Endocrinologist Ruth Weinstock MD, PhD, was first drawn to a career in diabetes care and research because of her cousin, who collapsed in high school gym class due to diabetic ketoacidosis (DKA).
“I didn’t know anything about type 1 diabetes before that,” Dr. Weinstock says.
She learned about it as she watched her cousin struggle in an era before blood glucose monitoring, pumps, sensors, or human or analog insulins. After decades of complications, Weinstock’s cousin died a day after her 51st birthday.
“I didn’t want other people to go through that,” Dr. Weinstock says.
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She embarked on a career of award-winning research and medicine, earning MD and PhD degrees from Columbia University in New York and then becoming the division chief of Endocrinology, Diabetes, and Metabolism at State University of New York (SUNY) Upstate Medical University.
At this point in her clinical career, Dr. Weinstock says she is struck by a paradox. While now there are more devices, tools, and medicines than ever to help individuals with type 1 diabetes, the resources to give people access to these tools or to teach them how to use these tools are shrinking. Most people can’t afford to pay for a continuous glucose monitoring device out of pocket, and many even with insurance, she says. Even if a device is approved by insurance, she says, there are still hurdles to getting started with new diabetes therapies, including high co-pays. Some of Dr. Weinstock’s Medicaid patients have plans that only pay for one hour of diabetes education every six months, leaving patients on their own too much of the time and/or diabetes centers providing needed services that are not reimbursed.
“It is a struggle, honestly, to get people what they need,” she says.
The challenges extend to getting people access to even the basics – like insulin. To help them, Dr. Weinstock has had to be tenacious—and creative. For example, Dr. Weinstock and her team enroll some patients in clinical trials to test new insulins against older insulins, which gives them free insulin.
In her quest to improve care for her patients, Dr. Weinstock has joined the T1D Exchange Quality Improvement (QI) Collaborative, a network of 10 diabetes centers with the common goal of improving care for people with type 1 diabetes using quality improvement methods developed by T1D Exchange. Clinic members brainstorm and make small changes in their practices in short cycles of duration, and then measure the results. Successes are then shared and implemented throughout the network.
One of the Collaborative’s first efforts Dr. Weinstock oversaw at SUNY focused on depression. Using the QI methods in partnership with the Collaborative, the SUNY team went from not offering patients with type 1 diabetes screening for depression to evaluating more than 90 percent of children and adults with type 1 diabetes for depression. Using data and experiences generated by these efforts and those of other Collaborative members, the SUNY team was able to justify hiring a full-time social worker, who could also provide counseling services. As a next step, the SUNY team is working with the QI Collaborative to improve its program to help teenagers with type 1 diabetes transition to adult providers, and to reduce the number of adolescents and young adults with poor glycemic control.
“I am so appreciative of the Collaborative,” Dr. Weinstock sums. “It helped us a lot in thinking about our systems and giving us ideas for different approaches…If we share our best practices, even with all the challenges, we will all get better.”