The young adult with diabetes was at Boston Medical Center (BMC), along with his supportive mom, and he was feeling defeated.
Despite the family support and his desire to do well, he was struggling with a double-digit A1C result and days on end of just not feeling well.
His endocrinologist looked him in the eye and made a promise.
“We’re going to get you there,” the doctor told the young man. “One step at a time.”
What that young man and his mother, who come from a nearby underserved and economically challenged area, did not know was that the endocrinologist making that vow wasn’t just another doctor filling in at a city clinic. Rather, it was Dr. Howard Wolpert, one of the nation’s most respected and most-quoted specialists in the field.
Wolpert spent decades serving patients and leading research at the Joslin Diabetes Center in Boston, Massachusetts, followed by a handful of years as a vice president at Eli Lilly and Company’s Innovation Center, working to better diabetes technology, So, what brought him to this city clinic?
A combination of seeing a need in society and feeling his own need as a physician, he says.
In a one-on-one interview, after joining the team at Boston Medical Center, Wolpert told DiabetesMine about this next effort in his long career, why he chose it, and how he hopes it will help the diabetes world at large.
The case of that bewildered young adult patient shows why he’s made the move, he said.
“His A1C is high not because he’s not concerned, and not because he doesn’t have support at home. It’s because he’s at the bottom of the socioeconomic ladder,” Wolpert said.
“I’ll tell you: He has the potential to do as well as any patient I have ever had,” the doctor added.
“To me, that’s the real need and challenge,” Wolpert said.
While over the years he’s supported breakthroughs in technology — he’s considered an early adopter physician by most — he said he had a recent realization: All the technology in the world won’t do any good if it’s not in the hands of those who need it. This is important, along with the full training and long-term support, people need to use that technology well in their daily lives.
Wolpert left Eli Lilly to build the BMC program, one he hopes not only reaches those who in need in the greater Boston, Massachusetts area, but serves as a model for other cities as well.
“What’s missing [for most] is formalized training for people who are not getting diabetes care in centralized places,” he said.
At BMC, he hopes to build just that, with a program that loops in pharmacists more, helps people with diabetes (PWDs) learn how to work with an entire diabetes team to evolve in their self-care — ideally in a way that “makes sense in that place and time,” he said.
For instance, they have what they call a “therapeutic food pantry.” The medical team writes a “prescription” for food that gives the PWD a good basis of what and how to eat. But rather than send them off and hope they can afford what’s needed for those dietary tweaks, BMC sends them to the clinic’s own in-house food pantry for that food prescription to be “filled.”
That’s just a start. They work closely with patients in deciding on medications, on dosing, filling those prescriptions, and making practical plans to increase physical exercise. It’s a hands-on approach that isn’t often seen in diabetes care.
What motivated Wolpert to dig back into a time-consuming and challenging project like this, rather than sitting atop a company as VP?
Wolpert started his diabetes training at the Joslin Center in 1987, and was immediately drawn to diabetes above all the other medical practices he’d discovered in his educational years.
First, he loved the “personal” part of serving the diabetes community, he said. “It’s a field in which you have real engagement, and you get to know people over a long period of time.”
“It’s also collaborative; like a coaching role, rather than a more prescriptive [kind of medical care],” he said.
“I felt like that would enrich and broaden my own world. Seeing other people’s realities and helping them in that context just spoke to me,” he said.
And then there’s the intellectual side of it all. Wolpert said he liked how diabetes care interwove medicine, pharmacology, psychology, and more.
Around 1993, the results of the
Seeing that need, he partnered with Dr. Joe Wolfsdorf of Boston Children’s Hospital, another well-respected name in diabetes, to begin focusing on transitional care.
“That,” he said of the transitional care focus, “gave me a window into how to engage in ‘the art of medicine,’ that is, how to engage [the person with diabetes] in their self-care.”
In 2004, Wolpert published his book, “Transitions in Care,” with respected co-authors Barbara Anderson and Jill Weisberg-Benchell. The book has long served as a guide for helping PWDs navigate that time in life.
Wolpert stayed at Joslin until 2018, creating such revolutionary programs as the DO IT program, a kind of week-long crash course in daily care for both those newer to diabetes and longtimers.
While there, he says he witnessed an evolution in daily care tools. Once test strips became covered by insurance, that opened the floodgates to bring in more improved treatments and tools. Better insulin choices (and more nuanced approaches to using insulin), more insulin pump usage (after early years of safety concerns), improved pump therapy with more bells and whistles, and continuous glucose monitoring (CGM) technology all came to the market. Best of all, he saw a change in their patients that’s telling of how far the diabetes treatment world has come, many thanks to those tools.
“The whole future outlook of type 1 diabetes [T1D] has changed. We see control now — not only in terms of A1C, but more. These tools have enabled people to prevent most of the major complications of diabetes.”
“What I saw when I started at Joslin was people coming in with blindness, amputations, neuropathy,” he said. “When I left, that was not the case anymore at all.”
When Wolpert left Joslin for the Eli Lilly program, those who knew him as a practitioner were disappointed to lose his perspective there, but excited for what he may deliver in his new role.
At Lilly, Wolpert worked on things like smarter insulin pens, that would ideally expand the types of technology available to the general public.
But as he dug into that work, he had both a personal and professional revelation.
As a doctor, he realized, that patient interaction was a must for his own personal fulfillment. And as a provider to the diabetes community, he realized: all the technology in the world wasn’t going to better things until we find a way for that access — not just to the tools but the care.
“A CGM device is basically just a number carrier; a data catch,” he said. And if you look at the numbers through a diabetes center, you’ll see high overall usage, but if you look at the general population, you’ll see a great lag in uptake of this technology, he said.
“Most people with T1D are not cared for by an endocrinologist in society at large,” he said. “It’s a huge problem.”
Wolpert is in the early months of building the BMC program and already, he’s been profoundly moved by what he sees.
“For the first time in my 32 years [of diabetes care], I actually saw a patient who is homeless,” he said. “It’s wrenching.”
He now sees his role, he said, “as more of a catalyst.”
He hopes to not only build the BMC program, but build help support programs around the country by mentoring and engaging young endocrinology team members, another thing he likes to do personally.
“There’s a huge challenge,” when it comes to bringing long-term future endocrine team members through the ranks, he said. “A huge challenge in terms of having enough clinical professionals to care for patients with diabetes. That’s the bigger crisis.”
In other words, he hopes to build a future community of like-minded practitioners, something he sees as more vital to long-term positive diabetes outcomes even than emerging technology — at least for now. He hopes to use a growing staff as well as things like telehealth to get there.
“With all this technology we have, we need more learning, and we need that for everyone,” he said.
As he digs into the project, he looks back on those years at Joslin and the positive changes he saw in patient outcomes and rather than see it as a memory, he sees it as a goal.
“I’d like to see programs that were available to a select few at the Joslin be available to a greater amount of people,” he said.