UCSF maintains strong efforts to help patients and their families in coping with all forms of diabetes, particularly type 1 and type 2, which are the most common.
The UCSF Diabetes Center, which marked its 10th anniversary in 2010, unites clinical care, basic science and clinical research, and education aspects of diabetes in a comprehensive program to improve the quality of life of those living with the disease.
Diabetes Center Director Matthias Hebrok, PhD, says the center has one mission: to advance the care and treatment of patients with diabetes worldwide and ultimately “to bring an end to the disease.”
Patients with diabetes test their blood sugar, or glucose, levels regularly.
The center treats both adults and children with diabetes, a disorder that develops when the body’s immune system disrupts the way insulin regulates blood sugar. In type 1 diabetes, which is often diagnosed in children, the immune system destroys the pancreatic beta cells that make insulin, and in type 2, which can develop later in life, the body does not use insulin properly and insulin production in the pancreas is impaired. Type 2, which is linked to obesity, is far more prevalent, and is affecting increasing numbers of people.
Nationwide, UCSF diabetes patient care ranks among the very top programs in the country, earning the No. 2 spot in the 2010 survey of best hospitals by US News & World Report.
The Diabetes Center specializes in clinical trials to test new therapies, including drugs to alter or slow progression of type 1 by changing how the immune system recognizes and destroys the pancreatic cells. Clinical teams also continue to evaluate and improve procedures that involve organ and cell transplants as treatment strategies.
Clinical trials are supported in part by the Immune Tolerance Network (ITN), an international consortium of the world's leading scientific researchers and clinical specialists that focuses on testing new therapies for autoimmune diseases such as type 1 diabetes.
The clinical care program includes a full team of experienced physicians, nurse educators, dietitians and other health care professionals, as well as a superior Diabetes Teaching Center dedicated to educating patients about how they can manage their own disease.
People with diabetes often develop other health issues. “Patients who have complex issues in diabetes like to come to our clinic because of our expertise,” says Mark S. Anderson, MD, PhD, an endocrinologist who treats patients and conducts research.
The patient care team includes a broad range of outstanding ophthalmologists, cardiologists, nephrologists and specialists. “Our patients value having the access to those kinds of resources,” Anderson says.
Patient care has vastly improved over the years, with insulin pumps often replacing needles, and continuous glucose monitors making it much easier for some patients to stay on top of their health. New oral medications have also been developed that promote the production of hormones that tell the pancreas to produce more insulin when food arrives in the stomach, Anderson says.
In addition, transplant surgeons Peter Stock, MD, PhD, and Andrew Posselt, MD, PhD, are using two different transplant strategies to tackle type 1 diabetes: transplanting a donor pancreas into the patient, a procedure with a high success rate; and a new approach, still in clinical trials around the country, in which insulin-producing beta cells from a donor pancreas are infused into the patient.
Stock says the main goal is to replace the insulin-producing beta cells that are destroyed with the onset of type 1 diabetes. Less than 5 percent of cells in the pancreas produce insulin, and those beta cells are located in small areas known as the islets of Langerhans.
Stock says that pancreatic transplants, done since the 1990s, have 90 percent of patients off insulin within one year. “Every last one of them will tell you it was worth it,” he says. “But it’s a big operation with surgical risks.” It requires a lifetime of follow-up drugs to combat the immune system’s tendency to reject new organs. Newer, safer and more effective immunosuppressive regimens continue to be developed at UCSF.
With the development of islet cell transplantation, surgeons can transplant only the 5 percent of cells needed, rather than an entire pancreas. The process is complex and costly because the cells must be extracted from the donor pancreas, Stock notes, and the recipient still requires antirejection medication.
Stephen Gitelman, MD, directs the UCSF Pediatric Diabetes Clinical Research Program, and much of his work involves efforts to improve current treatment of type 1 diabetes in children and ultimately to prevent the disease. Gitelman works closely with other members of the Diabetes Center and with scientists at other renowned centers to devise novel therapies to block autoimmune destruction of beta cells.
The cornerstone of UCSF diabetes care is the Diabetes Teaching Center. One of the country’s oldest and most innovative programs in this field, the teaching center was established in 1978. It educates individuals on how to successfully manage their lives as diabetes patients.
Andy Altman shared his success story of living with diabetes at the 10th anniversary celebration for the comprehensive Diabetes Center.
Diabetes Teaching Center Medical Director Martha Nolte Kennedy, MD, says that all schools at UCSF – dentistry, medicine, nursing and pharmacy – have participated in the center’s programs. The primary educators are nurses, nutritionists and pharmacists, and researchers from the UCSF Diabetes Center update patients on the search for a cure.
“Patients have to make medical decisions that affect their well-being as well as their life on a daily basis,” Kennedy says. “Someone who has type 1 diabetes who does not get insulin could be mortally ill or dead within 24 hours. There’s an urgency in knowing how to use the medicine correctly.”
“We are providing information to patients to empower themselves,” adds Anderson. “We aren’t home with them. They have to take the information and run with it. That is a huge component of diabetes care.”
The center also has special classes for people with type 2 diabetes, such as a simple insulin regimen class, and a two-day “oral agent” class detailing various pills that help the body produce more insulin or regulate its glucose.
Kennedy says that Diabetes Teaching Center programs are akin to “putting a patient through medical school strictly for diabetes,” sometimes in a class that lasts as long as four days. “The patient gets a diagnosis and has to acquire all of this information in a matter of days,” Kennedy says. University professionals are not the only ones who help; other patients and students in the classes form a support group, offering reality checks and, most of all, hope.
With the proper information, medicine, diet and exercise regimen, however, people can “live a long, successful life with diabetes,” Kennedy says.
The classes are not mandatory, but they are often covered by insurance, and they are strongly recommended. The teaching center also offers its courses for free online.
Kennedy says her work at the center is only a stopgap measure while patients, families and caregivers await the work on a cure. “One day, all of this will seem so primitive,” she predicts. “Until that time, we are helping people figure out a path through the forest.”