Teaching for Life: Diabetes Institute director is committed to value of education
Dr. Linda Siminerio, executive director of the University of Pittsburgh Diabetes Institute, is recognized for her pioneering efforts in diabetes education and management programs.
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At 13, she foresaw a future in diabetes education after an unfortunate episode during breakfast.
Dr. Linda M. Siminerio's father John Mulac had returned home from the hospital after being diagnosed with type 1 diabetes. But the next morning he had a seizure during breakfast, and no one understood why.
"I thought he had died with a grand mal seizure on the floor," Dr. Siminerio said. "No one ever told us this could happen."
Mr. Mulac and his family soon learned he'd taken too much insulin or hadn't eaten soon enough, causing low blood-glucose levels. Hypoglycemia, as it's called, causes shaking spells, profuse sweating and, in more serious cases, seizures and unconsciousness. Untreated, it can be deadly. To prevent it, a patient must ingest juice, sugar or quick-acting carbohydrates.
After watching her father struggle inside their McKeesport home, and learning it was an insulin reaction, Dr. Siminerio said she realized that diabetes education would have prevented it. Then and there she vowed to correct that oversight when she grew up.
"Wow, it's really weird that there is no one to teach this," she said, recalling her teenage reaction. "It seemed simple to me."
Decades later, she's turned those thoughts into reality. Dr. Siminerio has had a worldwide impact in promoting diabetes education and providing research to prove its value.
Education is essential, she said, to develop the skills to maintain normal or near-normal blood-sugar levels.
People must learn about medications, how to give insulin injections and how to balance injections or medications with food intake. One also must learn how to test blood sugar then consume food or drink when blood sugar levels dip too low. When levels rise too high, the person must exercise, take insulin or refrain from eating.
It's a tricky balancing act with potential for mistakes. As studies prove, knowledge leads to better management, while ignorance can prompt health complications and even death.
Nowadays, most people in the field recognize Dr. Siminerio's contributions in educating people with diabetes, which has become a worldwide epidemic. One fourth of the American population, or 75 million people, have the disease or show elevated sugar levels that can lead to diabetes.
She has authored or coauthored 37 published studies, various book chapters, and two books to help parents care for children with diabetes. She's also held leadership posts and editorships with the American Diabetes Association and the International Diabetes Federation, among many other organizations.
As leader of national and international task forces on diabetes, she espouses a philosophy that prevention and education are worth the expense. For example, she said, Children's Hospital fields 50 calls each morning from parents with questions about their children's problems. By providing advice over the phone, nurses and educators prevent many emergency room visits.
For that reason, she said, health-care providers would save health-care costs by reimbursing hospitals or education centers for telephone consultations with patients. No such reimbursement currently exists.
Dr. Andrew Stewart, chief of endocrinology and metabolism at the University of Pittsburgh School of Medicine, and Dr. Mary Korytkowski of UPMC's Center for Diabetes and Endocrinology, developed plans to open a diabetes institute, and UPMC backed the idea.
They hired Dr. Siminerio to put their brainchild into action. In 2000, the University of Pittsburgh Diabetes Institute opened with her as its only employee. The institute now promotes diabetes education programs, does research on various topics and develops policies to manage the disease.
Dr. Siminerio serves as its executive director with 25 people in the institute's Oakland headquarters, along with a force of certified diabetes educators in the University of Pittsburgh Medical Center's 19 hospitals.
With federal funding, she has established education programs in many rural hospitals that had no way to assist people with diabetes. More recently she's worked to place educators in primary care facilities in Fayette County and elsewhere so people can get advice and information during regular doctor's appointments.
The Diabetes Institute's programs school thousands each year on nutrition, exercise and disease management.
During a springtime speech at Indiana University of Pennsylvania, U.S. Rep. John Murtha, D-Johnstown, described Dr. Siminerio as "the hardest working" person in the field. She serves as the point person for various federal programs that Mr. Murtha has championed.
Whether it's the ADA, the Centers for Disease Control and Prevention, or the American Association of Diabetes Educators, she's an oft-quoted expert. She's traveled the world many times discussing education and diabetes.
"She's absolutely fantastic," said Dr. Allan L. Drash, the retired pediatric endocrinologist at Children's Hospital who hired her in 1972 then agreed with her idea to start a diabetes education center at the hospital. "She had tremendous energy and was very good with people. She has the talents to make things like that go without problems.
"I don't know anyone at that level who has done what she's done politically and day to day with the general work of the center," he said. "She's super."
Her father died in 1979 at 52 after suffering a series of strokes, one of the many complications of diabetes. Control in that era was difficult because there was no means to test blood sugar at home, making diabetes a "guessing game." Complications also can include heart disease, renal failure, nerve damage leading to amputations and blindness, among other ailments.
"It was no surprise why people had problems back then," Dr. Siminerio said. "I wanted to expand education so people know how it fits together and how these things work. You should be able to self-manage, but of course, you need direction."
Control remains difficult but is feasible now with new medications, insulin pumps, and blood glucose monitors, as long as people understand the disease and the process of control.
Dr. Siminerio received her nursing degree in 1972 at Penn State University, then a master's degree in child development and child care in 1978 from Pitt's School of Health Related Professions. She earned a doctoral degree in health education from Penn State in 1998.
Dr. Drash said Dr. Siminerio was the first nurse he hired at Children's. At the time, diabetes education programs were unheard of, and many doctors and healthcare officials discounted the need for them.
Dr. Drash, whom she describes as her mentor, pioneered modern diabetes care, having published hundreds of studies and doing speaking engagements around the world.
The educational program Dr. Siminerio developed at Children's Hospital included a diabetes camp for children. The ADA-sponsored camp is held each year at Camp Crestfield, near Slippery Rock, Butler County. To save time for diabetes educators, the institute has developed a questionnaire to evaluate a patient's willingness to follow treatment regimens and outline a course of action. Without the process, educators would spend countless hours questioning patients to gauge their willingness to follow a treatment regimen.
Tests already prove its value, and Dr. Siminerio now is working to have Medicare adopt and pay for the process. She also has done considerable work in developing chronic-care management models for Gov. Ed Rendell for diabetes treatment statewide.
But Dr. Siminerio said pharmacists and nurses could serve as educators and answer questions about medications, testing equipment, diet and exercise. Nurses could be trained to adjust medications and suggest lifestyle changes for people struggling with control.
For now, doctors must make those decisions.
Centers for diabetes education and management also could be established based on the MedExpress model, where people can walk in for service when needed. Such centers could be placed in malls or Wal-Mart stores.
"I believe that if we put money into educational resources, we would save health-care costs," Dr. Siminerio said.
But it's important, she said, that experts are "all singing off the same song sheet" to kick-start such statewide and national projects. Key is adopting standards of care based on science.
It's just the latest of ideas that have been roiling around in her mind ever since that fateful breakfast.
First Published October 10, 2007 12:00 am