Leader in Diabetes Research and Care
Imagine your average workday. Chances are you’re trying to cram as much into it as humanly possible, never quite checking off the day’s to-do list. Now add a chronic disease such as diabetes. “Every action has the potential to affect you such as what you ate, how much activity you had, whether these were planned activities, or how much stress you encountered,” says Dr. Andrew J. Ahmann, M.D. “You can imagine how difficult it is for a person with diabetes to cope and go about an average day the way they would like.”
Dr. Ahmann has worked at OHSU for twenty years and has dedicated his career to helping patients with diabetes and making advancements in research and care. He explains that diabetes is often misunderstood and hopes for readers to realize its significance.
To help paint the picture, according to the American Diabetes Association, 29.1 million people or 9.3% of the population suffers from diabetes, making it the seventh leading cause of death in the United States. As of March 2013, total cost associated with diagnosed diabetes in the United States was $245 billion. I asked Dr. Ahmann to share more about his experience working with the disease.
Can you tell me about your path to becoming a doctor?
I’m originally from North Dakota. My aptitude tests indicated I was destined to be an engineer, so I began an undergraduate education as an engineer. I soon realized, though, that I didn’t really embrace the engineering perspective despite academic success.
I soon switched my major to the pharmacy and then participated in a clinical pharmacy residency at the VA in Palo Alto and Stanford University, where the majority of my time was spent on the clinical wards, integrated into the internal medicine teams. That experience spurred my interest in a career in medicine. I completed my master’s degree in clinical pharmacy while applying to medical school. It was a slow path marked by an evolution of interest, but with the growing recognition that I enjoyed working with those affected by chronic disease to educate, encourage and guide them in constant pursuit of improved health and quality of life.
After completion of medical school at the University of Colorado and completing fellowship training in Endocrinology and Diabetes at Walter Reed Medical Center, I spent 4 years as a staff physician at Walter Reed and assistant professor at the Uniformed Services University for Health Sciences. In 1990, family considerations led to the acceptance of a position as co-director of a diabetes center at Providence Portland. Three years later, after serving as volunteer faculty, I was asked to join OHSU to help develop clinical programs in endocrinology.
What drew you to diabetes?
I had mentors who were endocrinologists. Although I did know a number of people with diabetes, including a father-in-law who lived with type 1 diabetes for fifty years, it wasn’t that directly. In my pharmacy background, I was always interested in the disease state, pharmacological agents and the patient education involved in caring for those with diabetes.
What are some things that might surprise readers about the disease?
A misconception around type 1 is that it’s a children’s disease, when in fact 50% of the people who develop type 1 are adults (which is the kind where you destroy the cells that make insulin and therefore you have to rely 100% on insulin).
Another misconception is people might say type 2 diabetes isn’t even a real disease, but rather a result of behavior. While it’s true that our modern society is part of what brings out type 2 diabetes, there’s a much stronger inheritance than type 1 diabetes. There are many factors involved. We know that Latinos, Native Americans, and African Americans have twice the rate of diabetes than what you would find in a Caucasian population. It’s ignorant and certainly detrimental for people to look at diabetes as insignificant or as strictly a cultural or behavioral problem.
Can you talk about your involvement in teaching?
What has always interested me is that academic medicine offers the opportunity to be clinically relevant while at the same time being able to educate people around your specialty with a strong opportunity for meaningful clinical research. Teaching has always been very rewarding — to help deliver a message resulting from one’s expertise and experience that leads to compassionate and knowledgeable clinicians caring for patients.
How do you manage the emotional investment of your work?
It’s particularly rewarding when you see patients make even small progress. Over time, there are cases where you’re not so successful and you see the unfortunate complications of diabetes — it’s the leading cause of kidney failure and amputations, eye disease in adults leading to blindness, etc. While you’re trying to prevent these things, you also have to deal with them. Anybody who’s successful in clinical medicine or research, is somebody who sees the individual successes. They are somehow the ones that you best remember while the negatives are something that you don’t forget for their significance, but you try not to let affect your positive approach and persistence.
On that note- what is the most challenging aspect of your job?
In a practical sense, an area of research like diabetes is so underfunded and so undervalued in relation to its significance it is very difficult to have the rapidity of advances that I’d like to see. People are more aware of the extra costs associated with caring for people with chronic disease than they are willing to put money forward to prevent those complications. It’s a constant struggle to get the resources you need to really make a difference. Our biggest step forward was in 2007 when, through the kindness of the Harold and Arlene Schnitzer Care Foundation, we were able to develop the Harold Schnitzer Diabetes Health Center. (The word health is in there deliberately because we want to convey that even people with chronic disease can live a healthy and productive life.)
Are you aware of any ground breaking prospects in diabetes research?
Ever since I’ve been involved in diabetes, there’s been this talk that the cure for type 1 diabetes is five or ten years away. We said that for so long that I think we all finally came to realize it was inappropriate to convey false short-term hope to patients because it only led them to disillusionment. Breakthroughs were not coming through as fast as we had hoped. Diabetes is viewed as an underfunded area of research, although the number of people affected and the death rates are much higher than for breast cancer or HIV, for example. The funding is dramatically low on a national basis. However, some things are starting to change, particularly around the prevention efforts and advances in technology. Many things are headed in the right direction and there’s reason for optimism, whether it’s in clinical care or in research.
What is your proudest personal accomplishment?
Assembling our team. For decades, diabetes care has been viewed as a team approach and that’s what we strongly believe and try to develop in our clinic. I think we have among the best group of diabetes educators, psychologists, social workers, and diabetes specialists right now. I’m really proud of where we stand in terms of quality of our personnel and the overall integrity and excellence of our center.
How does your work differ from that of your peers and predecessors?
The main difference over time has been emphasizing the importance of building a team that can be a resource for many to improve quality of care. Ten or fifteen years ago we probably had 600 patients specific to our diabetes clinic, and now we’re at 3,000 adults and about 1,000 children. We draw many patients who seek the best in diabetes care, but we don’t differentiate by income or social circumstance. We have maximized our opportunities to expand meaningful clinical research in such areas as technological advances in the care of type 1 diabetes and national multicenter studies to determine the best medications and practices in type 2 diabetes.
What inspires you to dedicate your life to helping others?
I came from a modest background of a father who was a mail carrier and a mother who was a homemaker. They taught us to work hard and to think about other people.
Once you get into an area like medicine, you’re encouraged by the good feelings you get from seeing successes. Those successes may simply be people feeling more comfortable and feeling they have a better quality of life, people actually preventing complications, having healthy babies, or moving into new areas that they were afraid to explore before because they feel more confident in their self-care. All those experiences drive you to continue to strive for excellence in the programs and research that improve people’s health and lives. People who are successful as physicians have to really care about others and value small successes.
What’s the advantage to working at OHSU versus another hospital?
This environment is empowering and energizing. While there are complexities of having a research component, a clinical care component, and an education component, it’s this combination that creates satisfaction and opportunity. You’re collaborating with people doing research around the country and therefore you can better translate that experience and the latest breakthroughs to improve clinical care of your patients.
Patients hear so many wrong things in the media — everything has to be so dramatic and sound like there’s a big breakthrough right around the corner and it seldom is. You try to help patients understand that it’s all about incremental steps, but there is progress. You keep learning because you’re driven to learn. You feel that you have to be a leader in your area, not just for your patients but for the medical community. OHSU has a complex mission, but the environment fuels unequaled opportunity to make a difference. There’s a strong emphasis on doing what’s best for the state and the community.
What do you enjoy doing in your free time?
I spend a lot of time volunteering with the American Diabetes Association, JDRF, Gales Creek Camp, and the Chris Dudley Foundation. Those are all really rewarding experiences.
There’s nothing more important to me than family. We have two sons, two daughters-in-law whom we love, and now five grandchildren ages one to six. We try to spend as much time with them as we can. I exercise a lot, especially hiking. I love to golf, but I almost never get to. I’m a regular golfer once a year. I also like to read non-fiction.
What personal goals do you have in the years to come?
My personal goals are to accomplish as much as I can in the next five years toward having our diabetes center play a meaningful role in changes in health care that impact diabetes prevention and care. I don’t know what that looks like exactly, but I know that it’s going to be important for us to find a way to change the way healthcare is delivered so that we can improve quality of life, economic burden, and outcomes for those affected by diabetes. The old system has been very limiting for diabetes. I think our center can have a greater impact in the region with more remote diabetes care, for instance using technology to communicate with patients through the internet or telephone with shared information about their blood sugars and their barriers to self-management. It is a much more impactful and efficient way of making a difference. Educating patients is critical — patients are their own doctors 99.9% of the time. They’re checking their blood sugar and making decisions about what they’re going to do, so they need to be well educated. We also have much expertise that is not efficiently shared with primary care physicians in a way they value. New methods of consultation and provider education are also a priority. In the final analysis. I want to find ways to integrate new concepts to make the type of difference Harold Schnitzer envisioned.
By Haley Martin
Photos by Tim Sugden