Optimizing Outcomes for Type 2 Diabetes with Research and Education

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With a research focus on two underserved patient populations—women and the elderly—Rita Kalyani has built her career on educating health care providers and patients, and refining best clinical practices. Image shows 3D representation of human insulin.

Johns Hopkins endocrinologist Rita Kalyani completed all of her medical training at Johns Hopkins, from medical school to residency to fellowship. During that time, she not only developed a deep interest in diabetes—a disease that affects many members of her family—but also a strong drive to serve the most vulnerable populations who develop this condition. Much of her research has focused on the elderly and women, two groups which have largely been ignored by many mainstream clinical trials.

“When I started my career, there was very little research on these populations,” she says. “There was a strong need for more studies to better support our clinical practice guidelines.”

Toward that end, part of her groundbreaking research program has sought to understand the mechanisms behind frailty in older adults with type 2 diabetes, the population most affected by this condition, and she has conducted investigations in the Women’s Health and Aging Studies. Using data from the Baltimore Longitudinal Study of Aging, a decades-long study that has tracked the health characteristics and development of disease among thousands of older adults, Kalyani and her colleagues also found that persistently high blood glucose levels over time predict an acceleration of muscle loss with aging. The finding has spurred discussion in the field over whether current blood glucose targets are aggressive enough to prevent this consequence in older adults.

She and her colleagues have also studied differences in coronary heart disease in men and women with type 2 diabetes. Men typically have a higher risk of this condition at a younger age than women when diabetes isn’t present. However, Kalyani’s team showed that with diabetes, middle-aged men and women have equivalent risk across multiple cohorts. The finding led to a change in clinical practice guidelines for when health care providers should prescribe preventive therapies for women.  

Kalyani has also played a more direct role in establishing diabetes care guidelines. She recently served as the chair of the Professional Practice Committee for the American Diabetes Association (ADA) from 2017–2018. This committee is responsible for authoring and updating the ADA’s Standards of Medical Care in Diabetes which includes all of the organization’s current clinical practice recommendations. 

“This 150 page document is a central resource for clinical practice guidelines in our field, and it’s updated every year after an extensive review of the latest research,” she says. “It was incredibly exciting to serve in this role.”

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“By targeting education to providers and patients alike while performing research on the best clinical practices, we are helping to provide the best outcomes possible for this disease.” —Rita Kalyani

Her efforts have also extended to educating physicians in other ways. Kalyani is the editor-in-chief of the Johns Hopkins Diabetes POC-IT guide for health care providers, an electronic resource and decision-making support tool that puts the latest information on the disease at providers’ fingertips. A mobile app that can be downloaded, the guide helps providers find answers to questions as diverse as the starting doses for diabetes medicines to tests for diagnosing comorbid conditions. Continuing medical education programs in audio and video formats help physicians learn about managing various complications or new therapies. More than 150 institutions around the globe — including North America, the Middle East, Asia, and beyond — use this tool, Kalyani says.

She has developed several tools for patient education. Kalyani is the editor-in-chief of the Johns Hopkins Patient Guide to Diabetes, a website that contains lay-language information developed and thoroughly reviewed by medical experts in the field. This site is accessed over 200,000 times annually and is supported by the Frannie Foundation.

Kalyani and colleagues also recently authored a book titled Diabetes Head to Toe, a resource that explains how type 2 diabetes affects the entire patient, not just the more common complications affecting the heart, eyes, nerves and kidneys. It was published by Johns Hopkins University Press.

“Our efforts can’t be solely aimed at health care providers. It’s simply not practical to try to relay everything patients need to know in a short clinic visit,” she says. “By targeting education to providers and patients alike while performing research on the best clinical practices, we are helping to provide the best outcomes possible for this disease.”

 

 


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