NETWORK DIABETES PROGRAM (NDP)
Hektoen manages grant funding for a comprehensive diabetes program that includes three acute care hospitals and 30 ambulatory sites for an estimated population of 30,000 patients with diabetes. The basis of the program are multidisciplinary diabetes teams operating in several sites throughout the Cook County area. The team consist of primary care physicians, Certified Diabetes Educators (CDEs) including dietitians, nurse practitioners, clinical pharmacists, clinical psychologists and social workers. The diabetes teams provide patients education and management in conjunction with the primary care physicians. The teams also serve as a diabetes resource for the health care providers, develop with standards of care and maintain diabetes patients database to generate diabetes care outcomes.
The current four NDP sites include the Fantus Clinic, Near South Clinics, South Suburban Clinics, and Western Hub 4 clinics serving mainly the Hispanic population. Clinical psychologists, psychology externs and a social worker, with specialties in individual and group counseling and stress management, provide the behavioral and social support for the Diabetes Program. The NDP staff is involved (as part of “Bridges to Health” project) in developing diabetes education skills for Latino peer mentors “Promotores”. Five diabetes Promotores trained in NDP serve already in other County Clinics.
The NDP in its fourth year has managed about 7,000 single patients for almost 20,000 visits. All the patients data are recorded in a detailed computerized database which tracks longitudinally parameters of diabetes control, laboratory and medication data, and self-management information (glucose monitoring, adherence to medications, diet and exercise). Psychosocial problems are tracked as well.
The NDP Center in Fantus is an ADA recognized Diabetes Center. The Division of Endocrinology is responsible for the entire diabetes program. In the Diabetes Center a multidisciplinary Diabetes Clinic staffed by endocrinologists manages patients with difficult and uncontrolled diabetes on daily basis. Patients with unstable diabetes arriving to emergency care sites are having immediate access to diabetes care. Such treatment includes medical management of diet, oral, and injectable medication for diabetes.
As part of quality improvement, the four NDP teams participated 2002-2003 in the Chicago Regional Diabetes Collaborative (Dr. Fogelfeld, the medical director of the NDP, was the Co-Chairman of the Collaborative), which implemented the “Chronic Care Model” components.
The Division provides intensive education in clinical endocrinology to medical students, medicine, family practice podiatry and ophthalmology (in planning phase) during their monthly rotations. Medicine residents are participating on an elective basis in yearlong continuity outpatient endocrine clinic. Combined Fellowship Program with Division of Endocrinology Rush-Presbyterian Medical School provides clinical and research training to 4 fellows.
The NDP is serving as a professional resource for the structured programs of multidisciplinary management of diabetes involving physicians, physician assistants, nurses, nurse practitioners, residents and students.
The NDP has been a site for several master theses in the course of “Masters in Clinic Research” by Rush University as well as dissertations for clinical psychologists
RESEARCH and DEVELOPMENT
The NDP is also involved in several research projects in the area of diabetes, some to be periodically presented this year in the annual scientific meetings of the American Diabetes Association.
A new multi-year program for detection and management of pre-diabetes/metabolic syndrome is currently being launched by NDP in conjunction with primary care sites of ACHN. The principles and resources needed for such an extensive program are being delineated. The clinical space needed for one of the components of this program the “Lifestyle School” has been recently identified and secured in the Fantus Clinics.
- Diabetes Outcomes and Care delivery
- Diabetes Self Management
- PreDiabetes/Metabolic Syndrome
- Investigator initiated drug studies
- Exanatide for Type 2 DM
- Glimeperide vs. Metformin in Type 2 DM in children
- Ertapenem in Diabetic Foot
- Rosiglitazone in Type 2 DM (beta cell preservation)
- Glargine vs. TZDs in Type 2 DM
- Pioglitazone in atherosclerosis
- NAPH Diabetes Studies (with Dr.Reilly)
STUDIES (original and ongoing)
- Metabolic Syndrome in adolescent Hispanics.
- Motivational Interview for New Diabetics
- Diabetes burden in CCBHS (with Dr. Shiff group)
- Accuracy of Home Blood Glucose Monitoring
- Safety-net therapy for unstable diabetes (With ED Department)
- Asymptomatic ventricular dysfunction in new diabetics (with Div. of Cardiology).
STUDIES IN ADVANCED PLANNING
- Detection and management of prediabetes and metabolic syndrome-feasibility phase
- Multifactorial intervention in patient with advanced nephropathy (with Renal Division)