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 Division has also instituted a comprehensive advanced practice provider training program to further expand and improve inpatient clinical diabetes management.
The University of Pittsburgh Diabetes Institute has organized one of the largest networks of American Diabetes Association (ADA)-recognized diabetes self-management education and support programs in the US. There are 48 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. Diabetes care, education, and support is also widely available via various outreach initiatives for improving access, including telemedicine for patients and electronic consultation for primary care providers to the Division. The Division of Endocrinology has also partnered with the University of Pittsburgh Diabetes Institute Registry and the ADA-Recognized 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. Partnerships with the large network of diabetes education programs and primary care practices affords a unique platform to implement and evaluate new models of care delivery and telehealth approaches. NIH, foundation, and industry have supported studies designed to examine technological applications like phone apps insulin instruction and videoconferencing for ongoing diabetes care and support.
Efforts continue in the development and validation of a database of greater than 185,000 patients with diabetes who receive care in UPMC hospitals or associated outpatient facilities and clinics in Western Pennsylvania. This is one of the largest diabetes registries of unselected patients in the United States, providing a source to estimate how patients with diabetes are progressing in their treatment, how complication risk is mitigated through specific intervention efforts, and estimation of risk to provide the most comprehensive care to those in greatest need. Medicare, the VA, and Kaiser-Permanente have larger—but demographically selected—diabetes registries.
The Neuroendocrinology Service cares for patients with pituitary and adrenal disease at UPMC. The inpatient service is covered by three subspecialty neuroendocrinologists with approximately 200 consults/year. The team works closely with an outstanding multidisciplinary group of providers from the Departments of Neurosurgery, Otolaryngology, Ophthalmology, Radiation Oncology, Neuroradiology, Neuropathology, Pediatric Endocrinology, and Neuro-Oncology. Dr. Pouneh Fazeli (Director of the Neuroendocrinology Unit) and Dr. Hussain Mahmud also serve as the neuroendocrine specialists for the Pituitary Center of Excellence at UPMC. The Neuroendocrinology Unit and Pituitary Center of Excellence provide education to the wider UPMC community, both through a monthly Multidisciplinary Pituitary Case Conference as well as annual webinars on the Multidisciplinary Management of Pituitary Tumors.
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.
Over 1/3 of US adults are living with obesity, and a significant percentage of those presenting for health care in the inpatient and outpatient setting have obesity causing or exacerbating their current health problems. The Obesity Unit in the Division of Endocrinology and Metabolism is committed to addressing obesity head-on, providing evidence-based care including intense lifestyle interventions, medically supervised meal-replacement programs, and prescribing anti-obesity medications (AOM), as well as medically managing patients before and after bariatric surgery. Our multidisciplinary team includes American Board of Obesity Medicine certified physicians, a dietitian, a psychologist and an exercise specialist providing personalized care and group support meetings. All services can be provided virtually, allowing for frequent visits from any location. Resting energy expenditure and body composition analysis are also available. Patient populations that benefit greatly from this care include those with diabetes, hypertension, hyperlipidemia, polycystic ovaries/infertility, osteoarthritis seeking to get or to avoid joint replacement surgery, obstructive sleep apnea, and fatty liver disease/NASH. The Obesity Unit also engages in the training of residents and fellows and participates in clinical research to advance the field to find better treatments in the future
Adult Cystic Fibrosis Endocrine Clinic at UPMC Center for Diabetes and Endocrinology
The Cystic Fibrosis (CF) Endocrine Clinic is established in conjunction with the University of Pittsburgh Adult Cystic Fibrosis Center as a part of the Adult Cystic Fibrosis (CF) Care Program at UPMC. We work very closely with the UPMC Lung Transplant program in managing transplant-related diabetes, metabolic bone disease, and other endocrine disorders. Our center works closely in transitioning children with cystic fibrosis endocrine disorders to adult care. This clinic focuses on screening for glucose disorders in CF, management of CF-related diabetes, CF-related bone disorders, growth and nutrition, and related endocrine disorders. We facilitate optimal use of diabetes technology, insulin pumps, closed-loop pump technologies, continuous glucose monitors, and other devices. We have a cadre of diabetes educators who can assist appropriate diabetes control by remote glucose case management, device set up and training, training in diabetes self-management, and other education for patients on nutritional supplements and tube feeding. Our clinic is equipped with an infusion clinic staffed by trained nurses who can administer various injectable therapies for metabolic bone disease. We have an active clinical and basic science research program and work closely with national organizations like the Cystic Fibrosis Foundation. Alison Kohan, PhD and Jagdeesh Ullal, MD are members of the Cystic Fibrosis Extrapulmonary CF Working Group at Pitt.
Lipid and Adipose Tissue Disorders Unit
High cholesterol is well-known to increase the risk of atherosclerotic cardiovascular disease (ASCVD). Many lipid disorders are also characterized by high triglycerides (either alone or in combination with high cholesterol) that increase the risk for acute pancreatitis. These conditions are quite common in the context of obesity, diabetes, and other metabolic diseases, but also occur in the context of underlying genetic risk factors. The Lipid and Adipose Disorders Unit provides evaluation and treatment for both common and rare lipid and adipose tissue disorders, particularly those that have been refractory to standard therapy. These include 1) hypercholesterolemia with statin intolerance; 2) severe/familial hypercholesterolemia (i.e., LDL receptor deficiency, sitosterolemia, etc.); 3) hypertriglyceridemia with pancreatitis; 4) severe/familial hypertriglyceridemia (i.e., LPL deficiency) or mixed dyslipidemias; 5) rare adipose tissue disorders (i.e., lipodystrophy); 6) severe insulin resistance syndromes (i.e., insulin receptor deficiency); and similar disorders. This unit performs clinical trials to evaluate the efficacy and safety of novel therapies for these conditions. The Lipid and Adipose Tissue Disorders Unit also conducts additional genetic/genomic and clinical/biochemical evaluations to better inform diagnosis and treatment. The Unit’s goal is identify better and more personalized therapies for these disorders.