Q&A: Endocrine hospitalist makes music in inpatient diabetes care
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CHICAGO — When Mihail Zilbermint, MD, MBA, was accepted to music school to become a classical singer, his mentor asked him if he was possibly interested in any other career.
“I said, ‘What do we mean?’” Zilbermint, associate professor of clinical medicine at the Johns Hopkins University School of Medicine and chief and director of endocrinology, diabetes and metabolism at Suburban Hospital in Bethesda, Maryland, told Healio. “He says, ‘Well, some people are interested in business or computers.’”
Although he still loves music, Zilbermint took the advice to pursue his second interest — medicine. His particular focus is inpatient diabetes care and research. He started an endocrine hospitalist service at his community hospital to help patients living with type 1 diabetes achieve better outcomes. Later, he expanded his initiative to other community hospitals at Johns Hopkins Medicine. One result was shorter hospital stays, which saved Suburban Hospital money in addition to improving patient care. During the COVID-19 pandemic, Zilbermint innovated to bring telehealth to inpatient diabetes care.
Zilbermint received the Endocrine Society’s Vigersky Outstanding Clinical Practitioner Award recognizing extraordinary contributions by a practicing endocrinologist to the endocrine and/or medical community.
In an interview with Healio, Zilbermint described his approach to patient care and his predictions for the future of medicine.
Healio: Was there a defining moment that led you to your field? Why do you do what you do?
Zilbermint: Obviously, there was more than just one defining moment, but there is one patient in particular who made me do a better job, to be a better clinician every single day. Shortly after I started the endocrine hospitalist program at Suburban Hospital, which was in 2015, I was invited to a meeting with people from the community who were passionate about diabetes and wanting to change diabetes care. They were all community members and representatives of different organizations for different departments at Suburban Hospital.
This patient told me that a year prior he was hospitalized at my hospital. He had type 1 diabetes, and he was asking for a long-acting insulin. The nurses kept telling him, “No, you’re fine. The doctor prescribed the sliding scale, it is going to be enough.” And he knew it was not going to be enough. It was the middle of the night and he didn’t have anyone to communicate with, so he just took his own long-acting insulin from his bag and administered his own insulin just to protect himself.
When he shared the story with me, I told him first of all, “Thank you so much for sharing this story,” but that’s exactly why we need an inpatient endocrinologist. That’s why I need an inpatient endocrine hospitalist team that would protect people living with type 1 diabetes who come to small community hospitals where the staff and the nurses and the providers in the hospitals would have enough knowledge to understand why people with type 1 diabetes should be managed on long-acting and rapid-acting insulins or basal-bolus therapy. Otherwise, they can develop life-threatening complications, like diabetes with ketoacidosis.
One of the things I do when I interview my patients, I sit down and ask them, “Tell me about your diabetes story.” Then I have to be cool and quiet and let them share their stories. I’ve learned that people, especially those who lived with type 1 diabetes for a long time, know a lot about their conditions. Sometimes they know more than some of the clinicians. They’re the best advocates.
Healio: What area of research in endocrinology interests you the most right now?
Zilbermint: At the present time, my biggest interest is related to quality improvements in inpatient diabetes care, especially in the community hospital setting. One of the reasons is to make sure that people get a high level of care even if it’s in the community hospital setting, but another reason is because most of the research that has been done happened in large academic centers, which have maybe 20 endocrinologists, five endocrine fellows, multiple diabetes educators, and the data probably is a bit skewed.
I also found that some of the quality improvement initiatives are much easier to implement in smaller settings. So, for example, Suburban Hospital has about 230 beds, but I get to know my nurses and my staff quite intimately. We know each other by name, we say hello to each other, and this really helps to implement any projects we are interested in.
For example, we wanted to transition at Suburban Hospital from insulin vials to insulin pens, so our diabetes educators and some of the nurses just went around and essentially educated every single nurse in the hospital about how to use an insulin pen. Even though initially we had a bit of “Oh, this is so new, we’re not sure we’re going do it,” now it’s completely embraced in practice.
Our next step is to educate our nurses in being comfortable using continuous glucose monitoring systems. Right now, we are looking into getting some grants to see if the nurses can not only learn more continuous glucose monitoring systems, but also try one themselves to see what it feels like to wear one.
Healio: Have you ever seen health care history in the making?
Zilbermint: In the summer of 2021, I had a patient who was hospitalized at Suburban Hospital. She was living with type 1 diabetes and presented with DKA, a life-threatening complication. We looked into why that would happen — she was taking her insulin, she was on an insulin pump.
But one thing was out of the ordinary: She was just vaccinated against COVID-19. The vaccines were just new. Most people started getting vaccines in February, and this was in July. I thought it could not be possible. I looked on PubMed to see if COVID-19 vaccines could cause diabetic ketoacidosis and found no articles in the public domain. However, I did not give up this idea because I could not find any other reason for this patient to develop DKA. So, I biked home and called my best friend, who is also my partner, Andrew Demidowich, MD. He runs the endocrine hospitalist program at the Johns Hopkins Howard County Medical Center in Columbia, Maryland, and he’s an inflammation and obesity expert. I said, “Andrew, you’re not going to believe me, but this is what happened.” And he said, “Misha, we’ve got to study this.” Andrew put together a full clinical trial where we studied patients and their sugar numbers using a continuous glucose monitor before they got a booster vaccine and after. He’s going to present this research at the American Diabetes Association meeting [next week].
Is this health care history? Probably not. But think about it, from just one case, you take it to create a clinic trial and just prove the concept — taking it from the patient bedside to the bench and then again to the clinical practitioners who are providing guidance to other clinicians. Obviously, everybody needs COVID-19 boosters; however, people living with type 1 diabetes should know that it may affect blood glucose level.
If you ask me what excites me and lets me be a little part of history, this is it.
Healio: What do you think will have the greatest influence on your field 10 years from now?
Zilbermint: Three main things. One is definitely the treatment of obesity/diabetes by using the new powerful “big guns,” the GLP-1 and GIP/GLP-1 agonists. They will really help us as endocrinologists to tackle the challenge of obesity and diabetes.
No. 2 is wearables, continuous glucose monitors, because they will provide a lot of data for analysis. I found that some of my patients improve their control just by wearing a continuous glucose monitor, even without any new medication, because they can see the instant feedback on what is happening with their sugars when they’re eating any kind of food. Some of them are very proud that they are making progress and they can actually share it immediately with you with a link.
Lastly, we have to talk about artificial intelligence. I think ChatGPT (OpenAI), which just appeared 6 months ago, our patients are using it more and more to look up their condition and actually understand better about their treatment. I think some clinicians, myself included, are using ChatGPT for little, simple projects, and I hope that maybe, in the future, artificial intelligence will help me to come up with faster solutions to some challenging clinical problems and hopefully lead to new discoveries.
Healio: If you weren’t a physician or researcher, what would you be doing?
Zilbermint: I would be playing music — classical vocal. I actually applied to music school before I applied to medical school, and I was even accepted. So, after the entrance exam — you have to sing to be accepted — my mentor took me aside. I’d been taking lessons for maybe a year, a little bit more, to try to get accepted to the music school, and he said, “Hey, aren’t you interested in anything else?”
I said, “What do we mean?”
He says, “Well, some people are interested in business or computers.”
That was in 1997. In parallel, I’d been studying for medical school as well. He said to go and become a doctor. It’s so hard to make a living as a musician or a classical singer. And he said when I was in my third year of medical school, I could come back. So, that’s what I did. I went to medical school in Moldova where it’s a 6-year program right after high school. After my third year, I actually went back to music school. I started attending classes there, but I quit after a couple weeks, since medical school was so demanding.
I still play guitar. I still sing a lot, I still sing for my children, and I love music. I’ve brought my guitar to the hospital a number of times. I still enjoy doing both of those things.
Reference:
- Endocrine Society honors endocrinology field’s leaders with 2023 Laureate Awards. www.endocrine.org/news-and-advocacy/news-room/2022/endocrine-society-honors-endocrinology-fields-leaders-with-2023-laureate-awards. Published Oct. 26, 2022. Accessed June 5, 2023.
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