• Gurevich Y, Poretsky L. Can pamidronate prevent hungry bone syndrome after parathyroidectomy? 16th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists, Abstract #393, Seattle, WA, April 11-15, 2007.

• Avtanski DB, Strizhevsky M, Parikh G, Araki T, Rosen O, Demetri C, Goldman M, Cadaq S, Rosenwaks Z, Poretsky L, Seto-Young D. The effect of thiazolidin-ediones on estrogen production in human granulose cells. 89th Annual Meeting of the Endocrine Society, P1-317, Toronto, Canada, June 2-5, 2007.

• Song L, Seto-Young D, Liu L, Poretsky L. Lack of con-sistent effect of insulin-like growth factor I (IGF-1) on plasminogen activator inhibitor type 1 (PAI-1) produc-tion in cultured human aortic endothelial cells (HAEC). 89th Annual Meeting of the Endocrine Society, P-3-389, Toronto, Canada, June 2-5, 2007.

• Martinez RE, Poretsky L, Lam A, Krymskaya M, Burke G. Diabetes education for the deaf: unexplored ter-ritory. 16th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists, Abstract #272, Seattle, WA, April 11-15, 2007.

• Bernstein G, Poretsky L, Lam A, Krymskaya M, DeJe-sus J, Doyle R, Burke G, Towe M, Worthington B. Culturally Competent Diabetes Education Program for Deaf Patients. 34th Annual Meeting of the American Association of Diabetes Educators, Abstract CQ01, St. Louis, MO, August 1-4, 2007.

• Song L, Busta A. A case of benign symmetric lipoma-tosis can thiazolidinediones be of benefit. American Association of Clinical Endocrinologist Annual Meet-ing, Seattle, WA, April 11-15, 2007.

• Martinez RE, Rosen O, Saliby A. Pagets disease, pimary hyperparathyroidism, and osteoporisis: report of a case and therapeutic implications. 89th Annual Endocrine Society Meeting, Abstract #850265, Toronto, Canada, June 2-5, 2007.

• Martinez RE, Cadag A, Gouller A. Plasmapheresis: A life-saving therapy for thyroid storm. 89th Annual En-docrine Society Meeting, Abstract #851695, Toronto, Canada, June 2-5, 2007.

• Patel P, Gurevich Y, Liao E. Primary hyperaldoster-onism with normal potassium and high renin levels in patient with chronic renal failure. Endocrine Society 89th Annual Meeting, Abstract P3-87, Toronto, Cana-da June 2-5, 2007.

Beth Israel Division of Endocrinology • Progress Report 2007 page 8

• Patel P, Seto-Young D, Poretsky L, Liao E. Effefts of Vitamin D supplementation in type 2 diabetes mel-litus. Osteoporosis Update, Santa Fe, New Mexico, August 2007.

• Seto-Young D, Poretsky L. The role of PPAR-g in hu-man ovarian regulation. The 5th Anniversary Con-gress of International Drug Discovery Science and Technology, Xi’an, China, November 2007.

Major Goal for 2008

Interdisciplinary Diabetes Treatment Unit: “one-stop-shopping” for patients with diabetes

• Adult Endo• Pediatric Endo• Cardiology• Nephrology

• Neurology• Ophthalmology• Psychiatry• Vascular

• Podiatry/Ortho• OB/GYN• Other

New Staff in 2007

Diabetes Institute: • Jenny De Jesus, RN• Artee Srivastava, NP• Monique Welbeck, NP• Jennifer Regester, RD• William Craig, RD

• Natalie Morrow, LCSW• High Voltage, Wellness Dir.• Karina Ziskovich, Adm. Asst.• Sandy Farrell, Adm. Asst.

• Lisa Newman, MD• Dorothy Perry, RN

Directions

• Continued growth of Gerald J. Friedman Diabetes Institute

• Continued growth of clinical activities • Increase funding for research programs• Maintain full accreditation of fellowship program• Maintain full accreditation from the American Diabe-

tes Association for the education program

Presentations at National and International Meetings: 2007