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Diabetes, Endocrinology & Metabolism Bookmark and Share

Diabetes

City of Hope’s Department of Clinical Diabetes, Endocrinology & Metabolism offers a comprehensive diabetes and endocrinology program combining groundbreaking research and unique treatments with patient education to help people living with diabetes and other endocrine diseases get the medical care and information they need to achieve optimal quality of life.
 
Recognized for its excellence in research, patient care and teaching, the department made its debut in 1971, marking the start of a new era in clinical and basic science diabetes research at City of Hope.
 
Diabetes Program
 
The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research building houses City of Hope's comprehensive diabetes research and treatment services.  We are committed to providing the highest quality diabetes clinical care programs and advanced training for physicians and scientists specializing in diabetes care and research.
 
Our diabetes program offers a multidisciplinary approach to advance research initiatives and patient care in several key areas:
 
Molecular Genetics and Drug Intervention
 
As diabetes is a multifactorial disease, understanding its genetic basis and molecular underpinnings is the subject of much ongoing research.  Drug discovery and drug design are focused on inhibiting undesirable reaction processes such as glycation.  Some of our research involves:
 
  • Discovering new genes, molecular signaling and cellular mechanisms that are involved in the development of diabetes and its complications
  • Continuing research efforts in inhibition of glycation and advanced glycation endproducts, thereby blocking or reversing long-term complications of diabetes
 
Addressing Complications of Diabetes
 
Diabetes brings a host of related complications, including nephropathy, neuropathy and cardiovascular disease. Understanding how to prevent and treat them is a vital part of managing diabetes patients. Some of our research in this area includes:
 
  • Advancing research efforts in cellular mechanisms of atherosclerosis and nephropathy
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 
Milestones in Diabetes Research and Treatment
 
  • 1949: Dr. Rachmiel Levine discovers the metabolic effects of insulin
  • 1968: Dr. Samuel Rahbar discovers HgbA1c and its role diabetes management
  • 1971: City of Hope establishes the Division of Diabetes
  • 1978: Drs. Arthur Riggs and Keiichi Itakura first engineer human insulin in the laboratory
  • 1982: Dr. Yoko Fujita-Yamaguchi isolates specific cell proteins that join with insulin and mediate its metabolic effects
  • Late 1980s: City of Hope enchances the Clinical Diabetes Care Program
  • 1991: City of Hope establishes the Diabetes Education Program
  • 1992: City of Hope establishes the Diabetes & Cardiovascular Risk Reduction Program
  • 1993: Drs. Rama Natarajan and Jerry Nadler conduct seminal research dealing with diabetic complications and islet cell dysfunction
  • 1993: Inaugural Community Diabetes Symposium held
  • 1994: City of Hope establishes the Male Sexual Medicine Program
  • 1997: Inauguration of Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center
  • 1997: Dr. Barry Forman identifies molecules that promote fat cell formation and affect insulin resistance in patients with type 2 diabetes
  • 2000: Inaugural International Rachmiel Levine Symposium on Diabetes and Obesity Research
  • 2001: City of Hope establishes the Southern California Islet Consortium
  • 2004: Dr. Fouad Kandeel leads first islet cell transplantation at City of Hope
  • 2003-2007: City of Hope's is the first program in the nation to train an endocrinologist as an islet transplant physician under UNOS regulations
  • 2011: Expansion of the Gonda Center more than doubles the available scientific space for diabetes research
 

Diabetes, Endocrinology & Metabolism Team

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone secreted by the islet cells of the pancreas needed to convert sugar and starches into energy needed for daily life. Normally glucose enters your cells because of the action of insulin. It acts as a key and assists glucose transport from the blood to the cell. In people with diabetes, the body does not produce enough insulin or the cells do not properly respond to the insulin, therefore, glucose accumulates in the bloodstream and eventually is excreted in the urine.
 
An estimated 20 million, or approximately 7 percent, of Americans have diabetes, and many more are at risk for developing the disease. With the rate of diabetes steadily increasing, the need for an aggressive search for better treatments and a cure is glaringly apparent.
 
Type 1 diabetes
In the past, this was known as juvenile-onset diabetes, or insulin dependent diabetes mellitus, an autoimmune disease in which the body's own immune system slowly destroys the cells in the pancreas (islet cells) that produce insulin. Insulin is a hormone that works to allow glucose access to the body's cells, thereby providing fuel for metabolic processes. The pancreas of a patient with type 1 diabetes produces little or no insulin and, therefore, such patients must take insulin injections to survive. Type 1 diabetes can occur at any age, but most commonly develops in children between the ages of 5 and 15.
 
Type 2 diabetes
Formerly referred to as adult-onset diabetes, or non-insulin dependent diabetes mellitus, type 2 diabetes is usually found in individuals who are more than 40 years old and overweight. In type 2 diabetes, insulin does not work effectively. Therefore, the insulin produced by the pancreas is not sufficient to keep the blood sugar level normal and the body's cells are unable to properly use glucose.
 
Maturity-onset Diabetes of the Young (MODY)
This form of diabetes is inherited, and can vary in severity. Most often, MODY resembles a very mild version of type 1 diabetes, with continued partial insulin production and normal insulin sensitivity. A person with MODY is typically in their teens or 20s and thin.
 
Gestational diabetes
Gestational diabetes develops during pregnancy in women who have never been diagnosed with diabetes. It occurs when the body is unable to properly use and produce enough insulin during pregnancy and as a result glucose levels rise. Symptoms usually occur during the second or third trimester when the babys body has developed and is growing.
 
Other causes of diabetes
Diabetes may also be caused as a result of organ transplants, certain types of cancers, as well as a host of medications (for cancer and other diseases).
 
If you are concerned about being at risk for diabetes, make sure your physician has done a thorough health history and is aware of all the medications you are taking.
 
Complications of diabetes
Unfortunately, the effects of uncontrolled diabetes can be harmful. Complications stem from damage to blood vessels and nerves throughout the body. As a result, diabetic eye disease, kidney disease, vascular disease and nerve damage can occur.
 
More educational information
For more about diabetes education, visit the American Diabetes Association and/or the Juvenile Diabetes Foundation websites, or contact City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism at 626-256-HOPE (4673), ext. 62251.
 

Diabetes, Endocrinology and Metabolism Treatment Programs

Treatment options and approaches for diabetes and endocrinology are more plentiful than ever.  Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
 
Continuous Glucose Monitoring (CGM)
Monitoring blood glucose over several days can help determine and individual’s blood glucose patterns and trends.  Your diabetologist may determine that placing you on a short term continuous glucose monitor will provide information that can be used to better manage your diabetes.

Continuous glucose monitoring device (CGM) is an FDA-approved system that records blood glucose levels throughout the day and night. It can provide up to 288 blood glucose measurements in a period of 24 hours. The system is used to monitor blood glucose changes through a given period of time, while the person with diabetes continues daily activities. The major advantage of CGM is to identify fluctuations and trends that would otherwise go unnoticed with intermittent finger stick measurements, especially blood glucose levels during sleep or first thing in the morning.

A small glucose-sensing device called a "sensor" will be inserted under the skin of abdomen. Tape is used to hold it in place. The blood glucose readings will be transmitted to an external receiver capable of graphing and trending your glucose readings.  However, at least  two finger stick blood glucose readings taken with a standard glucose meter every 12 hours are required for calibration and safety.

For the short-term use of CGM, there are up to four visits included in the program:
  • Initial consultation with a diabetologist to define the goal, need, and expectations of CGM
  • Placement of CGM sensor and instructions provided by a certified diabetes educator
  • Removal of CGM and download of readings provided by a certified diabetes educator
  • Follow-up visit with a diabetologist for data interpretation and adjustment of diabetes regimen
 
Insulin Therapy
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes.  Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. Now, recombinant human insulin is the standard treatment, and may be administered in several ways, such as:
 
Daily injections
Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
 
Insulin infusion
In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
 
Insulin Pump Therapy
City of Hope offers a comprehensive insulin pump program for patients interested in insulin pump therapy.  Our team of very dedicated health care professionals with extensive experience in both adult and pediatric insulin pump therapy are here to help you determine if insulin pump therapy is right for you.
 
An insulin pump is an FDA-approved device used as an alternative method of insulin delivery that provides a much smoother insulin profile with some flexibility to meet individual needs, and can be used in patients with both type 1 and type 2 diabetes as well as diabetes from other causes, such as total removal of the pancreas for various reasons.  Patients with a very strong motivation in improving glycemic control, diligent in their daily management, and a capacity and willingness for frequent blood glucose testing are best suited for using the insulin pump.  In order to master the skills for insulin pump therapy, you must be confident and compliant with your diabetes self-care skills on a daily basis. Furthermore, the eligibility of insulin pump is highly variable depending upon insurance policies.
 
At City of Hope, the diabetologist will meet with you in consultation before entering the insulin pump program to decide if insulin pump therapy is the best treatment to meet your personal needs and goals.  If you decide that insulin pump therapy is for you, you will begin the three step process.
 
Step One: Pre-pump Assessment and Counseling
To be successful with insulin pump therapy, we emphasize these pre-requisitions that are required before initiation of insulin pump therapy:
  • Assessing your general knowledge of diabetes
  • Education on the benefits and risks of using an insulin pump
  • Discussing how the insulin pump will change your life, and the lives of your significant others
  • Determine your ability to meet the demands of pump therapy, financially, physically, and psychologically
  • Assessment of your ability to handle situations such as hypoglycemia, hyperglycemia, exercising with the insulin pump, temporary pump removal, and sick days, as well as any dietary changes
  • Instructing you on how to make insulin dose adjustments based on prevailing blood glucose, carbohydrate intake, and anticipated activity
Once you have completed the pre-pump assessment and counseling, we will help you obtain your insulin pump through your insurance plan, if eligible.
 
Step Two: Initiation of Insulin Pump Training
You will be trained by an insulin pump nurse, who is specialized in the type of insulin pump recommended by the team and chosen by you, for pump operation, catheter insertion, and daily care of your insulin pump. Then, you will meet with a certified diabetes educator to ensure the competency of insulin pump operation and to determine the daily insulin requirement. Insulin pump therapy will be started after your visit with an experienced diabetologist to determine the initial insulin pump setting.

Step Three: Insulin Pump Therapy Optimization
After initiation of insulin pump therapy, intense blood glucose monitoring, up to 6 to 12 times a day, is required.  Intense telephone follow-up for fine tuning of your insulin regimen with the members of the insulin pump program is essential to ensure a successful insulin pump therapy.  In addition, we recommend weekly follow-up visits with the certified diabetes educators and diabetologists for the first few months. We will provide 24-hour access and frequent phone contact after starting and using the insulin pump.  We will continue to provide this support depending on your individual need.
 
Male and Female Sexual Dysfunction (primary and secondary)
  • Management of male and female sexual dysfunction in premature gonadal/ovarian failure patients
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 
Neuroendocrine Tumors (carcinoids, pancreatic endocrine tumors, etc.)
These tumors present a significant challenge both at diagnosis and in treatment. Research efforts include:
  • Advancing the management of neuroendocrine tumors with the use of radioactive iodine MIBG
 
Non-Endocrine Cancers
  • Investigation of endocrine complications as a result of chemotherapy, radiation therapy and bone marrow transplant in cancer patients.
  • Management of immunosuppressive therapy-related endocrine complications.
  • Development of clinical practice guidelines for the management of hypothalamic-pituitary endocrine complications after bone marrow transplant.
  • Aggressive prevention and treatment of bone marrow transplant osteoporosis in both men and women.
 
Thyroid Cancer
After thyroid cancer surgery, standard treatment consists of radioiodine to ablate residual tumor cells.  However, we have been exploring methods of augmenting or supplanting this therapy. Initiatives include:
  • Continued clinical research in thyroid cancer exploring new diagnostic and therapeutic alternatives to radioactive iodine therapy
  • Providing compassionate use of recombinant human thyroid stimulating hormone (Thyrogen) for thyroid cancer therapy
 
 
For more information, please contact us at 626-256-HOPE (4673), ext. 62251.
 

Research and Clinical Trials

City of Hope has promoted an aggressive program of pioneering research in all aspects of endocrine diseases, from decoding their genetic and molecular underpinnings to developing pharmaceutical and biological-based therapies for their management. Management of these diseases encompasses a myriad of considerations. Leading-edge techniques such as islet cell transplantation may one day result in a cure for type 1 diabetes. But until a cure is found, optimal therapies must be found to keep the disease in check. Type 2 diabetes is prevalent in the United States, and islet cell transplantation is not a solution because type 2 diabetes is not insulin dependent. Therefore, research centers on drug therapies to both control diabetes itself and prevent its attendant complications such as heart disease, stroke, limb amputations and blindness.
 
Promising research is also taking place in non-diabetic endocrine disorders. Thyroid cancer rates continue to rise, perhaps due to environmental factors. While most types of thyroid cancer are treatable surgically, diligent follow-up is necessary to prevent recurrence. New methods of destroying residual thyroid tissue after surgery such as Thyrogen (thyrotropin) are thus being tested. Neuroendocrine tumors such as carcinoids and pheochromocytoma are also being treated with new investigational therapies.
 
City of Hope’s multidisciplinary team of basic science and clinical researchers consistently strives to develop novel and effective therapies to better the lives of patients with diabetes and other endocrine disorders.
 
Learn more about our clinical trials program and specifically about clinical trials for diabetes and endocrinology.
 

Living with Diabetes - Resources and Supportive Care

Our patients are encouraged to take advantage of the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Certified Diabetes Nurse Educators
City of Hope employs certified diabetes educators who are part of the health care team. Our diabetes educators are also registered nurses whose role is to be a teacher, counselor and coordinator of care for people with diabetes. The diabetes nurse will make sure the patient and, when possible, the patient's family or other support people understand all doctor's orders and the many aspects of the disease. This may include information about medications, how to monitor and interpret blood glucose levels, the importance of exercise, a realistic food plan, dealing with emotions, and when other health team members need to be called upon. Because diabetes is a chronic, progressive and serious disease, support over the long-term is essential to successful management.
 
Diabetes and Cardiovascular Risk Reduction Program (DCVRRP)
The Department of Clinical Diabetes, Endocrinology and Metabolism offers a comprehensive medical, nutritional and behavioral management program aimed at reducing obesity associated health risks.  This is achieved through safe and consistent weight reduction of high-risk patients who are at least 30% or 50 pounds above ideal body weight and have one or more of the following medical problems: diabetes, high blood pressure, high cholesterol, sleep apnea, heart disease, polycystic ovary syndrome, disabling joint disease, chronic obstructive pulmonary disease, and/or breast cancer one-year after completion of therapy.

Duration of the intensive risk management (phase 1) is six months and transition (phase 2) is six months for a total of one year.  For more information, please contact us at 626-256-HOPE (4673), ext. 62251.
 
Diabetes Education Program
Research clearly shows that complications of diabetes can, in many cases, be prevented if proper education and treatment are given soon after diagnosis.  For this reason, City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism is dedicated to educating and helping people with diabetes manage and take control of their disease.  The adult Diabetes Education Program is accredited by the American Diabetes Association. In the four class series, participants learn:
 
  • Proper diet, exercise and lifestyle changes to help manage diabetes
  • Latest advances in diabetes research and treatment
  • Information to gain a better understanding of the disease, empowering each person to take control of their disease by learning self-management skills
 
You may be referred by your primary care physician or refer yourself by calling City of Hope.  You can also contact the diabetes nurse educator at 626-256-HOPE (4673), ext. 65640 with any questions and/or to obtain a current schedule of classes.
 
 
Additional Resources
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
800-DIABETES (800-342-2383)
The American Diabetes Association leads the fight against the consequences of diabetes and the fight for those affected by diabetes.
 
866-44-ISLET (866-444-7538)
The mission of the City of Hope ICT program is to address the problems currently facing islet transplantation and catalyze advancements in the field by sharing the vast and unique resources and expertise available in Southern California.
 
800-533-CURE (800-533-2873)
JDRF is the leading global organization funding type 1 diabetes (T1D) research.  JDRF’s goal is to progressively remove the impact of T1D from people’s lives until we achieve a world without T1D.  JDRF collaborates with a wide spectrum of partners and is the only organization with the scientific resources, regulatory influence, and a working plan to better treat, prevent, and eventually cure T1D.

National Comprehensive Cancer Network (NCCN)
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.

National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
 
 

Professional Education and Training

Endocrine Fellowship Program
An important commitment of the department is to provide state-of-the-art training for physicians wishing to specialize in endocrinology. To that end, the department offers the Endocrine Fellowship Program in association with Harbor-UCLA Medical Center. Fellows receive rigorous training in all aspects of endocrinology, with heavy emphasis on new therapeutic directions in diabetes treatment and exploration of a wide variety of endocrine cancers.
 
Rachmiel Levine Diabetes and Obesity Symposium
Each year, City of Hope hosts an annual diabetes and obesity symposium in memory of the late Dr. Rachmiel Levine, the scientist responsible for clarifying the nature of insulin action.  The Annual Rachmiel Levine Diabetes and Obesity Symposium covers recent scientific advances in diabetes and highlights the results of recent diabetes clinical trials.  It also includes poster sessions where promising trainees can present their work, and debate sessions with world leaders in areas of controversy in diabetes research and clinical care.
 

Basic Science Research

Basic science research in biochemistry and immunology provides the foundation that drives the development of new therapies for diabetes and other endocrine diseases.  Investigators in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research work closely with clinical researchers in the Department of Clinical Diabetes, Endocrinology and Metabolism and are conducting a number of important basic science research studies, including those described below:
  • Battling the complications of diabetes
  • Gene and cell-based therapies
  • Islet encapsulation and isolation
  • Islet imaging
  • Islet isolation and distribution
  • Islet quality assessment
  • New drug discoveries
  • Stem cell biology and development
  • Translational immunology
 
Researchers in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research:
 
Ismail Al-Abdullah, Ph.D.: Islet cell isolation.
 
Sanjay Awasthi, M.D.: Diabetes and cancer.
 
Kevin Ferreri, Ph.D.: Islet cell transplantation; epigenetics; and diabetic biomarkers.
 
Wendong Huang, Ph.D.: Genetic and epigenetic regulation of diabetes; stem cell and drug development for diabetes.
 
Janice Huss, Ph.D.: Characterization of transcriptional mechanisms regulating skeletal muscle metabolic adaptations during growth and differentiation and in response to physiologic stress; an the etiologic role of orphan nuclear receptors in obesity and type 2 diabetes.
 
Fouad R. Kandeel, M.D., Ph.D.: Islet cell transplantation.
 
Hsun Teresa Ku, Ph.D.: In vitro differentiation of human and mouse embryonic stem cells towards pancreatic lineage cells; and identification, purification and characterization of embryonic and adult pancreatic stem/progenitor cells.
 
Chih-Pin Liu, Ph.D.: Development of methods to induce immune tolerance; identification of novel cellular and molecular targets to improve cell-based therapy for diabetes.
 
Yoko Mullen, M.D., Ph.D.: Extrahepatic islet transplantation; and prevention of islet loss for transplantation.
 
Rama Natarajan, Ph.D.: Identification of the molecular mechanisms underlying the accelerated cardiovascular and renal disease observed in diabetic patients and in obese subjects; role of epigenetics and microRNAs, and other non-coding RNAs; and inflammatory responses in islet destruction.
 
Defu Zeng, M.D.: Induction of mixed chimerism for reversal of autoimmunity; beta cell regeneration; and transplantation immune tolerance.

 

 

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Donor Relations Department at 800-667-5310 or developmentrelations@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 

Diabetes, Endocrinology & Metabolism

Diabetes

City of Hope’s Department of Clinical Diabetes, Endocrinology & Metabolism offers a comprehensive diabetes and endocrinology program combining groundbreaking research and unique treatments with patient education to help people living with diabetes and other endocrine diseases get the medical care and information they need to achieve optimal quality of life.
 
Recognized for its excellence in research, patient care and teaching, the department made its debut in 1971, marking the start of a new era in clinical and basic science diabetes research at City of Hope.
 
Diabetes Program
 
The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research building houses City of Hope's comprehensive diabetes research and treatment services.  We are committed to providing the highest quality diabetes clinical care programs and advanced training for physicians and scientists specializing in diabetes care and research.
 
Our diabetes program offers a multidisciplinary approach to advance research initiatives and patient care in several key areas:
 
Molecular Genetics and Drug Intervention
 
As diabetes is a multifactorial disease, understanding its genetic basis and molecular underpinnings is the subject of much ongoing research.  Drug discovery and drug design are focused on inhibiting undesirable reaction processes such as glycation.  Some of our research involves:
 
  • Discovering new genes, molecular signaling and cellular mechanisms that are involved in the development of diabetes and its complications
  • Continuing research efforts in inhibition of glycation and advanced glycation endproducts, thereby blocking or reversing long-term complications of diabetes
 
Addressing Complications of Diabetes
 
Diabetes brings a host of related complications, including nephropathy, neuropathy and cardiovascular disease. Understanding how to prevent and treat them is a vital part of managing diabetes patients. Some of our research in this area includes:
 
  • Advancing research efforts in cellular mechanisms of atherosclerosis and nephropathy
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 
Milestones in Diabetes Research and Treatment
 
  • 1949: Dr. Rachmiel Levine discovers the metabolic effects of insulin
  • 1968: Dr. Samuel Rahbar discovers HgbA1c and its role diabetes management
  • 1971: City of Hope establishes the Division of Diabetes
  • 1978: Drs. Arthur Riggs and Keiichi Itakura first engineer human insulin in the laboratory
  • 1982: Dr. Yoko Fujita-Yamaguchi isolates specific cell proteins that join with insulin and mediate its metabolic effects
  • Late 1980s: City of Hope enchances the Clinical Diabetes Care Program
  • 1991: City of Hope establishes the Diabetes Education Program
  • 1992: City of Hope establishes the Diabetes & Cardiovascular Risk Reduction Program
  • 1993: Drs. Rama Natarajan and Jerry Nadler conduct seminal research dealing with diabetic complications and islet cell dysfunction
  • 1993: Inaugural Community Diabetes Symposium held
  • 1994: City of Hope establishes the Male Sexual Medicine Program
  • 1997: Inauguration of Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center
  • 1997: Dr. Barry Forman identifies molecules that promote fat cell formation and affect insulin resistance in patients with type 2 diabetes
  • 2000: Inaugural International Rachmiel Levine Symposium on Diabetes and Obesity Research
  • 2001: City of Hope establishes the Southern California Islet Consortium
  • 2004: Dr. Fouad Kandeel leads first islet cell transplantation at City of Hope
  • 2003-2007: City of Hope's is the first program in the nation to train an endocrinologist as an islet transplant physician under UNOS regulations
  • 2011: Expansion of the Gonda Center more than doubles the available scientific space for diabetes research
 

DEM Team

Diabetes, Endocrinology & Metabolism Team

About Diabetes

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone secreted by the islet cells of the pancreas needed to convert sugar and starches into energy needed for daily life. Normally glucose enters your cells because of the action of insulin. It acts as a key and assists glucose transport from the blood to the cell. In people with diabetes, the body does not produce enough insulin or the cells do not properly respond to the insulin, therefore, glucose accumulates in the bloodstream and eventually is excreted in the urine.
 
An estimated 20 million, or approximately 7 percent, of Americans have diabetes, and many more are at risk for developing the disease. With the rate of diabetes steadily increasing, the need for an aggressive search for better treatments and a cure is glaringly apparent.
 
Type 1 diabetes
In the past, this was known as juvenile-onset diabetes, or insulin dependent diabetes mellitus, an autoimmune disease in which the body's own immune system slowly destroys the cells in the pancreas (islet cells) that produce insulin. Insulin is a hormone that works to allow glucose access to the body's cells, thereby providing fuel for metabolic processes. The pancreas of a patient with type 1 diabetes produces little or no insulin and, therefore, such patients must take insulin injections to survive. Type 1 diabetes can occur at any age, but most commonly develops in children between the ages of 5 and 15.
 
Type 2 diabetes
Formerly referred to as adult-onset diabetes, or non-insulin dependent diabetes mellitus, type 2 diabetes is usually found in individuals who are more than 40 years old and overweight. In type 2 diabetes, insulin does not work effectively. Therefore, the insulin produced by the pancreas is not sufficient to keep the blood sugar level normal and the body's cells are unable to properly use glucose.
 
Maturity-onset Diabetes of the Young (MODY)
This form of diabetes is inherited, and can vary in severity. Most often, MODY resembles a very mild version of type 1 diabetes, with continued partial insulin production and normal insulin sensitivity. A person with MODY is typically in their teens or 20s and thin.
 
Gestational diabetes
Gestational diabetes develops during pregnancy in women who have never been diagnosed with diabetes. It occurs when the body is unable to properly use and produce enough insulin during pregnancy and as a result glucose levels rise. Symptoms usually occur during the second or third trimester when the babys body has developed and is growing.
 
Other causes of diabetes
Diabetes may also be caused as a result of organ transplants, certain types of cancers, as well as a host of medications (for cancer and other diseases).
 
If you are concerned about being at risk for diabetes, make sure your physician has done a thorough health history and is aware of all the medications you are taking.
 
Complications of diabetes
Unfortunately, the effects of uncontrolled diabetes can be harmful. Complications stem from damage to blood vessels and nerves throughout the body. As a result, diabetic eye disease, kidney disease, vascular disease and nerve damage can occur.
 
More educational information
For more about diabetes education, visit the American Diabetes Association and/or the Juvenile Diabetes Foundation websites, or contact City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism at 626-256-HOPE (4673), ext. 62251.
 

Treatment Programs

Diabetes, Endocrinology and Metabolism Treatment Programs

Treatment options and approaches for diabetes and endocrinology are more plentiful than ever.  Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
 
Continuous Glucose Monitoring (CGM)
Monitoring blood glucose over several days can help determine and individual’s blood glucose patterns and trends.  Your diabetologist may determine that placing you on a short term continuous glucose monitor will provide information that can be used to better manage your diabetes.

Continuous glucose monitoring device (CGM) is an FDA-approved system that records blood glucose levels throughout the day and night. It can provide up to 288 blood glucose measurements in a period of 24 hours. The system is used to monitor blood glucose changes through a given period of time, while the person with diabetes continues daily activities. The major advantage of CGM is to identify fluctuations and trends that would otherwise go unnoticed with intermittent finger stick measurements, especially blood glucose levels during sleep or first thing in the morning.

A small glucose-sensing device called a "sensor" will be inserted under the skin of abdomen. Tape is used to hold it in place. The blood glucose readings will be transmitted to an external receiver capable of graphing and trending your glucose readings.  However, at least  two finger stick blood glucose readings taken with a standard glucose meter every 12 hours are required for calibration and safety.

For the short-term use of CGM, there are up to four visits included in the program:
  • Initial consultation with a diabetologist to define the goal, need, and expectations of CGM
  • Placement of CGM sensor and instructions provided by a certified diabetes educator
  • Removal of CGM and download of readings provided by a certified diabetes educator
  • Follow-up visit with a diabetologist for data interpretation and adjustment of diabetes regimen
 
Insulin Therapy
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes.  Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. Now, recombinant human insulin is the standard treatment, and may be administered in several ways, such as:
 
Daily injections
Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
 
Insulin infusion
In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
 
Insulin Pump Therapy
City of Hope offers a comprehensive insulin pump program for patients interested in insulin pump therapy.  Our team of very dedicated health care professionals with extensive experience in both adult and pediatric insulin pump therapy are here to help you determine if insulin pump therapy is right for you.
 
An insulin pump is an FDA-approved device used as an alternative method of insulin delivery that provides a much smoother insulin profile with some flexibility to meet individual needs, and can be used in patients with both type 1 and type 2 diabetes as well as diabetes from other causes, such as total removal of the pancreas for various reasons.  Patients with a very strong motivation in improving glycemic control, diligent in their daily management, and a capacity and willingness for frequent blood glucose testing are best suited for using the insulin pump.  In order to master the skills for insulin pump therapy, you must be confident and compliant with your diabetes self-care skills on a daily basis. Furthermore, the eligibility of insulin pump is highly variable depending upon insurance policies.
 
At City of Hope, the diabetologist will meet with you in consultation before entering the insulin pump program to decide if insulin pump therapy is the best treatment to meet your personal needs and goals.  If you decide that insulin pump therapy is for you, you will begin the three step process.
 
Step One: Pre-pump Assessment and Counseling
To be successful with insulin pump therapy, we emphasize these pre-requisitions that are required before initiation of insulin pump therapy:
  • Assessing your general knowledge of diabetes
  • Education on the benefits and risks of using an insulin pump
  • Discussing how the insulin pump will change your life, and the lives of your significant others
  • Determine your ability to meet the demands of pump therapy, financially, physically, and psychologically
  • Assessment of your ability to handle situations such as hypoglycemia, hyperglycemia, exercising with the insulin pump, temporary pump removal, and sick days, as well as any dietary changes
  • Instructing you on how to make insulin dose adjustments based on prevailing blood glucose, carbohydrate intake, and anticipated activity
Once you have completed the pre-pump assessment and counseling, we will help you obtain your insulin pump through your insurance plan, if eligible.
 
Step Two: Initiation of Insulin Pump Training
You will be trained by an insulin pump nurse, who is specialized in the type of insulin pump recommended by the team and chosen by you, for pump operation, catheter insertion, and daily care of your insulin pump. Then, you will meet with a certified diabetes educator to ensure the competency of insulin pump operation and to determine the daily insulin requirement. Insulin pump therapy will be started after your visit with an experienced diabetologist to determine the initial insulin pump setting.

Step Three: Insulin Pump Therapy Optimization
After initiation of insulin pump therapy, intense blood glucose monitoring, up to 6 to 12 times a day, is required.  Intense telephone follow-up for fine tuning of your insulin regimen with the members of the insulin pump program is essential to ensure a successful insulin pump therapy.  In addition, we recommend weekly follow-up visits with the certified diabetes educators and diabetologists for the first few months. We will provide 24-hour access and frequent phone contact after starting and using the insulin pump.  We will continue to provide this support depending on your individual need.
 
Male and Female Sexual Dysfunction (primary and secondary)
  • Management of male and female sexual dysfunction in premature gonadal/ovarian failure patients
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 
Neuroendocrine Tumors (carcinoids, pancreatic endocrine tumors, etc.)
These tumors present a significant challenge both at diagnosis and in treatment. Research efforts include:
  • Advancing the management of neuroendocrine tumors with the use of radioactive iodine MIBG
 
Non-Endocrine Cancers
  • Investigation of endocrine complications as a result of chemotherapy, radiation therapy and bone marrow transplant in cancer patients.
  • Management of immunosuppressive therapy-related endocrine complications.
  • Development of clinical practice guidelines for the management of hypothalamic-pituitary endocrine complications after bone marrow transplant.
  • Aggressive prevention and treatment of bone marrow transplant osteoporosis in both men and women.
 
Thyroid Cancer
After thyroid cancer surgery, standard treatment consists of radioiodine to ablate residual tumor cells.  However, we have been exploring methods of augmenting or supplanting this therapy. Initiatives include:
  • Continued clinical research in thyroid cancer exploring new diagnostic and therapeutic alternatives to radioactive iodine therapy
  • Providing compassionate use of recombinant human thyroid stimulating hormone (Thyrogen) for thyroid cancer therapy
 
 
For more information, please contact us at 626-256-HOPE (4673), ext. 62251.
 

Research/Clinical Trials

Research and Clinical Trials

City of Hope has promoted an aggressive program of pioneering research in all aspects of endocrine diseases, from decoding their genetic and molecular underpinnings to developing pharmaceutical and biological-based therapies for their management. Management of these diseases encompasses a myriad of considerations. Leading-edge techniques such as islet cell transplantation may one day result in a cure for type 1 diabetes. But until a cure is found, optimal therapies must be found to keep the disease in check. Type 2 diabetes is prevalent in the United States, and islet cell transplantation is not a solution because type 2 diabetes is not insulin dependent. Therefore, research centers on drug therapies to both control diabetes itself and prevent its attendant complications such as heart disease, stroke, limb amputations and blindness.
 
Promising research is also taking place in non-diabetic endocrine disorders. Thyroid cancer rates continue to rise, perhaps due to environmental factors. While most types of thyroid cancer are treatable surgically, diligent follow-up is necessary to prevent recurrence. New methods of destroying residual thyroid tissue after surgery such as Thyrogen (thyrotropin) are thus being tested. Neuroendocrine tumors such as carcinoids and pheochromocytoma are also being treated with new investigational therapies.
 
City of Hope’s multidisciplinary team of basic science and clinical researchers consistently strives to develop novel and effective therapies to better the lives of patients with diabetes and other endocrine disorders.
 
Learn more about our clinical trials program and specifically about clinical trials for diabetes and endocrinology.
 

Living with Diabetes

Living with Diabetes - Resources and Supportive Care

Our patients are encouraged to take advantage of the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Certified Diabetes Nurse Educators
City of Hope employs certified diabetes educators who are part of the health care team. Our diabetes educators are also registered nurses whose role is to be a teacher, counselor and coordinator of care for people with diabetes. The diabetes nurse will make sure the patient and, when possible, the patient's family or other support people understand all doctor's orders and the many aspects of the disease. This may include information about medications, how to monitor and interpret blood glucose levels, the importance of exercise, a realistic food plan, dealing with emotions, and when other health team members need to be called upon. Because diabetes is a chronic, progressive and serious disease, support over the long-term is essential to successful management.
 
Diabetes and Cardiovascular Risk Reduction Program (DCVRRP)
The Department of Clinical Diabetes, Endocrinology and Metabolism offers a comprehensive medical, nutritional and behavioral management program aimed at reducing obesity associated health risks.  This is achieved through safe and consistent weight reduction of high-risk patients who are at least 30% or 50 pounds above ideal body weight and have one or more of the following medical problems: diabetes, high blood pressure, high cholesterol, sleep apnea, heart disease, polycystic ovary syndrome, disabling joint disease, chronic obstructive pulmonary disease, and/or breast cancer one-year after completion of therapy.

Duration of the intensive risk management (phase 1) is six months and transition (phase 2) is six months for a total of one year.  For more information, please contact us at 626-256-HOPE (4673), ext. 62251.
 
Diabetes Education Program
Research clearly shows that complications of diabetes can, in many cases, be prevented if proper education and treatment are given soon after diagnosis.  For this reason, City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism is dedicated to educating and helping people with diabetes manage and take control of their disease.  The adult Diabetes Education Program is accredited by the American Diabetes Association. In the four class series, participants learn:
 
  • Proper diet, exercise and lifestyle changes to help manage diabetes
  • Latest advances in diabetes research and treatment
  • Information to gain a better understanding of the disease, empowering each person to take control of their disease by learning self-management skills
 
You may be referred by your primary care physician or refer yourself by calling City of Hope.  You can also contact the diabetes nurse educator at 626-256-HOPE (4673), ext. 65640 with any questions and/or to obtain a current schedule of classes.
 
 
Additional Resources
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
800-DIABETES (800-342-2383)
The American Diabetes Association leads the fight against the consequences of diabetes and the fight for those affected by diabetes.
 
866-44-ISLET (866-444-7538)
The mission of the City of Hope ICT program is to address the problems currently facing islet transplantation and catalyze advancements in the field by sharing the vast and unique resources and expertise available in Southern California.
 
800-533-CURE (800-533-2873)
JDRF is the leading global organization funding type 1 diabetes (T1D) research.  JDRF’s goal is to progressively remove the impact of T1D from people’s lives until we achieve a world without T1D.  JDRF collaborates with a wide spectrum of partners and is the only organization with the scientific resources, regulatory influence, and a working plan to better treat, prevent, and eventually cure T1D.

National Comprehensive Cancer Network (NCCN)
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.

National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
 
 

Professional Education/Training

Professional Education and Training

Endocrine Fellowship Program
An important commitment of the department is to provide state-of-the-art training for physicians wishing to specialize in endocrinology. To that end, the department offers the Endocrine Fellowship Program in association with Harbor-UCLA Medical Center. Fellows receive rigorous training in all aspects of endocrinology, with heavy emphasis on new therapeutic directions in diabetes treatment and exploration of a wide variety of endocrine cancers.
 
Rachmiel Levine Diabetes and Obesity Symposium
Each year, City of Hope hosts an annual diabetes and obesity symposium in memory of the late Dr. Rachmiel Levine, the scientist responsible for clarifying the nature of insulin action.  The Annual Rachmiel Levine Diabetes and Obesity Symposium covers recent scientific advances in diabetes and highlights the results of recent diabetes clinical trials.  It also includes poster sessions where promising trainees can present their work, and debate sessions with world leaders in areas of controversy in diabetes research and clinical care.
 

Basic Science Research

Basic Science Research

Basic science research in biochemistry and immunology provides the foundation that drives the development of new therapies for diabetes and other endocrine diseases.  Investigators in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research work closely with clinical researchers in the Department of Clinical Diabetes, Endocrinology and Metabolism and are conducting a number of important basic science research studies, including those described below:
  • Battling the complications of diabetes
  • Gene and cell-based therapies
  • Islet encapsulation and isolation
  • Islet imaging
  • Islet isolation and distribution
  • Islet quality assessment
  • New drug discoveries
  • Stem cell biology and development
  • Translational immunology
 
Researchers in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research:
 
Ismail Al-Abdullah, Ph.D.: Islet cell isolation.
 
Sanjay Awasthi, M.D.: Diabetes and cancer.
 
Kevin Ferreri, Ph.D.: Islet cell transplantation; epigenetics; and diabetic biomarkers.
 
Wendong Huang, Ph.D.: Genetic and epigenetic regulation of diabetes; stem cell and drug development for diabetes.
 
Janice Huss, Ph.D.: Characterization of transcriptional mechanisms regulating skeletal muscle metabolic adaptations during growth and differentiation and in response to physiologic stress; an the etiologic role of orphan nuclear receptors in obesity and type 2 diabetes.
 
Fouad R. Kandeel, M.D., Ph.D.: Islet cell transplantation.
 
Hsun Teresa Ku, Ph.D.: In vitro differentiation of human and mouse embryonic stem cells towards pancreatic lineage cells; and identification, purification and characterization of embryonic and adult pancreatic stem/progenitor cells.
 
Chih-Pin Liu, Ph.D.: Development of methods to induce immune tolerance; identification of novel cellular and molecular targets to improve cell-based therapy for diabetes.
 
Yoko Mullen, M.D., Ph.D.: Extrahepatic islet transplantation; and prevention of islet loss for transplantation.
 
Rama Natarajan, Ph.D.: Identification of the molecular mechanisms underlying the accelerated cardiovascular and renal disease observed in diabetic patients and in obese subjects; role of epigenetics and microRNAs, and other non-coding RNAs; and inflammatory responses in islet destruction.
 
Defu Zeng, M.D.: Induction of mixed chimerism for reversal of autoimmunity; beta cell regeneration; and transplantation immune tolerance.

 

 

Support This Program

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Donor Relations Department at 800-667-5310 or developmentrelations@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 
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Cancer patients need to have confidence in their treatment plans by exploring all possible options. Often that means they should get a second opinion.  For these four patients, getting a second opinion from experts at City of Hope was life-saving.
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