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Pieces of Eight


ECU Nurse Educator Helps Patients Control Diabetes

By Jeannine Manning Hutson

When Nancy Leggett-Frazier started working at East Carolina University’s medical school as a diabetes research nurse 20 years ago, the disease wasn’t the rampant epidemic that it is now.

That first job through a $3.1 million grant to study diabetes grew into what is now the Diabetes and Obesity Center at ECU. When the grant ended, she moved from research to working more with patients and educating them about their diabetes.

Then, it was rare to have a child come and be diagnosed with type 2 diabetes, in which the body doesn’t make enough insulin to regulate blood sugar. Now ECU averages one new pediatric patient with diabetes a week.

Diabetes nurse educator Nancy Leggett-Frazier (right) works with a patient in the Brody Outpatient Center. Leggett-Frazier has seen substantial strides in diabetes treatments, but notes there’s still much to be done. (Photo by Cliff Hollis)

Leggett-Frazier just shakes her head.

“How is the country going to pay for these kids who aren’t taking care of their disease? So in 15 years, they will be facing complications from diabetes.

“People have got to change their behaviors. People have got to start exercising. And they need to start being serious about their health to stem the tide,” said Leggett-Frazier, a certified diabetes nurse educator.

According to the American Diabetes Association, more than 20 million adults and children in America, or 7 percent of the population, have diabetes. Of that number, the ADA estimates that nearly one-third, or 6.2 million people, are unaware that they have the disease.

Diabetes is a leading endocrine disorder. It develops when the body either fails to produce insulin, known as type 1 diabetes, or develops insulin resistance, known as type 2. One function of insulin is to regulate blood-sugar levels. Both types of diabetes are associated with several serious or life-threatening conditions including heart disease and stroke, nerve damage, kidney disease and blindness.

Being overweight or obese is a leading risk factor for type 2 diabetes, according to the ADA.

In addition to treating patients and conducting research, the Diabetes and Obesity Center at ECU is also tackling the problem of few specialty trained physicians to manage the ever-growing number of patients with diabetes in eastern North Carolina. The center has created a fellowship program patterned after a similar program that has existed for more than 50 years at the respected Joslin Diabetes Clinic in Boston.

ECU’s fellowship program, launched in 2004, has been funded for three years by grants from the Duke Endowment, Eastern Area Health Education Center and has been administered by the Brody School of Medicine in conjunction with Pitt County Memorial Hospital.

The fellowship’s goal is to help alleviate the shortage of diabetes specialists in eastern North Carolina. The current number of diabetes specialists, most of whom are endocrinologists, are struggling to meet the demands of the growing number of people in eastern North Carolina with diabetes whose disease cannot be managed by most primary care physicians, said Dr. Robert J. Tanenberg, an endocrinologist and professor of internal medicine in the division of endocrinology at the Brody School of Medicine. He is also medical director of the Diabetes and Obesity Center at ECU and serves as director of the fellowship program.

The program graduated its first fellows in June 2005. In early July, two general internists completed the one-year clinical fellowship. Dr. Khalid Aziz has returned to Fayetteville to open a medical practice specializing in the treatment of diabetes and obesity. Dr. Silvia Abreu, who completed her internal medicine residency at the Brody School of Medicine-Pitt County Memorial Hospital, also plans to stay in North Carolina to practice.

Aziz, who is board certified in internal medicine, had practiced as a general internist in Spring Lake for eight years before coming to Greenville for the fellowship.

“During my eight years of practice in Spring Lake, I noticed the number of diabetes patients increasing. It’s an epidemic in America today,” Aziz said. “Through this fellowship, I have acquired specialized knowledge about caring for patients with diabetes. In my practice, I also noticed that we needed to do more for obese patients. Through this fellowship, I worked in an obesity clinic in Minnesota and there, and at ECU, learned different treatment options for obese patients.”

The combination of specially-trained physicians and diabetes nurse educators working with patients to control their disease is vital, Leggett-Frazier said.

“Educating patients about the disease is so important,” she said. “Exercise and changing what you eat make a big difference. That’s where the diabetes educators have such a big job. Diabetes is so widespread. Everybody knows someone or a member of their family with it.”

Tanenberg, who has been in the diabetes field for 30 years, was effusive in his praise for Leggett-Frazier. “Nancy is the most outstanding diabetes educator that I have ever worked with in my career,” he said. “Her exceptional educational efforts extend from lay persons to medical students, residents, nurses and, for the past two years, our diabetes

fellows. She is able to work seamlessly with patients of diverse backgrounds and they will miss her as much as her colleagues at the BSOM.”

Leggett-Frazier said the key is to have patients take control of their disease and their lives.

“If we can work with patients and have them in control of their disease early, hopefully they will not face amputation later in the disease. They are managers of their disease, not their doctors,” she said.

Even though she’s officially retiring after 30 years with the state, Leggett-Frazier said she can’t totally walk away from educating others about diabetes. Her mother already has “volunteered” Leggett-Frazier to present a diabetes education seminar at her church.

But first, the open road is calling her husband, Joe, who retired five years ago. They will pack up and head west to Yellowstone National Park.

“After that, I’ll probably do something in diabetes. I’m just not sure yet,” she said. “There’s still so much we don’t know about this disease.”

This page originally appeared in the July 28, 2006 issue of Pieces of Eight. Complete issue is archived at