MedStar Health Blog

As part of our continued progress toward becoming a world-class academic health system, and advancing health through research and innovation, we are pleased to announce the appointment of Raj Ratwani, PhD, as Vice President of Scientific Affairs for MedStar Health Research Institute (MHRI). In this new position for MedStar, Raj will play a pivotal role in connecting the scientific activities of MHRI, MedStar Institute for Innovation (MI2), and the MedStar Institute for Quality and Safety (MIQS). He will join the MHRI executive leadership team to provide additional scientific perspectives that support research activities and their interaction with clinical operations.

In his new role on the MHRI executive team, Dr. Ratwani will contribute to the strategy, growth, and administration of research across MedStar, with a focus on working closely with organizational leaders and investigators to translate research results into practice. He will supervise and mentor investigators to support research activities, identify new areas of research funding and enhance MHRI’s reputation as a leading research organization. Furthermore, Dr. Ratwani will lead strategy development for MHRI to support the effective dissemination of research outputs. Dr. Ratwani will remain director of the MedStar Health National Center for Human Factors in Healthcare.

Please join us in congratulating Dr. Ratwani on his promotion as we continue to advance health for our patients and community.

Diabetes is an epidemic in the United States. In fact, 30.3 million Americans have diabetes—an amount that has doubled since 1997. As a result, it’s more important than ever for people to understand ways they can successfully manage their diabetes.

Appropriately managing diabetes is vital because having too much or too little sugar in your blood can make you feel sick and cause larger health problems down the road, such as damage to the:

• Eyes
• Heart
• Kidneys
• Nerves

Through my work with diabetes patients over the years, I’ve come up with a few essential ways to help you manage your diabetes. Read on to learn about them and why they are important.

The No.1 type of food we typically recommend people with diabetes eat is nonstarchy vegetables, as they don’t negatively affect your blood sugar and have a lot of fiber, which helps curb your appetite.

During meals, we recommend that you follow the plate method. This consists of making half of your plate nonstarchy vegetables; a quarter of your plate protein, preferably a lean protein, such as chicken, fish, or turkey; and the other quarter a type of starch or carbohydrate. When you eat carbohydrates, opt for whole grains—such as brown rice or whole-wheat pasta—as they contain more fiber than refined grains.

Make sure you also drink plenty of water and avoid sugar-sweetened beverages, such as juice, soda, and sweet tea. I’ve seen patients who used to drink beverages high in sugar significantly reduce their blood sugar levels just weeks after cutting it out of their diet in favor of water.

While adjusting your diet, keep in mind that you don’t have to make your diet overwhelmingly restrictive, as those types of diets don’t often last long. Try to focus more on the foods you can have, rather than the ones you shouldn’t. For example, I usually ask patients during the holidays what one food they most look forward to. Then, we either discuss ways to prepare that food in the healthiest way possible or how they could adjust their diet, such as taking in fewer calories or limiting certain ingredients, for the rest of the day after eating their favorite food. This type of approach can be utilized year-round, not just during the holidays.

Exercising regularly is one of the best things you can do for your health if you have diabetes, as exercise helps lower your blood sugar and boosts your body’s sensitivity to the hormone insulin (which can help your body counter insulin resistance, a common cause of increased blood sugar levels).

We recommend that you get about 150 minutes of moderate intensity exercise each week—averaging out to about 30 minutes of exercise five days a week. When it comes to creating your exercise routine, keep in mind that everyone is different. Some people prefer taking a five- or 10-minute walk every few hours, while others enjoy going to the gym multiple days a week and using exercise machines for 30 minutes. Do whatever sounds most convenient, realistic, and fun for you.

If you haven’t exercised in some time, you should begin by working with your doctor, physical therapist, or trainer to slowly work your way up to moderate-intensity exercise. For people who have difficulty running or walking, low-impact exercises can be a terrific option. These can include doing water aerobics or using an elliptical or a stationary bike.

Medication is often necessary to successfully manage your diabetes. In fact, one study found that people who took their oral diabetes medications at least 80 percent of the time were 46 percent less likely to have poorly controlled blood sugar, compared to those who took their medications less than 80 percent of the time.

If you avoid taking your medication due to its side effects, schedule an appointment with your doctor. This way, you can go over your other medication options, as well as any lifestyle modification questions you have, to more successfully manage your diabetes.

The MedStar Diabetes Bootcamp is a one-year program in which we regularly work with people with type 2 diabetes, helping them reach their diabetes health goals and feel better.

Participants of the MedStar Diabetes Boot Camp use a blood glucose meter that sends their blood sugar numbers in real time to our team through the Cloud. Our diabetes educators keep track of participants’ numbers Monday through Friday, allowing us to provide them with personalized recommendations that work with their lifestyle. For the first three months, participants are contacted at a minimum of one time per week, and more frequently if needed, such as when their blood sugars are less than 80 or above 350. At the end of the three months, we contact participants weekly to support the changes that they’ve made and assist them in making further changes to their lifestyle and medication plan. We regularly provide updates to patients’ doctors, so that they’re aware of any medication or lifestyle changes that were made, and we also provide their doctors with a report at the end of the program that summarizes the progress the patients made.

To qualify for our Diabetes Bootcamp, you must have an A1C (a blood test for diabetes that measures your average blood sugar level over the past three months) of 9 percent or above. To learn more about the program, please call 202-877-2383.

Successfully managing your diabetes is vital to your overall health. Follow these recommendations to help reduce your risk, and make sure to reach out to your doctor or medical team if you have any questions.

As of January 2018, most non-exempt multi-site human subjects research (HSR) projects funded through NIH agencies require single IRB review. Additionally, in recent years, there has been an increasing trend toward the use of a single IRB (sIRB) review for multi-site HSR projects funded through other sources.  Specifically, many commercial sponsors prefer single IRB review for their multi-site projects.

Finally, the revised common rule includes a requirement for single IRB review of most federally funded multi-site non-exempt human subjects research projects. Initially, the Office of Human Research Protections (OHRP) indicated only that compliance with this common rule requirement was required starting on January 20, 2020. In a recent communication OHRP clarified that although sIRB review is required for all federally funded multi-site non-exempt HSR projects, the agency has granted an exemption for all projects approved prior to January 20, 2020. This eliminates the need to transition currently approve projects from review by multiple IRBs to sIRB review.

For all future federally-funded projects, it is strongly suggested that investigators include IRB review fees in the budget for their grant proposals. In most cases it is assumed that sIRB review will be conducted by a commercial IRB (such as WIRB or Advarra) or a larger academic/medical institution IRB. In some limited cases, the MHRI IRB may agree to serve as the IRB of record for a multi-site HSR project but this will not be the norm.

In all cases (regardless of funding) for which a MedStar investigator intends to request the MHRI IRB serve as the IRB of record, they must submit a request to the ORI office. The request must be submitted before the investigator commits the MHRI IRB to the responsibility of serving as IRB of record for other sites and before discussing reliance with any outside institution. The request should include a copy of the research protocol, an indication of the source of funding (if any), a list of all sites that may be engaged in the project, and the scope of involvement for each site. The ORI Director will evaluate the request and in consultation with the Institutional Official determine if the request will  be approved or should be declined.

This process is similar to  that for investigators requesting reliance on an external IRB. When an investigator would like to rely on an external IRB for review of their non-exempt HSR project, a request to cede review must be submitted to ORI in advance. In the case of the commercial IRBs for which there is a master reliance agreement (currently WIRB and Advarra), the investigator may simply submit an external IRB application through the Huron system. For other IRBs, a reliance agreement must be executed for each individual project. In the event that MedStar has not previously had an agreement with the intended external IRB, a request should be submitted to the ORI by email. The ORI Director will evaluate the request and in consultation with the Institutional Official determine if the request may be approved or should be declined. If approved the organization will be added to the Huron system and the investigator may submit the external IRB application for the project.

Please note that in most cases request for reliance involving exempt HSR projects will not be approved. Generally speaking, it is more efficient for these projects to be reviewed individually by each institution and most institutions have not been willing to enter into a reliance agreement for these projects.

In all cases, requests for reliance (either for the MHRI IRB to serve as the IRB of record or for MedStar to rely on an external IRB) will be considered with regard to the need for reliance, the feasibility of the arraignment and nature of the project. Ultimately the determination of reliance is left to the discretion of the ORI Director and the Institutional Official.

If you have any questions regarding this process, please contact MHRI’s ORI Director, Jim Boscoe, at James.H.Boscoe@medstar.net.

Congratulations to all MedStar researchers who had articles published in December 2019. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

Selected research:

1. Combined Vascular Brachytherapy and Stenting for the Treatment of In-Stent Restenosis.
   The American Journal of Cariology, DOI: 10.1016/j.amjcard.2019.11.035
   Chen Y, Buchanan KD, Chan RC, Zhang C, Torguson R, Satler LF, Waksman R.
   
   
2. Frequency of Advanced Cardiac Life Support Medication Use and Association with Survival During In-Hospital Cardiac Arrest.
   Clinical Therapeutics, 2019. DOI: 1016/j.clinthera.2019.11.001
   Benz P, Chong S, Woo S, Brenner N, Wilson M, Dubin J, Heinrichs D, Titus S, Ahn J, Goyal M.
   
   
3. Adherence among post-partum women living with HIV.
   The Lancet HIV, DOI: 10.1016/S2352-3018(19)30403-5
   Scott RK.
   
   
4. Microbiologic Failure Despite Clinical Cure in Pneumonia: Cum Hoc and Post Hoc Ergo Propter Hoc.
   Clinical Infectious Diseases, DOI:10.1093/cid/ciz1191
   Shorr AF, Spellberg B, Zilberberg MD, Kollef MH.
   
   
5. Creating a Care for the Caregiver Program in a Ten-Hospital Health System.
   Critical Care Nursing Clinics of North America, 2019. DOI:10.1177/1078390319878781
   Morales CL, Brown MM.