Stroll down the main hallway of theJoslin Diabetes Centerin Boston, Massachusetts, and you’ll know right away why the adjective often connected to their name is “storied.”
图形时间表延伸到了那个走廊，一遍又一遍地分享了起源于糖尿病护理的突破。从早期的开创性努力Dr. Elliot Joslin简单地让糖尿病患者活着，（几乎正好在100年前）向人类患者施用的第一批胰岛素镜头，以进行治疗的突破以及如何和为什么提供护理的进步，这个传奇的研究和护理中心长期以来一直处于带头。
今年，有CEO Dr. Roberta Herman与马萨诸塞州剑桥市建立新的合作伙伴关系贝丝以色列利希健康（BILH）, Joslin hopes to not just honor that history, but to continue progress towards better treatment, less stressful access, and of course, an eventual cure.
Joslin is the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education. It employs 600 people and has satellite clinics across Massachusetts, Maryland, Illinois, and New Jersey. BILH has more than 4,800 physicians and 36,000 employees.
“在一起，我们是代谢研究的强大力量，”赫尔曼告诉糖尿病。
赫尔曼（Herman）在小时候就失去了母亲，患有慢性病，多年来一直在初级保健领域担任领导职务，后来又担任哈佛大学朝圣者医疗保健公司（Harvard Pilgrim Health Care）的首席运营官，该保健是美国最大的保险公司之一。她于2020年1月在Covid-19-19大流行中接管了乔斯林糖尿病中心的领导。
DiabetesMine spoke with her recently about marking the legendary history of Joslin and the胰岛素100周年, as well as the outlook on the current and future state of diabetes care.
Herman reminded us that Dr. Fredrick Banting — co-discoverer of insulin — and his team administered insulin to thefirst-ever patient, Canadian teenager Leonard Thompson, 100 years ago on Jan. 11, 1922.
After that, the team knew they had to get insulin into the hands of doctors who understood diabetes and could bring insulin use up to speed quickly.
Elliot Joslin was an obvious choice. The Yale and Harvard graduate was motivated to study and treat diabetes after his mother and aunt were diagnosed with the then usually-fatal condition.
While he did not discover insulin, he did — among many other things — create the world’s first diabetes registry, treat patients before insulin with diet to keep them alive (his aunt lived a then-astonishing 13 years with his plan), push for tighter control for better health (something that would not be validated until the landmark
Joslin was always about finding a way to live — and live long — with this disease.
He was a master at teaching how to live with the condition, as well as a promoter of education as a vital part of treatment.
Some of his most famous quotes still stand up today:
“The diabetic who knows the most, lives the longest.”
“It’s better to discuss how far you have walked, than how little you have eaten.“
“A well-trained nurse is of more value than the patient’s doctors.”
Today, education, healthy living, and good team support from not just from doctors, but from nurses and other healthcare providers is considered crucial to successful diabetes care.
By the time he passed away in 1962, Joslin had helped with the discovery and early use of home blood glucose meters, empoweredDr. Priscilla White为了帮助糖尿病女性成功分娩和抚养孩子的计划，为仍然是1型糖尿病（T1D）的最具影响力的计划奠定了基础。奖章研究, and established his Joslin Clinic — sitting in the same place it sits now — as a world leader in care and breakthroughs.
Over the years, the Joslin Center has been responsible for a number of advancements that have improved the lives of people with diabetes.
TheBeetham Eye Institute,赫尔曼说，位于乔斯林中心的内部，是高质量护理（可访问）如何改善生活的一个光辉的例子。
That institute has been treating diabetes and eye disease for decades, offering the first laser surgery to stop sight loss back in 1967. Today, as乔治·金博士3年前，他们在JDRF全国会议上告诉人群，他们已经将长期糖尿病患者的视力丧失从40％降低到不到1％。
赫尔曼说，证据就在贝瑟姆的候诊室里。
“Fifty years ago, there were as many seeing eye dogs as patients [here],” she said. “Now, there are almost none.”
她说，即使是最近被认为是变革型的激光手术也正在成为老学校。如今，他们可以大部分地区使用药物治疗和预防糖尿病眼病。
“That’s a huge clinical accomplishment,” she said. “But more needs to be done.”
乔斯林的儿科护理中心is relatively new in comparison to the 100-year-old-plus Joslin program. It continues to focus on creating a program that supports the entire family, Herman said.
“It’s a family affair,” she said of having a child with T1D in the house. “We’re not just treating the child; we’re engaging the whole family. This is a 24/7 disease, and families need help with that across the board.”
They’re also focused on an oft-overlooked segment of the diabetes population: the teen transitioning to adult, and the family surrounding them.
赫尔曼谈到生活阶段时说：“技术应该是伟大的均衡器，这意味着青少年成为年轻人都可以远程看到他们的团队，他们的家人可以通过远处通过continuous glucose monitors使用远程选项。
And then there is the type 2 diabetes (T2D) population, a group Herman feels Joslin can do better for and with. The BILH partnership, which will bring in about 100,000 diabetes patients and also offer resources throughout the BILH network, should help with that.
“That’s a question I’ve been asking from the start,” she said. “What is the proper role for Joslin to play in type 2?”
They’ve opened Latin and Asian clinics already, she said, “But there’s more to be done here too.”
她希望回答的问题是：“我们如何成功将一些糖尿病护理转移到初级保健？”
她说：“ BILH卫生系统为此完美匹配。”她认为，他们可以“扩大我们的影响五倍”，但是，必须非常关注细节的步骤。
Primary care teams need help, she said, because management is more complicated now with both many more drugs to consider and varied lifestyle choices to incorporate.
“We will be testing the boundaries of what should be managed in primary care and what should get a referral [to a specialized diabetes clinic],” Herman said.
换句话说，近距离护理是目标，但是当需要转介到另一个地方时，理解也是如此。
Joslin hopes to continue their quest to make diabetes care accessible and effective, to push forward with research projects both long-lasting and new, and to, overall, better the lives of all those living with all kinds of diabetes.
对于赫尔曼来说，努力既谦卑又激励。
She remembers the first time she walked into her office and the Joslin Library, which is stocked with not only literature but artifacts from the Joslin’s storied past, like Elliot Joslin’s dining room table. “I felt like a little girl walking into my dad’s office,” she said.
她说，迈向进一步改善糖尿病护理的第一步是意识到这种病情以主要方式影响世界。
“糖尿病是一名大流行，而在Covid将'大流行'成为家喻户晓的话。在[大流行通过]之后，仍然可能是。”
The coming era, she hopes, will make educational programs and team-approach guidance to living with diabetes more accessible to all.
The pandemic may have helped with that, but Joslin was on it prior, she notes. They introduced the concept of remote/online care back in 2015.
在2020年国家检疫之前,小于5便士ercent of patients were using telehealth for appointments. Once the pandemic hit, that jumped to 90 percent. Now, Herman said, Joslin will continue pushing accessibility for continued, and hopefully more frequent and impactful care.
A bonus benefit of that: Appointment cancellations have decreased exponentially, Herman said.
她说，从研究方面，奖牌主义计划（大部分由JDRF资助）将继续研究那些与T1D居住数十年的人，以及我们可以从中学到什么。
Already, the Medalist Study has unlocked some key findings. Topping them, perhaps, is the finding that even people who have had T1D for more than 50 years still produce at least a small amount of insulin.
That finding leads into another key area of research Herman wants Joslin to continue focusing on:β细胞繁殖.
她说：“β细胞研究是治愈糖尿病的主要竞争者。”
Joslin has been key in advances to convert adult human stem cells into functioning insulin secreting beta cells that, they hope, can ultimately be safely transplanted into humans.
他们也致力于发现c的方法orrect defects in beta cells, identifying new growth factors that stimulate beta cell regeneration, so those still functioning cells found in the Medalist Study can help. They’re also working on evolving technologies for detection, modulation, and protection against the immune response that causes the disease or threatens the potential viability of a transplant.
And what of the push tomake insulin more affordable and accessibleto all?
赫尔曼说，倡导和政策工作不在乔斯林的主要宪章中，因为他们专注于治疗和研究，而是他们确实可以提供任何帮助。
首先，如果需要患者，他们将通过制药商的折扣计划或以其他方式访问胰岛素来将其连接到胰岛素供应。
“With our patients, an important way our role is increasing is to help them make the best of their benefits,” she said, as well as guide them to resources like discount programs and clinical trials.
他们还可以根据需要借出声音。赫尔曼说：“我确实有影响政策的兴趣。”他补充说，当被问及时，她愿意露面并大声疾呼。
The Joslin Center did take a vocal role, she said, in getting the Centers for Disease Control (CDC) to include both T1D and T2D as risk factors for COVID-19.
Herman said technology is being embraced and woven into diabetes care in many ways, and that will continue. Right now, about 50 percent of patients are choosing it, she said. They are still working on when and why patients should opt for telehealth versus in-person care visits.
除了远程医疗转变似乎及功率tive for patients, Joslin is studying how to better integrate technology into the lives of those who have diabetes and those who help them. That includes the T2D community.
使用类似的技术continuous glucose monitorsearly on in a T2D diagnosis could help people control the condition sooner, and possibly keep more people off insulin, she said.
“Insulin gets used too much,” she said of the T2D community. “And it takes way too much time to go from finding out to being ‘well-managed.’ We hope to change that.”
The BILH partnership will make those things more attainable, she said. With more of a “satellite presence” in more places, Joslin will be able to reach more patients, see trends and help guide better treatment on a wider scale.
Herman said she’s thrilled to be at the helm at this crucial time, while she is mindful of Joslin’s storied past.
“我们将忠于创始人的目的，该目的是在发现，教育和治疗的领先边缘。我认为这比这更复杂。”她说。