The diabetes/obesity epidemic and the increasing recognition of thyroid disease and osteoporosis are driving demand for endocrinologists across the United States, and the Western Pennsylvania population is no exception. The Division of Endocrinology and Metabolism has responded to rising demand for endocrine and diabetes clinical services by enhancing patient access across the region with increased provider availability in established areas, newly opened outpatient offices, and a diabetes telemedicine initiative serving the region’s rural areas.
The Division of Endocrinology and Metabolism’s clinicians provide inpatient endocrinology and diabetes consultative services at UPMC’s Oakland campus, UPMC Mercy and UPMC McKeesport. Outpatient care is provided at the Center for Diabetes and Endocrinology in Oakland and at community-based sites in Monroeville, Mt. Lebanon, Mt. Nebo, UPMC Mercy and UPMC McKeesport. Map of clinical site locations (embedded link to clinical site locations page). Diabetes and related disorders account for 50% of visits to our outpatient offices. Thyroid-related disorders account for approximately 30% of outpatient visits, and the remaining 20% of visits are for osteoporosis, other calcium and mineral metabolism-related disorders, pituitary and adrenal disease, lipid disorders, male and female reproductive disorders, and other rare endocrine diseases (e.g. carcinoid syndrome, neuroendocrine tumors, multiple endocrine neoplasias). The Division’s compliance with standards of care as recognized by the Endocrine Society and the American Diabetes Association (ADA) exceeds national averages.
Diabetes Treatment and Prevention
The Division of Endocrinology and Metabolism oversees the UPMC Diabetes Inpatient Safety Committee. This committee is dedicated to implementing system-wide computer-based physician order-entry initiatives that target rational goal-directed inpatient glycemic management as a way of improving patient outcomes, while minimizing risk for hypoglycemia and other adverse events. These initiatives have led to marked, large-scale improvements in the management and outcomes of hospitalized patients with diabetes and newly recognized hyperglycemia, including reductions in hospital lengths of stay and improved compliance with national recommendations for inpatient glycemic management.
The University of Pittsburgh Diabetes Institute has organized the largest network of American Diabetes Association (ADA)-recognized diabetes self-management education programs in the US. There are 50 established sites in a variety of clinical settings where patients are able to receive these educational sessions. These sites include all UPMC hospitals, primary care practices, and community-based clinics. The Division of Endocrinology has partnered with the University of Pittsburgh Diabetes Institute Registry and ADA-Certified Diabetes Education Network to support team-based care at all diabetes care locations and launch large-scale quality improvement initiatives across the UPMC system and the UPMC Health Plan. The Division [also collaborated in] developing Chronicle, a national self-management program database, which is being used as a national repository for the ADA Self-Management Education Recognition Program.
In collaboration with the Diabetes Prevention Support Center (DPSC), the Division has now trained more than 1,000 health care providers for primary prevention. Additional ongoing support tools, including instructional DVDs and online programs, have been designed to complement the training programs. Members of the Diabetes Institute and the DPSC are active leaders in the development of the National Diabetes Prevention Program under the direction of the Centers for Disease Control (CDC).
Efforts are ongoing in the development and validation of a database of the more than 185,000 patients with diabetes who receive care in UPMC hospitals or associated outpatient facilities and clinics in Western Pennsylvania. This is the largest diabetes registry of unselected patients in the United States. Medicare, the VA, and Kaiser-Permanente have larger—but demographically selected—diabetes registries.
Approximately 800 thyroid cancer patients are followed in the UPMC Multidisciplinary Thyroid Center outpatient clinic, located in the UPMC Center for Diabetes and Endocrinology, Falk Medical Building. This center uses a coordinated care approach to scheduling patient visits for thyroid nodule evaluation, fine needle aspiration biopsy with same day cytological analysis, oncogene mutation analysis as needed, and immediate referral to endocrine surgery when necessary. The Multidisciplinary Thyroid Center’s coordinated evaluation plans reduce the anxiety that can occur with uncertainties and prolonged delays in diagnosis and treatment. In addition, the Division operates one of the country’s largest Thyroid Cancer Registries.