November is Diabetes Awareness Month and we are so pleased to share a story of resilience and quick, innovative thinking on the part of Dr. Anastassios Pittas, Co-Director of the Diabetes and Lipid Center at Tufts Medical Center. Dr. Pittas, co-Director Dr. Richard Siegel and their team in the Diabetes and Lipid Center work hard and smart to care for patients living with diabetes. This story is about Emily Barron, who was unexpectedly diagnosed with type 1 diabetes during the peak of the COVID-19 pandemic in Massachusetts. That was when hospitals were overwhelmed with severely ill patients with COVID-19 infections, and patients without COVID-19 were unwilling to seek in-person care in hospitals or clinics, even for urgent medical issues.
Diabetes care during COVID-19
As a Division 1 Track and Field collegiate athlete, Emily had always been healthy, but then started not feeling well with fatigue, thirst, increased urination and weight loss. She was seen by her pediatrician and was found to have high blood glucose level, consistent with new-onset diabetes, most likely type 1 diabetes. That was the easy part. Her pediatrician, who is not affiliated with Tufts MC, called multiple providers in local hospitals and nobody was willing to see her in the outpatient setting, and recommended she go to the nearest emergency room. Dr. Pittas agreed to see her on a Friday afternoon. The laboratory work-up confirmed that she had diabetic ketoacidosis (DKA), a dangerous and sometimes life-threatening condition and often the first sign that someone has type 1 diabetes, which is sometimes referred to as juvenile-onset diabetes because it is usually diagnosed in children or young adults.
Safe with us
A new diagnosis of type 1 diabetes with DKA requires hospitalization, most often in the intensive care unit, because of the need to carefully monitor blood glucose levels almost every hour. In the peak of the COVID-19 pandemic in the Boston area, Emily and her family were hesitant about admission to the hospital, especially in the intensive care unit, given the risk of exposure to patients with COVID-19 infection. At the beginning of the visit, Dr. Pittas asked Emily for permission to place a Continuous Glucose Monitor sensor on her arm. While the sensor was calibrating, Dr. Pittas went over the diagnosis and treatment of type 1 diabetes, which requires multiple daily injections of insulin to control blood glucose. At the conclusion of the visit, Emily’s real-time glucose level was showing on her smart phone and also on Dr. Pittas’ computer screen. The ability to monitor glucose levels remotely and continuously allowed Dr. Pittas to manage this life-threatening condition as an outpatient with frequent calls to Emily over the weekend and adjustments to her insulin dose. “I had two goals in mind,” said Dr. Pittas. “The first goal was to safety and effectively manage Emily’s new-onset diabetes. The second goal was to achieve a glucose level close to normal within the next three days, so she could enjoy a piece of cake for her birthday.” Three days later, both goals were achieved.
Over the next few weeks, through virtual medicine, Emily learned how to use in insulin pump, a complex technology that provides insulin to the patient 24-hours a day without the need for repeat injections. A few months later, her hemoglobin A1c level – a blood test that measures diabetes control – was in the normal range.
Emily is currently working towards completing her master’s degree in education full-time and is also working full-time as a Preschool teacher. “I was very happy to help Emily navigate life with newly diagnosed type 1 diabetes. This is always a difficult diagnosis and even more so during a very challenging time when a global pandemic limited our ability to see patients in clinic and patients avoided the hospitals,” said Dr. Pittas. “Our work as clinicians managing patients with immediate and life-threatening emergencies was deeply impacted by COVID-19. At the same time, the pandemic provided opportunities to think innovatively, applying recent advances in modern technology, such as glucose sensors and digital medicine, to continue providing the best care possible to our patients.”
Research and Innovation
Drs. Pittas and Siegel are proponents of the new diabetes technology and virtual medicine, which will revolutionize the care of patients with diabetes. Their work and research to understand and apply these swiftly moving innovations has made possible by the support of generous donors who believe in their work and the work of the entire Tufts MC clinical and research team. Drs. Pittas and Siegel care for over 2,000 patients at the Tufts MC Diabetes and Lipid Center, but only a minority of them can afford the new technology. Please consider making a donation today to enable their efforts to improve the lives of patients living with diabetes.
