Joslin Diabetes Center

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Coordinates: 42°20′21″N 71°06′30″W / 42.339101°N 71.108440°W / 42.339101; -71.108440

The Joslin Diabetes Center (at the right)

Joslin Diabetes Center is the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education. It is located in the Longwood Medical and Academic Area in Boston, Massachusetts, USA. Among the Harvard Medical School Affiliated institutions, Joslin is unique in its sole focus on diabetes. Joslin has the world’s largest team of board-certified physicians treating diabetes and its complications, as well as the largest staff of Certified Diabetes Educators anywhere in the world.[citation needed]

Since its inception, Joslin has focused on aggressive, comprehensive care of the patient. Over 23,000 active patients receive specialty care for their eyes, hearts, kidneys, pregnancies and feet.

Joslin supports the world’s largest diabetes research team with more than 40 faculty level investigators for a total of more than 300 researchers.[citation needed]

Joslin has 46 clinical care affiliates in the US and two in other countries.

History[edit]

Joslin Diabetes was founded in 1898 in Boston by diabetes specialist Elliott P. Joslin on the belief that the key to managing diabetes is with patient involvement, education and empowerment.[1]

Joslin Clinic has helped revolutionize the diagnosis, treatment and prevention of diabetes, most notably by improving the survival rate of babies born to women with diabetes, developing sight-saving laser surgery, devising treatments to reduce amputation, and uncovering ways to predict who will develop diabetes.

Some notable historic milestones include:

  • 1949: Priscilla White, M.D., a founding member of Joslin Clinic, introduces the White Classification of Diabetic Pregnancies. This pioneering concept classifies patients according to their level of risk and tailors their treatment protocol accordingly. When Dr. Priscilla White joined Joslin’s practice in 1924, only 56 percent of babies born to diabetic mothers survived; 50 years later when she retired, that rate had jumped to more than 90 percent.[2]
  • 1967: A laser treatment (Ruby laser photocoagulation) is developed by William Beetham, M.D., and Lloyd M. Aiello, M.D., which within the next five years revolutionizes the care of diabetic retinopathy, a potentially blinding complication of diabetes.[3]
  • 1976: Joslin researchers perfect the A1C test, paving the way for this blood test to assess blood glucose control over a two- to three-month period.
  • 1980s: Basic research at Joslin shows that type 1 diabetes evolves over a period of years, presenting hope that a means may be found to prevent autoimmune destruction of the pancreas’ beta cells before they stop producing insulin.
  • 1980s: C. Ronald Kahn and his team define the molecular mechanism of insulin action and how it is altered in insulin resistant states such as type 2 diabetes and obesity.
  • 1989: George King, M.D., and colleagues demonstrate that high blood glucose levels activate protein kinase C (PKC), part of a major signaling pathway that causes cellular changes in the eye, kidney and arteries that lead to diabetic complications.[4]
  • 1996: A molecular pathway (called NF-κB) is identified in fat and the liver that is activated by obesity (and a fatty diet) and causes the insulin resistance that can lead to type 2 diabetes (Steven E. Shoelson, M.D., Ph.D.).
  • 1998: Joslin Vision Network—a telemedicine technology developed at Joslin—found to produce images of the retina just as accurately as standard equipment, but without having to dilate the pupil. Remote sites across the United States can now access Joslin’s expertise in diabetic eye disease diagnosis and treatment.
  • 2002: The Diabetes Prevention Program (DPP) study shows people with elevated blood glucose levels who are at risk for developing type 2 diabetes can reduce their risk by 58 percent through sustained modest weight loss and increased moderate-intensity exercise, such as walking 30 minutes daily.[5]
  • 2003: Researchers discover that early signs of kidney disease (microalbuminuria) can be reversed back to normal with proper medical screening and diabetes control.[6]
  • 2006: Joslin researchers find that specific genes can determine both obesity and body-fat distribution in humans.[7]
  • 2009: Researchers in the lab of C. Ronald Kahn, MD discover that brown fat is present in some adults, providing a new target for the treatment of obesity.[8]

Clinical services (Joslin Clinic)[edit]

JoslinCare is a multi-disciplinary program that includes:

  • State-of-the-art medical care
  • Sequenced diabetes education
  • Personalized nutrition and exercise prescriptions
  • Lifelong management program

Some of the clinical programs at Joslin include:

Beetham Eye Institute: The Beetham uses advanced diagnostics, laser treatment, cataract and retinal surgery, vision rehabilitation and novel therapies to help preserve the eyesight of diabetic patients. Over the last 30 years, techniques pioneered at the Beetham have preserved the vision of millions of people.

Pediatric Diabetes Section: Joslin Clinic has a reputation for pioneering care and support of pediatric patients with diabetes and their families. The pediatric staff includes board-certified endocrinologists, pediatric diabetes nurse educators, pediatric nutritionists child psychologists, a social worker, and a child life specialist.

Nephrology Section: Joslin provides the educational, medical, and emotional support needed to manage all forms of kidney disease, which impacts a significant number of people with diabetes. The goal is to detect, delay, and potentially reverse the effects of diabetes on the kidneys as early as possible.

Multicultural Health Clinics: In response to the fact that Latinos and Asian Americans develop diabetes at a much higher rate than the general population, Joslin established clinics for both of these patient populations. They offer culturally appropriate care and bilingual staff.

Patient Education Patient education is an integral part of JoslinCareTM — the model of diabetes care at the Joslin Clinic. Joslin has the largest staff of Certified Diabetes Educators anywhere in the world. Expertly trained, nationally certified diabetes educators include diabetes nurse educators, registered dietitians and exercise physiologists. Specialists work with patients one-on-one, or through a variety of programs and classes. Educators work as part of the diabetes care team to provide coordinated, sequenced learning activities.

Joslin also offers specialty programs in cardiovascular disease, mental health and counseling services, peripheral neuropathy, obesity, insulin pump therapy, diabetes and pregnancy, diabetes and aging, hypoglycemia, sexual function and disorders of the feet. In addition, Joslin has a number of initiatives aimed at developing and providing culturally-competent diabetes education, such as the Latino Diabetes Initiative[9] and the Asian American Diabetes Initiative.

Research[edit]

Joslin Research conducts the most comprehensive diabetes research effort in the world and is at the forefront of discovery aimed at preventing and curing diabetes.[citation needed]

Many important historical discoveries and improvements in diabetes care worldwide were developed at Joslin. These include recognition that tight blood glucose control can slow or prevent diabetes complications, creation of treatment protocols to enable women with diabetes to have healthy babies, the identification of markers for pre-diabetes, and pioneering laser surgery for diabetic eye disease.

Joslin researchers have won top awards and recognition from the National Academy of Sciences, the Institute of Medicine, the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF), among many others. The number of papers Joslin researchers present each year at the annual ADA Scientific Sessions surpasses any other organization. Joslin also offers one of the largest diabetes research training programs in the world, with more than 120 M.D. and Ph.D. fellows training at the center annually.

Affiliates[edit]

Joslin has 46 clinical care affiliates in the United States and two internationally.

References[edit]

  1. ^ Kahn CR, Rafferty JF. The Joslin DiabetesCenter. Molecular Medicine 6(2): 65-68, 2000.
  2. ^ Dunn, PM. Dr Priscilla White (1900-1989) of Boston and pregnancy diabetes. Arch Dis Child Fetal Neonatal Ed. 2004 May;89(3):F276-8.
  3. ^ Beetham WP, Aiello LM, Balodimos MC, Koncz L. Ruby-laser photocoagulation of early diabetic neovascular retinopathy: preliminary report of a long-term controlled study. Trans Am Ophthalmol Soc. 1969;67:39-67.
  4. ^ Lee TS, Saltsman KA, Ohashi H, King GL. Activation of protein kinase C by elevation of glucose concentration: proposal for a mechanism in the development of diabetic vascular complications. Proc Natl Acad Sci U S A. 1989 Jul;86(13):5141-5. Erratum in: Proc Natl Acad Sci U S A 1991 Nov 1;88(21):9907.
  5. ^ Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
  6. ^ Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003 Jun 5;348(23):2285-93.
  7. ^ Gesta S, Blüher M, Yamamoto Y, Norris AW, Berndt J, Kralisch S, Boucher J, Lewis C, Kahn CR. Evidence for a role of developmental genes in the origin of obesity and body fat distribution. Proc Natl Acad Sci U S A. 2006 Apr 25;103(17):6676-81.
  8. ^ Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, Kuo FC, Palmer EL, Tseng YH, Doria A, Kolodny GM, Kahn CR. Identification and importance of brown adipose tissue in adult humans. N Engl J Med. 2009 Apr 9;360(15):1509-17.
  9. ^ webmaster@joslin.harvard.edu. "Latino Diabetes Initiative | Joslin Diabetes Center". Joslin.org. Retrieved 2013-02-12. 

External links[edit]