(gentle music)
>> My name is Nes Mathioudakis.
I'm an endocrinologist at Johns Hopkins Hospital
and clinical director of the Division of Endocrinology,
Diabetes, and Metabolism.
Endocrinologists diagnose and treat conditions
related to hormonal imbalances in the body.
Whether hormone levels are too high or too low,
the goal is really to restore normal hormone levels.
Hormones are produced by multiple glands
throughout the body.
Some examples are the pituitary gland
which is the master endocrine gland.
The thyroid, parathyroid glands, adrenal
and the pancreas which makes an important hormone, insulin,
and that's my particular area of expertise
within endocrinology.
It's diabetes.
I really see myself as an advocate for my patients.
I think patients should take a really front
and center role in their care
and, really, there are a lot of therapeutic options
available in endocrinology but choosing the one
that best fits a patient for their medical conditions
and their lifestyle requires a frank discussion.
I like to have a very open dialogue with my patients
and I'm there to really provide information
and ultimately guide them in selecting
the right choice for themselves.
My research focuses on two patient populations
with diabetes that are at really high risk
of adverse outcomes, so my work is really focused
on improving the safety and quality of care
for these patients.
The first group is hospitalized patients
with diabetes and the second is patients
with diabetic foot ulcers.
In terms of hospitalized patients,
it turns out that one in four patients
in the United States that's hospitalized
has diabetes or high blood glucose
and insulin is the recommended therapy
for the majority of these patients.
My research is really focused
on trying to identify those patients
that are at highest risk of having a low blood sugar
from insulin therapy and intervening before it happens.
To do this, I use machine learning
which is a form of artificial intelligence
where we look at millions of blood glucose observations
and other clinical data points from hospitalized patients
to develop a prediction model
that will actually flag a person
who's going to go low in the next 24 hours
with the goal being that we
would notify the healthcare provider.
In the diabetic foot ulcer realm,
the reason I got interested in that
is that I've been a member
of the Johns Hopkins Multidisciplinary
Diabetic Foot and Wound Clinic since 2012
and this was really established to try
to create coordinated care for patients
with diabetic foot ulcers.
I work with a wonderful team of a vascular surgeon,
surgical podiatrist, a wound care nurse,
and a diabetes nurse practitioner
to provide sort of a one-stop shop
for patients with diabetic foot ulcers
and we've had really impressive outcomes
in terms of wound healing,
diabetes control, and prevention of major amputations.
My particular research question in this area
is what role blood glucose control has
in clinical outcomes in patients
with established diabetic foot ulcers.
It's been really well established
that poor blood glucose control
over a long period of time
leads to nerve damage in the legs
and poor circulation which are the risk factors
for the ulcer developing.
But what's been less studied
and what's less understood
is once you have an ulcer,
what role does blood glucose control have on outcomes?
I chose endocrinology for several reasons.
First, endocrine conditions can be somewhat difficult
to diagnose and a lot of patients
have seen multiple specialists
trying to get an answer for what's causing their symptoms
and it's very rewarding to be the person
to actually identify the condition
that really explains things and,
more importantly, to be able to treat them.
That's one.
Another reason is that most
endocrine conditions are treatable.
We have hormones to replace deficiencies
if people are lacking hormones
and we have medical, surgical, or other treatments
if hormone levels are too high.
I also like the fact that, for diabetes,
there are non-medical treatments
that are very effective at controlling blood glucose,
so diet, physical activity, and weight loss,
and really working with patients and their families,
to be an advocate and a health coach for them
is very rewarding for me.
It's always great to see a patient
actually make changes in their lifestyle
and come back and see, you know,
dramatic reductions in their A1C
which will hopefully prevent complications in the long term.
(gentle music)