Overcoming Barriers to Insulin Initiation, Intensification, and Adjustment: A Question-and-Answer Course

Robert J. Tanenberg, MD, FACP, is Professor of Medicine, Division of Endocrinology, Brody School of Medicine, East Carolina University in Greenville, North Carolina.He serves as Medical Director of the E.C.U. Diabetes and Obesity Institute and Director of the Clinical Diabetes Fellowship. Dr. Tanenberg is also the medical director of the Inpatient Diabetes Program at Vidant Medical Center, a 900 bed teaching and tertiary referral medical center in Greenville, NC. In addition, Dr. Tanenberg directs the East Carolina University-Diabetes Research Center for Clinical Trials where has been a principal investigator for over 60 diabetes research studies. Dr. Tanenberg is board certified in internal medicine, and in endocrinology and metabolism.

 

After earning his medical degree from the University of Illinois, Chicago, Dr. Tanenberg completed a medicine residency at the Mayo Clinic, Rochester, Minnesota, and an endocrine fellowship at the University of Minnesota, Minneapolis. He was also fellowship trained in diabetes at the Joslin Diabetes Center, Boston, Massachusetts. He was formerly on the faculty of Georgetown University School of Medicine and Director of the Diabetes Treatment Center at Georgetown University Hospital. He was also a consultant to the NIH for the landmark Diabetes Control and Complications Trial.

 

With special interests including insulin therapy, Type 1 diabetes, and treatment of patients with diabetic neuropathy, severe insulin resistance, and metabolic syndrome, Dr. Tanenberg has over 100 publications including articles, book chapters and abstracts. He has been published in scientific journals including Diabetes, Metabolism, Endocrine Practice, Diabetes Care, Mayo Clinic Proceedings and the New England Journal of Medicine. He has been endocrinology editor for Hospital Physician and is an editor of the lay journal, Diabetes Health. He lectures throughout the country on the treatment of diabetes and the prevention and treatment of diabetic complications.

Dr. Smiley is an Associate Professor of Medicine at Emory University School of Medicine in Atlanta, Georgia and she received her Master of Science in Clinical Research degree from the Emory Graduate School of Arts and Sciences. She currently serves as the Grady Memorial Hospital site director for the Endocrinology Fellowship program and works with fellows in the inpatient and outpatient setting. In the past 4 years, her main funding has been from the NIH-NIDDK (K08 program) that funded her research focus in the area of ketosis-prone diabetes mellitus (KPDM). Dr. Smiley's investigations aim to correlate the patient response to treatment with the mechanism(s) and markers of short- and long-term remission and to determine the optimal therapeutic approach in order to prevent future glycemic decompensation in these patients. With the data from the current NIH-K08 study and collaborations in the field of epigenetics and insulin signaling mechanisms, Dr. Smiley anticipates getting further funding to research further avenues such as 1) validating a model for remission in subjects with KPDM and a model for subsequent failure after remission, 2) exploring the mechanistic link underlying glycemic decompensation which potentially could be altered (pharmacological activation vs. deactivation of an insulin signaling pathway) to change clinical outcomes and 3) establishing formal treatment guidelines for patients with KPDM.

Dr. Smiley also serves as a co-investigator in several research protocols supported by the Emory University School of Medicine/Grady satellite General Clinical Research Center that concentrate on the management of inpatient and outpatient hyperglycemia/insulin protocols, glycemic management in the long-term care facilities, pharmacoeconomic impact of inpatient diabetes management, and the effects of free fatty acids (FFAs) on endothelial function and inflammation. In addition to these areas, Dr. Smiley has expertise in doing physiometabolic studies such as modified oral glucose tolerance tests, glucagon stimulation tests, vastus lateralis muscle biopsies and euglycemic insulin clamps.

Dr. Smiley has been productive publishing original manuscripts and text chapters, including the 2014 American Diabetes Association's Greenbook chapter on perioperative glycemic management, presenting scientific abstracts at national and international meetings, obtaining funding for clinical research studies, and teaching the housestaff and ancillary staff. In addition to her NIH-KO8 award that she was recently completed, Dr. Smiley serves as the PI for an Abbott Nutrition protocol to assess the benefit of nutritional supplements in elderly patients admitted to the hospital and she is the co-PI/site investigator for the ADA-funded study evaluating the use of dipeptidyl dipeptidase 4 inhibitors in long-term care residents with type 2 diabetes.

Dr. Smiley has served as a journal reviewer for peer-reviewed journals such as Diabetes Care, JCEM, Diabetes, Obesity and Metabolism and Journal of Hospital Medicine and a post-hoc grant reviewer for the American Diabetes Association. She served as a co-chair for one of the 2008 Endocrine Society Annual Meeting abstract sessions and she serves as a board member and elected treasurer for the Georgia AACE Chapter.