Beatriz Visit 1: A 61-year-old Latino female with type 2 diabetes, CAD, and suboptimal glycemic control

0.5 AMA PRA Category 1 Credit(s)™
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John P. Sheehan, MD, FACE, FACN

John P. Sheehan, MD, FACE, FACN
Associate Clinical Professor of Medicine
Case Western Reserve University
Medical Director
North Coast Institute of Diabetes and Endocrinology, Inc.
Cleveland, OH

John P. Sheehan, MD, FACE, FACN, is Associate Clinical Professor of Medicine at Case Western Reserve University in Cleveland, Ohio. He is also Medical Director of North Coast Institute of Diabetes and Endocrinology, Inc. in Westlake, Ohio.

Dr. Sheehan is board certified in Internal Medicine, with much of his internal medicine training conducted in Dublin. He is also board certified in Diabetes, Endocrinology, and Metabolism, with fellowship trainings conducted in the United States, at Joslin Diabetes Center/New England Deaconess Hospital (Diabetes) and Cleveland Clinic Foundation (Endocrinology).

A full member of the Royal College of Physicians, Dr Sheehan is a fellow of the American College of Endocrinology and the American College of Nutrition, as well as a member of several diabetes societies: the American Diabetes Association, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, and International Diabetes Federation.

In addition to active membership in diabetes-related scientific societies, Dr Sheehan's research is diabetes-focused: insulin and insulin pump therapy in type 1 diabetes; oral agents and dietary therapy in type 2 diabetes; diabetes and pregnancy, especially high-risk management; and diabetes-associated complications, including diabetic neuropathy, nephropathy, endothelial dysfunction, dyslipidemia, and macrovascular disease. He is widely published on these and other related topics.

Suzanne Ghiloni, BSN, RN, CDE

Suzanne Ghiloni, BSN, RN, CDE
Diabetes Nurse Educator
Joslin Diabetes Center
Boston, MA

Suzanne Ghiloni, BSN, RN, CDE, is a Certified Diabetes Educator working at the Joslin Diabetes Center in Boston for 26 years. She provides direct clinical care in individual and group settings for patients with type 1, type 2, and gestational diabetes. The majority of her practice involves intensive insulin therapy and insulin pump therapy. A subspecialty is her involvement as lead nurse educator at the Diabetes and Pregnancy Program, an affiliation of the Joslin Diabetes Center and Beth Israel Deaconess Medical Center. She is co-author of several articles in Diabetes Technology & Therapeutics and Diabetes Forecast. Other written work includes chapter authorship for the textbook Diabetes Complicating Pregnancy: The Joslin Clinic Method and an upcoming Joslin publication, Staying Healthy with Diabetes: Pregnancy. Research activities include participation in the JDRF Artificial Pancreas Project (2007–20008) and The Seven Center Study – Use of the Paradigm 722 System to Improve Glycemic Control in Adult and Adolescent Subjects with Type 1 Diabetes: A Multi-Center, Randomized Controlled Trial (2005–2007).

Osama Hamdy, MD, PhD

Osama Hamdy, MD, PhD
Instructor in Medicine
Harvard Medical School
Medical Director, Obesity Clinical Program
Joslin Diabetes Center
Boston, MA

Osama Hamdy, MD, PhD, is Medical Director of the Obesity Clinic and Assistant Investigator in the Section on Clinical Research at Joslin, and an Instructor in Medicine at Harvard Medical School in Boston, MA. He received his medical and doctoral degrees from Mansoura University in Egypt. Dr. Hamdy did his residency in Internal Medicine at Mansoura University Hospital, and his fellowship in Endocrinology, Diabetes and Metabolism at the University of Missouri Hospital and Clinics and Joslin Diabetes Center. Before coming to Boston, he was an Associate Professor of Internal Medicine at Mansoura Faculty of Medicine in Egypt. He is a Fellow of the American College of Endocrinology.

Dr. Hamdy focuses on the effects of lifestyle modification (diet and exercise) on the function of the endothelium (the layer of cells lining blood vessels) in obese individuals with and without type 2 diabetes. Healthy vascular (blood vessel) function is often altered in obesity and diabetes, and marks the early stage of atherosclerosis and coronary artery disease. Dr. Hamdy and colleagues found that obese adults who lost just 7 percent of their weight—the equivalent of 16 pounds in a 220-pound woman—and did moderate-intensity physical activity for six months had significant improvement in endothelial function. This improvement may eventually prevent progression of atherosclerosis, coronary artery disease and the subsequent risk of heart attack and stroke—the leading causes of death in at least 75 percent of patients with type 2 diabetes.

Dr. Hamdy studies the long-term effects of sustained weight loss on endothelial function, distribution of body fat and circulating adipokines (chemicals produced by fat cells that contribute to insulin resistance, atherosclerosis, inflammation, coagulation and coronary artery disease) in obese patients with type 2 diabetes. He also studies the impact of surgical removal of visceral (abdominal or hidden) fat on insulin sensitivity, endothelial function and blood glucose control for obese patients newly diagnosed with type 2 diabetes—an approach that prompts some hope for treatment of type 2 diabetes and insulin resistance.
To develop better strategies for managing obesity and diabetes through lifestyle modifications, Dr. Hamdy plans to investigate the differences between the effects of diet and exercise on endothelial function as well as the effects of diets that vary in macronutrients ratio (the proportion of carbohydrates, protein and fat). To better identify patients at risk, he will explore the relationships among fat distribution, adipokines, insulin resistance and endothelial function. He also plans to validate a new index that can be used in clinical practice for identifying people who are insulin resistant and at higher risk for type 2 diabetes and cardiovascular complications.
Selected References
Hamdy O, Ledbury S, Mullooly C, et al. Lifestyle modification improves endothelial function in obese subjects with insulin resistance syndrome. Diabetes Care. 2003;26:2119-2125.
Hamdy O, Moussa A, Ledbury S, et al. Effects of weight loss and increased physical activity on insulin and glucose dynamics in obese subjects with insulin resistance syndrome. Diabetes. 2002. 51(Suppl 2):411.
1. Explain the natural history of type 2 diabetes including evolution of insulin resistance, insulin secretory decline, derangements in incretin system, and endocrinologic role of abdominal adiposity as key components of clinical progression of disease
2. Describe the pathophysiologic and clinical interrelationships between type 2 diabetes and risk factors for, and consequences of, cardiometabolic syndrome
3. Assess underlying pathophysiologic factors contributing to hyperglycemia of type 2 diabetes based on an individualized clinical assessment of patients with type 2 diabetes
4. Advance individualized nonpharmacologic and pharmacotherapeutic treatments for type 2 diabetes that address underlying pathophysiology
5. Improve office-based systems to manage treatment and facilitate therapeutic advancement, as well as provide patients with educational support to actively participate in their care