Clinically, the division of endocrinology and metabolism provides outpatient care for patients with diabetes, obesity, bone disease, thyroid and parathyroid conditions, gender issues and other endocrine disorders at the UNCH Diabetes and Endocrinology Clinic at Meadowmont. Led by Dr. Josh Evron, our thyroid and endocrine tumor service line includes a weekly thyroid biopsy clinic at Meadowmont, and a monthly multi-disciplinary endocrine tumor conference with surgical oncology, ENT, pathology, and radiology. Led by Drs. Beth Harris and David Clemmons, we support the UNC Department of Neurosurgery’s Multidisciplinary Pituitary Tumor Clinic with an integrated multidisciplinary conference including our division, neurosurgery, ENT and supporting services.
UNCH Medical Weight Program
The UNCH Medical Weight Program led by Dr. Sriram Machineni provides integration between primary care, behavioral therapies, medical subspecialty care in the endocrinology clinic, and surgical care of obesity.
Clinically, the field of endocrinology is exploding with novel therapies in diabetes, obesity, bone disorders and pituitary disease. Our clinicians are skilled in using these cutting-edge therapies. In particular, GLP-1 receptor agonists and SLGT2 inhibitors have been shown to substantially reduce:
- cardiovascular events and mortality in patients with type 2 diabetes at high cardiovascular risk; and
- progression and mortality in patients with chronic kidney disease and heart failure with reduced ejection fraction, in people both with and without diabetes.
Not sure if your patient might benefit from one of these newer agents? Our eConsult program led by Dr. Maya Styner, provides for quick assessments that determine if there is something new to offer your patients. More than 120 endocrine eConsults were completed in FY2020 alone.
Diabetes Management Service
The inpatient consultative services led by Dr. Morgan Jones, in collaboration with multiple hospital services and departments have dramatically altered processes of care at UNC over the past two years. “Glucose precautions” focus on optimizing the timing of glucose testing, meal delivery and insulin administration. Diabetes education modules have been developed and training required of all nursing, nutrition and food services personnel. Combined with expert intervention by advanced practice providers, April Goley, FNP, Bonnie Alexander, PA, Veronica Hudson, PA, and Avni Garg, PA, in developing appropriate glucose targets and insulin dosing regimens, this effort has reduced hyperglycemia, hypoglycemia and variability in hospitalized patients at UNC.
Fracture Liaison Service
Outside the diabetes realm, the Fracture Liaison Service (FLS) is providing care to patients with hip fractures. Led by Donald Caraccio, MD, in the endocrine division, the inpatient endocrine service works with the UNC Hospitalist group to provide inpatient consultative care and improve transition to outpatient care after discharge for patients with osteoporosis. This has led to more patients being diagnosed with osteoporosis and improves access to medical therapies.
The division supports educational offerings in the UNC Schools of Medicine, Pharmacy, Public Health, Nursing and for the Physician’s Assistant Program. The Foundation Phase Endocrine Block ended November 2. Faculty and students worked hard to navigate remote learning with great success. Both the inpatient and outpatient endocrine teams continue to enjoy working with the housestaff as they learn first-hand about the intricacies of endocrine disease diagnosis and management. Our fellows and faculty are participating in a newly-instituted educational series that focuses on inclusiveness and unconscious bias in the care of endocrine patients. We support educational programs across the state and world including the division of geriatric medicine’s Dr. Marvin McBride’s ECHO training series on diabetes management.
UNC Diabetes & Obesity Clinical Trials Unit, Now Enrolling
In research, basic science programs in bone disease and metabolism are led by Drs. Janet Rubin, Maya Styner, and Eric Klett. The UNC Diabetes & Obesity Clinical Trials Unit conducts 15-20 trials at any given time and is currently enrolling for several studies for which we could use help:
- Phlebotomy as treatment: In collaboration with Wake Forest we are recruiting for an NIH-funded study of patients with pre-diabetes and diabetes. Preclinical and pilot studies support the notion that phlebotomy (1 unit every 2 months) until iron stores are at the lower end of the normal range improves glycemia and liver health.
- Rare and Atypical Diabetes: A national NIH-funded effort to discover novel forms of diabetes. If you have patients with diabetes associated with unusual manifestations or strong family histories, this study will use whole genome sequencing and advanced phenotyping to identify previously unrecognized genetic causes of diabetes.
- FLOW: A trial of subcutaneous semaglutide to prevent the progression of chronic kidney disease in type 2 diabetes
- SOUL: A trial of oral semaglutide to prevent cardiovascular events in patients with type 2 diabetes at high cardiovascular risk
- Icodec: A novel once weekly formulation of insulin recently featured in the New England Journal of Medicine for type 2 diabetes.
Our division has been fortunate to add three new faculty members this year. Dr. Donald Caraccio, is a former UNC Internal Medicine resident, turned hospitalist, who subsequently found his way to the UNC Endocrine Fellowship program. You will find Donald serving both on the inpatient service as well in the outpatient clinic. Dr. Shannon Aymes, joined the division as our second obesity medicine provider, bringing a focus in population health and policy from her training in Preventive Medicine. Finally Jamie Diner, FNP, is back. While earning her FNP at UNC, she worked at the UNC Diabetes Care Center as a study coordinator. After a stint in primary care practice, she returned to UNC to support both the clinical research program and as a provider specializing in type 1 diabetes management.
John Buse, MD, PhD
Division Chief