By Scott Scanlon
The Diabetes-Endocrinology Center of Western New York has conducted key research for more than two decades, first in Millard Fillmore Gates Circle Hospital, later in a Kaleida Health complex tucked quietly onto a side street in Amherst.
Endocrinologists with UBMD handled trials that showed insulin not only helps control blood sugar but can prevent heart attacks. That one in three obese men with diabetes suffers from low testosterone, and that treating those men with testosterone made their insulin treatments more effective. That medicine combinations more effectively treat Type 1 and Type 2 diabetes.
Dr. Ajay Chaudhuri, a native of Calcutta, India, wanted to be part of that work. He arrived in Buffalo from Manchester, England, 21 years ago, drawn by Dr. Paresh Dandona, an internationally known doctor who started the Western New York center.
Today, Chaudhuri directs the center. He recently led the Kaleida effort to move it from Flint Road into a more visible location: the former Vix plaza at Maple and North Forest roads, about 2 miles away.
“I want this community to be very optimistic about diabetes prevention and treatment,” said Chaudhuri, 52, who lives in Clarence with his wife, Mukta, a senior executive with HSBC, their son, Sahil, 17, and daughter, Maygha, 13.
Chaudhuri also leads the Endocrine Fellowship Program with the University at Buffalo Department of Medicine and Biomedical Sciences, where he is a clinical professor. He also heads the American Diabetes Association Community Leadership Board in the region, and this year will be a major player in the Tour de Cure and other diabetes education efforts.
Q. Why the optimism?
If someone is at risk, I want them to know we can do something to prevent diabetes. If somebody develops diabetes I want them to know that with good care, we can prevent all the things we hear about diabetes in terms of eye problems, nerve problems, kidney problems. I also want them to know if they’ve already developed these complications, with the kind of care we are providing, we can reverse some of these complications. We have shown that in some of our patient population.
Q. What is available to folks who are prediabetic or diabetic in Western New York?
For folks with prediabetes, there is a diabetes prevention program that is well validated with research. If you get into that program, you have a 58 percent reduction in the chance of the development of diabetes. Right now, that is available through the YMCAs. I’m also trying to make that available through our center. ... With the patients who have been coming to the UBMD Endocrine Group, we have been able to show a reversal of complications and we have not had a single amputation in our patients in the 20 years that we have existed. A lot of times, patients diagnosed with diabetes think they’re going to develop all these problems and they can’t do anything about it. We know that is not true.
Q. What is the new center allowing you to provide that you couldn’t over on Flint?
Because of it’s location, suddenly people are realizing that there is a diabetes-endocrinology center. With the facilities that have been provided, it is becoming a nucleus for people to think about an expertise in diabetes care. Because of the space available, we can also have affiliated care. For example, I can have a podiatrist who can also be here so that patients with diabetes who come to the center don’t have to go somewhere else. We are thinking about more collaborations with people who are involved in weight loss surgery. Sometimes, that might help people who have diabetes with their glucose control. By elevating your presence, you are able to make many more collaborations. Right now, one of the things we’re working on is how to provide more support for people with diabetes outside the clinic. It’s a chronic disease where just providing support in the clinic may not be enough. I want to make sure that places outside in the community where they visit – say for example, the pharmacies, some of the stores – can provide them with more education. What people with diabetes need is the right education and the right information. If we can provide that, it helps to keep people with diabetes motivated and do the right things.
Q. Talk about the center itself.
It is approximately 9,000 square feet. We have three endocrine specialists who are all board certified. We have two nurse practitioners, two certified diabetes educators and one certified dietitian. We have a podiatry service. We do diabetes education classes in DeGraff Hospital, Buffalo General and Millard Fillmore Suburban. What we provide to patients with diabetes who come to see us is a team approach ... with the patients being in the center.
Q. How does this compare with the old place?
We were doing the same thing in Flint but it was crowded and we couldn’t think about some of these ancillary services which are important for people with diabetes.
Q. What attracted you to Buffalo?
The opportunity that was being provided by Dr. Dandona to get involved with the research he was doing.
Q. How does Buffalo compare to Calcutta and Manchester?
Calcutta is a bigger city. Manchester is a different environment. I think Buffalo is probably the best-kept secret in the U.S. It’s a great place to live and raise a family. It has got all the amenities of a big city without all the hassles, such as commuting time. It’s got fantastic schools and it provides you the opportunity if you do want to enjoy a big city, you have Toronto very, very close by. It’s very easy to get in and out of when you’re traveling.
Q. Is there any symbiosis in Maple West Plaza with Buffalo Therapy Services next door?
We don’t have a symbiosis at present, though when we start the diabetes program, one part will be physical activity that will need to be done and some exercise programs that will need to be done. We have talked about collaborating with them because we will need to make sure some of our patients will be able to do the exercising.
Q. How has the nature of treating diabetes and endocrine disorders changed in the 21 years since you’ve been in Buffalo?
Clearly, the number of patients with diabetes has increased. With the recent change in health care, I’m seeing more people with diabetes who have not received any care for the past 10 years or so, so they’re coming in with more complications. At the same time, in more recent years, we have a lot more therapies available to treat people with diabetes, so we can clearly do patient-centered care. We can design a treatment regimen with patients and work with their lifestyle in order to improve their blood sugars and help them with losing weight. The weight is higher than it used to be.
Q. What has led to the increased weight and increased numbers?
One thing is clearly the lifestyle. One of the things I’ve noticed is that people don’t realize the affect of portion sizes. Although they might be having three meals a day, the portion sizes have increased. And as far as physical activity is concerned, it has become more limited. In the downtown area, where I also have a clinic, I find that certain amenities are not available for people to lead a healthy lifestyle. If I ask people to eat a healthy diet, sometimes they don’t have stores that have healthy food which are easily accessible.
Q. How has the nature of treating diabetes and endocrine disorders changed during the last decade or two?
Around 20 years ago, people were not convinced that improving glucose was going to reduce the complications of diabetes. We have learned that we need to be very aggressive about getting people to their goal. I mention to people that they’ve got to focus on the ABCs of diabetes. The A is A1C, which tells them what their average blood sugar is. The B is the blood pressure and C is the cholesterol. We know that if people are getting to goal as to their ABCs, they will not get the complications of diabetes. I tell my patients it’s not the diabetes that causes complications, it’s the elevated blood sugars, blood pressure and cholesterol.
We have learned more about what causes the high blood sugars in diabetes, so now we have a lot more therapies available that we use in combination to get the blood sugars down without increasing the risk of glycemia, which is low blood sugar. We also have more therapies for helping people to lose weight. For people who are on insulin, we have better devices, better ways of monitoring blood sugars. Those are the kinds of things you’ll see when people come to a center.
Q. You also say people should get tested for prediabetes.
Exactly. Right now, we’re really suggesting that people start getting tested for diabetes after the age of 45. It’s a simple blood test to find out what the risk is. If people have a family history of diabetes, if they are overweight or have other problems like high blood pressure or cholesterol, or if women have had diabetes while they were pregnant, they should be tested earlier. Programs have shown that if you’re at risk for developing diabetes, with lifestyle changes, you can prevent diabetes by 58 percent.
Q. What is a typical day and week like for you? How much time do you spend here and what are the main responsibilities of the job?
Apart from diabetes, we treat thyroid conditions. There are six endocrine organs in the body. We treat pituitary problems that might manifest as problems with the menstrual period or sexual function, fatigue, dizziness. We also deal with problems of the adrenal glands. We also deal with endocrine issues of the ovaries and testosterone. Our research center in 2004 showed that one out of three men with diabetes who are also obese have low testosterone. We have just shown in a study if you replace testosterone in these men, you make them more sensitive to insulin. It’s helpful for them. And there is vitamin D deficiency in the area. That can lead to calcium problems. We also deal with calcium problems and osteoporosis.
Q. What is the endocrine system and what does it do?
It handles hormones, which has a wide variety of effects in almost every system of the body. A lot of times when people are getting symptoms that could be related to other organs of the body, if nothing is found you always have to think about if there could be a hormonal problem. Hormones travel from the glands all over the body and affect different systems.
Q. What tends to drive endocrine disorders?
Apart from diabetes, most of the others are not lifestyle-related. They tend to run in families. There could be something that it produced in the body that destroys the glands or causes them to hyperfunction.
Q. Kaleida is a main player on the Medical Corridor with projects that include Buffalo General Medical Center, Gates Vascular Institute and the John R. Oishei Children’s Hospital. Yet the chain also has demonstrated interest in operating outpatient clinics like this one. Why?
Right now, as a health system, we’re looking to be able to provide that full continuum of care to the patient.
Q. Another trend is more doctors are starting to work with health systems again after once having hung out their own shingle or work in a small group.
The way health care is moving and the way the reimbursement models are going to be, all of us understand we’ll have to operate as a group in improving care rather than focus on ourselves as individuals. What is happening is that cooperating as a group and collaborating with the hospitals, it’s providing us the opportunity to provide more cost-effective and quality care.
Q. Docs also are locking on to the reality that many of the conditions you’re treating are chronic.
Exactly. Previously, it was top down care. Everybody was concentrating on care in the hospital. Now, it’s really a bottom-up care. We are really saying there is somebody who’s out there in the community and I don’t want them to develop complications that will require hospitalization. The whole model has gone to a disease-prevention model, which I think is going to be very good for the community, especially with chronic conditions like diabetes, where previously it was difficult to access some of the resources or get reimbursed with some of the resources. With a disease-prevention model, there are a lot more resources that are available for patients.
Q. Are we likely to see another Diabetes-Endocrine Center of WNY pop up in another part of the region in the coming year or two?
Along with the center, and the UBMD Internal Medicine Group on Youngs Road in Amherst, there will be another center opening up at Erie County Medical Center. For patients in the downtown area, the access to a suburban locality might be difficult.
Q. We talked a couple of years back about tips to find a specialist in the midst of a New York State doctor crunch. You were brining on two more endocrinologists at the time. Is the shortage still an issue and, if so, what specialties remain the most problematic?
There is still a shortage of endocrinologists. We are planning to bring in one more endocrinologist when we open up the ECMC site. Clearly there are specialists who are also retiring, so that would create another shortage. There is also a shortage of primary care doctors, which is a very important specialty. I know both UB and Kaleida are trying to focus on how they can include recruitment and retention.
I’m the director of the Endocrine Fellowship Program, which is one of the largest programs in the country. I train eight endocrinologists in a span of two years. Fortunately, we have been able to retain some of our trainees. In fact, everybody who is working in the UBMD group has been trained here and there are three other endocrinologists in this area who are also UB endocrine graduates. Right now, I’m happy to report that I have my trainees working in academic institutions like Harvard Medical School, Temple University and the University of Texas. I have approximately 60 graduates peppered all over the country.
Q. Are the fellowship doctors who decided to stay from this area or did they feel they found a home here?
The three endocrinologists working in their own practices are from this area and the others we have retained were because of their research interests. They’re academically inclined. Based on the research they were doing, the only place that provided the expertise was here.
Q. Can you talk about the center and UB continuing research?
Right now, we are doing innovative research with Type 1 diabetes where we are using a novel approach in terms of improving glucose control, (federally) NIH and JDRF funded, pioneering studies where we were the first to discover these novel interventions. ... Till now, people with Type 1 diabetes were being treated with insulin and, in spite of their best efforts, still having a lot of fluctuations in their blood sugars. What we have shown is that by combining insulin with a couple of medications that are approved for people with Type 2 diabetes, we are able to reduce those fluctuations. We think that with the use of these combinations, 75 percent of people with Type 1 diabetes will get to their goal. We are looking for research subjects who have Type 1 diabetes and Type 2 diabetes. Those interested in participating can call 898-1944 or 898-1950.