EndocrinologyOur nationally and internationally recognized physicians are experts in diagnosing and treating diseases related to the body’s endocrine system, which regulates hormones. They also specialize in treating metabolic disease, or any of the diseases or disorders that disrupt normal metabolism, the process of converting food to energy. We are a national referral center for 3,000 patients with type 1 and type 2 diabetes, as well as other metabolic conditions. We help patients transition seamlessly from pediatric to adult care. We emphasize a personalized approach to care, tailoring the treatment program to each patient’s needs. Our 24/7 consult service provides expert consultations to patients with complex conditions, spanning the full spectrum from disorders of the thyroid to electrolyte abnormalities and hormonal conditions. Specialized care is offered in the following areas: Bone Center Diabetes Center Endocrine Neoplasia Program (thyroid/adrenal) Pituitary Program A major referral center for 3,000 patients with type 1 and type 2 diabetes, as well as other metabolic conditions, including obesity and lipid disorders. Services include insulin pumps, continuous glucose monitoring, and access to clinical trials. An inpatient diabetes management service that is available 24/7 to assist clinicians in achieving optimal glucose control in hospitalized patients in both ICU and non-ICU settings A national referral site for patients with thyroid diseases, including hyperthyroidism, thyroiditis, thyroid nodules, and thyroid cancer; and adrenal diseases, including adrenal masses, Cushing syndrome, hyperaldosteronism, and pheochromocytoma Multidisciplinary care provided to patients with pituitary diseases, including tumors, prolactinomas, Cushing syndrome, acromegaly, hypopituitarism, and hypophysitis. Special services include intraoperative MRI and intraoperative hormonal testing to ensure complete removal of tumor. National and international experts on metabolic bone disease, including osteoporosis, hyperparathyroidism, Paget disease, vitamin D disorders, and genetic conditions involving the skeleton. Challenging cases are reviewed at a monthly multidisciplinary bone conference. Bone density measurements by the Yale Densitometry Service that are taken on a new Hologenic DXA scanner
Metabolic Health & Weight Loss ProgramObesity is a common problem that can cause fatigue, diabetes, fatty liver disease, and sleep problems, and raise the risk of many cancers. It reduces energy, and can take the pleasure out of many aspects of life. Extra weight also places stress on vital organs, including the heart, liver, and kidneys, as well as joints and the reproductive system. Although organs can work under this extra stress for a number of years, eventually they are likely to fail. Most organs lose about 80% of their capacity before symptoms are evident, and by that time, it is often too late to return them to normal function. The conditions associated with obesity are: Cancer Cardiovascular disease Diabetes Liver disease Obstructive sleep apnea Losing weight can help improve and sometimes cure many of these conditions, as well as fertility issues. Losing weight can also lead to a life with fewer medications, lower health expenses, and overall greater enjoyment. At the Yale Metabolic Health and Weight Loss Program, we offer all nonsurgical weight-loss interventions in one location. Our philosophy is to focus on health, rather than specific disease, and to tailor our care to each patient’s specific needs and goals. The first step in our care is to determine weight-loss goals. Patients may need to lose 5 to 10% of their body weight to help in the treatment of a disease. We will help patients choose from interventions that include intensive meal-replacement programs, a range of medications, or endoscopic (nonsurgical procedure) options. Sometimes, there are additional medical necessities, such as an upcoming surgery, that require a specific weight-loss goal. We will explain the advantages and disadvantages of the various options, but the choice will depend primarily on what feels right to the patient. We provide therapies under the medical supervision of obesity experts. Patients can choose from the full range of tested interventions: Lifestyle changes: Nutrition counseling goes hand-in-hand with medical management of metabolic health. Care will include a personal visit with a registered dietitian with advanced training in weight management. OPTIFAST® program: OPTIFAST® is a medically monitored weight management program that allows patients, under the supervision of a physician, to consume a low-calorie diet and receive comprehensive lifestyle education. The OPTIFAST program provides full meal replacement for 12 weeks and transitions to self-prepared “everyday” meals in conjunction with comprehensive patient education and support, to help patients achieve long-term weight loss. Medications: All medications are used as part of a comprehensive program that includes proper nutrition and a healthy lifestyle. Belviq® is taken twice daily and can produce weight loss in the 5 to 10% range after about six months of use. Its main effect is to decrease appetite. Contrave® is a single pill that contains two medications (naltrexone and bupropion) and is taken twice a d
Diabetes CenterOur goal at the Diabetes Center is to give patients the tools necessary to successfully manage the day-to-day challenges of living with diabetes and prevent long-term diabetes complications. We provide comprehensive management and education for adults with type 1 and type 2 diabetes. We focus on lifestyle interventions and use the latest medications and technologies to improve our patients’ health. We also treat patients with: Pre-diabetes and metabolic syndrome Obesity Polycystic ovarian syndrome Lipid or cholesterol abnormalities Our nationally recognized doctors and nurse practitioners work as a team to address our patients’ needs in managing diabetes and other conditions. We understand that living with diabetes presents challenges. We focus on education and making patients their own advocates. Through the most current and state-of-the-art treatments, we will help them better manage their care. Oral Medications There are several classes of oral diabetes medications that we may prescribe if patients have type 2 diabetes. These medications differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination. Sulfonylureas: These drugs increase the amount of insulin produced by the pancreas. Meglitinides: These drugs rapidly increase the amount of insulin produced by the pancreas. Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in the liver. Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in the intestines. Thiazolidinediones: This agent makes the body more sensitive to insulin. Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by the pancreas after a meal and reduce the amount of glucose produced by the liver. Injection Therapies There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin. The most common injection therapy is insulin, which comes in many different formulations that differ in how fast they work and how long they last. Below is a list of the different types of insulins. Technologies and Experimental Treatments Insulin Pumps: Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the patient. While fasting, patients will administer a low level of continuous “basal” insulin to keep their blood glucose in the normal range. Prior to meals, they will determine a “bolus” of insulin based on the amount of carbohydrates in the meal. Continuous Glucose Monitoring systems (CGM): A CGM is a device that measures glucose under the skin (also known as “interstitial” glucose) every five minutes thr
Center for Weight ManagementWeight management is a complex and multi-faceted challenge that can involve a wide range of health issues, with solutions that are different for every person. The Center for Weight Management, part of Yale New Haven Health (YNHH) and Yale School of Medicine, is a multidisciplinary practice offering a comprehensive range of services for patients needing help to achieve their target weight. The center provides assistance with weight and weight-related health conditions from many different perspectives, with personally tailored solutions based on each patient’s specific needs and goals. Weight management is a lifelong journey, and we are here to help. The center brings together renowned experts in both the medical and surgical treatment of obesity, as well as in such fields as psychology, nutrition, exercise physiology, orthopaedics, endocrinology, cardiology, liver disease, and more. The center doesn’t just focus on weight management, but also on the many health outcomes associated with excess weight, such as diabetes, fatty liver disease, heart disease, joint problems, and cancer. Successful weight management can significantly improve these conditions and reduce the chance of developing them in the first place. In short, the center provides services across the entire continuum of care for weight management, including everything from dietary advice to psychological counseling, medications, endoscopic interventions, and surgery. Having all of those services under one umbrella gives us the unique ability to care for any patient with weight management needs, regardless of size or treatment options. The center also has an alliance with the YNHH Department of Pediatrics, and since obesity tends to run in families, center administrators are planning an intergenerational clinic where the entire family can receive care. Currently, the center is situated at several different locations within the health system; in 2022, all of the components of the center are scheduled to move to a single location at 8 Devine St. in North Haven. Consultations are also available via telehealth. The Center for Weight Management has three physician-directors: John Morton, MD, MPH, medical director of bariatric surgery for the Yale New Haven Health System; Wajahat Mehal, MD, PhD, director of the Yale Weight Loss Program and an expert in obesity medicine and endobariatrics; and Ania Jastreboff, MD, PhD, an adult and pediatric endocrinologist with expertise in obesity medicine and weight management. The center has a fully integrated medical and surgical team. We have approximately 20 physicians, including 12 bariatric surgeons, who together have performed about 10,000 successful surgeries (Dr. Morton alone has performed about 4,000 successful bariatric surgeries). Other members of the team include nurses, dieticians, psychologists, social workers, and an exercise physiologist, as well as the many experts on weight-related health conditions who partner with the center.