Referred to as "the Godmother of Modern Diabetes Care," Dr. Lois Jovanovic played a pivotal role in shaping treatment protocols for pregnant women with diabetes. She helped countless babies come into the world by moms who feared they would never be able to have healthy births, mentored many aspiring physicians just entering the field -- fondly referred to as 'Little Loises' -- and led landmark research that's changed how we think about managing diabetes across the board.
Not only that, but this whip-smart woman with a gentle personality shined with her smile and fashion sense, and also happened to be a third-generation type 1 herself -- diagnosed as an adult after her second child was born, and following her father and grandmother, who was one of the first to ever receive insulin back in 1922.
Dr. Jovanovic passed away on Sept. 18, 2018 at age 71, and her death isn't believed to be connected to her T1D.
“A star has fallen, but Dr. Jovanovic leaves behind a tremendous legacy, and her contribution to diabetes care will have an everlasting impact,” said Dr. Kristin Castorino at the Sansum Diabetes Research Institute, where Dr. Jovanovic spent 27 years of her career -- including 17 as CEO and Chief Scientific Officer until her retirement in 2013. "Her courageous and relentless fight to teach the world how to care for women with diabetes led to a global improvement in outcomes for both moms with diabetes and their babies.”
We at the 'Mine dubbed her one of the most influential Women in Diabetes History earlier this year, as it's clear that Dr. Jovanovic made a difference in our diabetes world in uniquely monumental ways.
Leading the World in Diabetic Pregnancy Care
A pioneer in the diabetes community for her research and practice, Dr. Jovanovic's career began in the early 1980s after she obtained a bachelor's degree in biology from Columbia University, a Master’s Degree in Hebrew Literature from The Jewish Theological Seminary in New York, and her Medical Degree from The Albert Einstein College of Medicine. She started out at the New York Hospital-Cornell University Medical College, before eventually heading to the Sansum Diabetes Research Institute (SDRI) in Santa Barbara, CA, where she stayed from 1986 to 2013, serving as CEO and Chief Science Officer from 1996 until her retirement. After stepping down, she stayed on with Sansum on as a part-time consultant, while also continuing her focus on diabetes and pregnancy along with clinical mentorship at the Santa Barbara County Public Health Department.
Dr. Jovanovic's groundbreaking work in diabetes pregnancy began with the premise that a woman with diabetes had the best chance for a successful pregnancy and healthy baby if near-normal blood glucose levels could be obtained. From her early days in New York, Dr. Jovanovic's research showed that strict BG monitoring was key. That led her to developing a program to monitor a woman's BGs around the clock, providing treatment strategies for lower-carb meals and intensive insulin delivery -- setting a new standard for strict glucose management during pregnancy. Her work in New York made this young endo stand out as one of the first principal investigators at Cornell involved in the Diabetes in Early Pregnancy Study as well as the landmark DCCT (Diabetes Control and Complications Trial), which led to the A1C test and realization that better A1C levels could reduce the risk of long-term diabetes complications.
In 1986, Dr. Jovanovic ventured west to Sansum to concentrate on her research in diabetic pregnancy. When she took over the helm in 1996, the SDRI became what it describes as a "worldwide center of excellence for diabetes and pregnancy and artificial pancreas technology."
Some of Dr. Jovanovic's key contributions to the field include:
Demonstrating that women with diabetes have the same chance of having a healthy baby as women without diabetes if they maintain near-normal blood sugar levels before and throughout pregnancy.
Working with the early Glucose-Controlled Insulin Infusion System prototype (aka: Biostator) in labor and delivery, establishing an innovative partnership between engineers and physicians that is now the model of current work on Artificial Pancreas (AP) and closed loop technology.
Creating a Pocket Doc insulin dosage calculator in the 1980s.
Establishing global guidelines of care adopted by the International Diabetes Federation (IDF), and traveling extensively throughout the world teaching her protocols to physicians, nurses, dietitians, and educators.
- Publishing more than 500 articles in numerous health arenas, leading to a role as an internationally-acclaimed authority who helped shaped and author consensus standards on multiple issues.
Those who knew her emphasize that Dr. Jovanovic's continued focus on understanding diabetes in pregnant women helped more broadly influence knowledge and treatment options for all people with diabetes (PWDs).
A Beloved 'Uber-Mom' and Mentor
Along with all of this important work, Dr. Jovanovic also mentored and helped nurture scores of young and aspiring endos, educators, physicians, and researchers in diabetes. They refer to themselves as Lil Lois', an affectionate term coined by many of her "mommies" with diabetes who credit Dr. Jovanovic and her research for helping them bring children into this world. In one interview years ago, she joked about that and estimated there were thousands of her "grand babies" out there across the world.
At Sansum, her colleague Dr. Castorino says that as a mentor and role model for so many, “Her brazen tenacity opened doors that were previously closed to women... She showed by example how to 'Lean In' well before it was popular to do so.”
At the JDRF, Chief Mission Officer and fellow T1 Dr. Aaron Kowalski considers Dr. Jovanovic a friend, and someone he's always looked up to.
“She was a legend to me and I was fortunate to work with her for many years," he shared. "I vividly remember meeting her for the first time and being in awe. She welcomed me into the research community with open arms and kindness. Her work will continue to positively impact people with diabetes lives for the better and for that we can not thank her enough. I will miss her and cherish all that I learned from her.”
The Diabetes Community Mourns
Across the D-Community, a wide range of people and groups have shared their sentiments about Dr. Jovanovic -- from praising her legacy in diabetes research to her warm personality, mentorship efforts, and great sense of style in her wardrobe. The SDRI, JDRF and AADE (American Association of Diabetes Educators) are among the organizations that have issued statements. In addition, some leaders in the community have shared their sentiments with us:
Dr. Florence Brown, director of the Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program in Boston:
"I have always thought of her as brave, powerful, energetic, warm and playful. I am reminded of an editorial that Lois wrote regarding a pivot in her thinking about a strictly glucose-centric approach to the treatment of gestational diabetes, to one that considered ultrasound evidence of excess fetal growth to determine glucose targets and the need for insulin. She described herself as 'an old dog' who will 'never say never' again as she reevaluates her biases. She reminds us that we all have our personal biases but we should 'take our head out of the sand' and 'change our spots,' and even mix metaphors when looking at scientific data that does not conform to our world view."
Dr. Brown also describes a "jaw-dropping" moment for her, when hearing Lois share her clothing-related considerations when prepping for a debate one year at the ADA's Scientific Sessions: "She did, as she said she would, wear a bright red dress, because red meant power," Dr. Brown recalls.
Nicole Johnson, Miss America 1999 and longtime type 1 who now serves on the JDRF executive team:
On the day Nicole found out she was pregnant, Dr. Jovanovic was her first call. “I was scared,” Nicole says, adding, "Dr. Jovanovic pulled me up and talked me through how we were going to do this together.” Prior to that, in 2004, Nicole had heard Dr. Jovanovic speak about diabetes and pregnancy for the first time. “Before that I thought women with T1D could not have healthy babies." After Nicole's daughter Ava was born, and was taken to meet Dr. Jovanovic for the first time, she said to the child, “You are one of my babies."
Now, Nicole says, “Dr. Jovanovic will always be my hero. It is because of her guidance and attitude that I have a healthy child, and I will be forever grateful.”
Kelly Close, longtime T1D and co-founder of the diaTribe Foundation:
"I was so lucky to know Lois over the last 15+ years, and to see her speak so very many times. Boy, was she committed and whip-smart and strong and elegant. She made me feel proud to have diabetes, to just be in community with her, just as someone in the audience seeing someone else like her who herself had diabetes and was making such a difference in the world to SO many patients. People listened to her. She acted and she did, in addition to talking – for a researcher, the number of patient appointments she had always baffled me ('how can you be seeing this many patients outside research?'), and she made so much happen for so many underserved patients all over."
Katie Haq, T1D for 30+ years who works as outreach manager at Sansum:
“Dr. Lois Jovanovic was such a special person to me, and I have such a heavy heart. She was my endocrinologist throughout both of my pregnancies, and helped me navigate diabetes and pregnancy with such grace. My husband and I went through many trials and tribulations to get pregnant, and on top of that I was very nervous about managing my diabetes throughout this new unknown territory. I was extremely fearful of what the road ahead would mean for me and my children, even though I had lived with diabetes for over 25 years at the time and had excellent control."
"The first time I met with Lois and Dr. Kristin Castorino at SDRI, they instantly put my mind at ease. Dr. Jovanovic’s insight and compassion were like nothing I had ever experienced. I was able to have two healthy pregnancies under her and Dr. Castorino’s care, and every time I look at my children, I have Dr. Jovanovic and SDRI to thank. She made the impossible, possible for me and my family. Dr. Jovanovic was a pioneer, and she leaves behind a tremendous legacy. I am so grateful to have been under her guidance, and she will be greatly missed.”
"A Life Measured by Good"
Dr. Jovanovic is survived by her two children -- Larisa Taylor, MD (and her husband, Nathan Taylor); and Kevin Jovanovic, MD (and his wife, Kim Many, Esq). She's also survived by four grandchildren, as well as all of those in the D-Community whose lives are a result of her work. Sansum Diabetes Research Institute also says it is dedicated to keeping Dr. Jovanovic’s legacy alive by expanding diabetes and pregnancy programs at the institute, and has also created a tribute page for her where donations can be made in her name. Over at diaTribe, many in the community are expressing their thoughts on Dr. Jovanovic's impact.
Indeed, many who knew Dr. Jovanovic feel that it's truly the end of an era. Thank you, Dr. Jovanovic, for all you've done!
One prominent researcher and friend, who worked with Dr. Jovanovic on the East Coast, shared in an email: "If a life is measured by the good one does during their time on Earth (and I believe that is the case), then Lois lived a very rich life indeed."
In that Dr. Jovanovic passed on the eve of the Jewish holiday of Yom Kippur, we reflect on the phrase "G’mar Hatima Tova" ("may you be inscribed in the book of life for good") and take comfort in knowing that her legacy will live on.