Speaker 1:

Welcome to AACE Podcasts. Thanks for tuning in as we elevate clinical endocrinology by taking deep dives into trends and topics that can help us improve our patient care and global health. Find the latest episodes on aace.com/podcasts. And now let's meet the endocrine experts who will be talking with us today.

Dr. Lansang:

Thank you for listening in. I have the pleasure of doing today's interview. My name is Cecilia Lansang. I direct endocrinology at main campus at Cleveland Clinic and I'm professor of medicine at a Cleveland Clinic Learner College of Medicine. Our special guest today is no other but Dr. Guillermo Umpierrez.

Dr. Umpierrez:

Hello. I'm Guillermo Umpierrez. I'm a professor of medicine in the Division of Endocrinology at Emory University School of Medicine in Atlanta. I'm a clinician educator and researcher, especially in the area of inpatient diabetes care. I've worked for the last 20, 30 years in trying to find out the mechanism for better cell dysfunction in minority populations and the management of inpatient hyperglycemia. I've been lucky enough to work and be invited to participate in national, international studies and guidelines, especially with major organizations. In addition, I've served as the director of the Emory Latino Diabetes Education Program in national accredited Spanish diabetes education dedicated to provide diabetes and education to Latinos. Thank you so much, Cecilia.

Dr. Lansang:

Again, this is a special way of honoring the people who have shaped endocrinology throughout the years, but tell us about the young Guillermo Umpierrez. What was he like? What was life like before you even entered medicine?

Dr. Umpierrez:

Well, I grew up in Ecuador in South America, did my training at Emory University, and I've stayed in Atlanta, off and on, for 40 years. I've joined the faculty 1992, left for a couple of years to the University of Tennessee, Memphis. I, then, came back to Emory and still here.

Dr. Lansang:

You've obviously had a successful academic life, but when do you think you decided to go into medicine? How did that happen?

Dr. Umpierrez:

Well, I always was very intrigued about medicine and health issues, since I was a teenager. So in South America, you have to decide if, at age 18, when you go to the university for seven years, you don't get a chance to go to college, so I made that decision and stay put.

Dr. Lansang:

Nice. And then, what about endocrinology? What made you think about that as your specialty?

Dr. Umpierrez:

As an intern, I was invited to participate in a clinical study, and at that time, the meters were not very well-developed. So, we did a study on diabetic ketoacidosis and [inaudible 00:03:26] in blood samples to be able to get a more accurate readings. That allowed me to be part of the endocrine section, I guess. So, when I finished my internal medicine residency, I applied and stayed at Emory.

Dr. Lansang:

That's nice. And so, who were your earlier mentors over there, that kind of shaped you to be of course who you are now?

Dr. Umpierrez:

This is interesting. Well, I signed my contract, and it was a one-page agreement, and the description of my job was take care of diabetes at Grady Hospital, a large community hospital, 1000 beds. By the way, you need to do research, so as a junior faculty, I talked to the diabetes educator. I said, "What kind of patient do you see?" I was very intrigued by the fact that there were a large number of patients with diabetic ketoacidosis, so we look at all of the patients that we have seen during that year, the year before, I was surprised by the rate of obesity in patients with diabetic ketoacidosis. At that time, 1992, when you asked, "Tell me about a patient with DKA," they said, "Well, it's a Caucasian, it's young," but what I was seeing at Grady was middle age in the late '30s, early '40s, newly diagnosed without precipitating costs developed TKA.

They were overweight or obese, so we had 50% at that time or those patients presented with newly diagnosed DKA were overweight or obese. We did some studies and determined the clinical characteristics, and then I got my first grant, I guess. I think a year after, I started working at Edward as a faculty to determine what was the insulin secretion, why did this patient develop diabetic ketoacidosis? Then, that will start all of this investigation that we had, and at that time we used to call obesity DKA. Now, with time, we changed the name to ketosis prone diabetes, because we knew that some people developed ketosis, some people did not, but they all presented with no diagnosed diabetes. So common.

Dr. Lansang:

I think that's great, that you latched on an observation and then ran away with it, because you certainly are looked upon as the father of inpatient diabetes and diabetic ketoacidosis. So, amongst your accomplishments then, academically, what are you the most proud of?

Dr. Umpierrez:

Honestly, to be a faculty member at Emory has been incredible, in a way that their very supportive environment would allow me to be with family and two daughter, four granddaughters, so I'm home for the past 40 years. In academic medicine, I guess I received multiple awards, but they really second by far my satisfaction working in this environment.

Dr. Lansang:

I think that's good for other people to know, that you can have all the accolades, but really, what's important to someone like you is to be available for family, so that's great, but I'm sure not everything was smooth all the way. So, what obstacles did you face that was really challenging? Because this is also part of the advice that you could give to junior faculty, so tell us about those.

Dr. Umpierrez:

Yeah. As a young faculty member, I didn't have much experience in doing clinical research. During my fellowship, I did basic research and there was no much support or training as a faculty to develop a research experience. So Larry Phillips, at that time, was the division chief. He helped me some, but then somewhere around two or three years later, after I joined the faculty, I was allowed to invite one professor from outside our institution, and I invited Abbas E. Kitabchi, who at that time was the top-notch guy in diabetic ketoacidosis. He was the one who did a lot of these studies to determine the frequency, what happened to people with DKA, and he accepted to come to Emory.

When I was there, I told him about my research that was about all these African American patients with DKA, and I invited him to join my research at that time and to mentor me, so he accepted. We did some number of studies with Avi and Larry Phillips. Then, a few years later, year 2000, when we got the Look Ahead trial, be part of the Look Ahead, I moved to Memphis, Tennessee for three years, and Abbas E. Kitabchi was the most incredible mentor. He would come to my office every day and say, "What are you doing?" At that time, we didn't have much computer system, so he would use this red pen and mark all my papers and everything, and always ask me, "Why are you asking these questions?" and made me think about why research should be done. I think that's what I took over in my research experience and now, of course, this is what I do for living, I guess.

Dr. Lansang:

No, that's great. So, finding true mentorship invested in your success.

Dr. Umpierrez:

And that's the big challenge for junior people. That's right. I think that you finish your training, three years internal medicine, three years of endocrinology fellowship, but that's not enough to find the right person, the right mentor that will have time and support you. I think it's needed to be, I guess, successful in academic medicine. The problem that we have is that there are not too many people who would like to invest in junior faculties, but at that time I was lucky enough to get [inaudible 00:10:25].

Dr. Lansang:

I think that there is indeed somewhat of a shift in some resources for medical school and training, but there are still great institutions who are keeping the tradition, which is good. So, tell us about your research nowadays. What are you into?

Dr. Umpierrez:

So, for the past 15, maybe 20 years, I've been very involved in inpatient diabetes care or hospital diabetes care. That was my job description, so we started doing the first studies, was very observational. What happened to patients in the hospital? I remember in 2002, we published a paper that now has over 1000 citations that's just a description of patients who present with hyperglycemia in the hospital, and we showed that 36% have high blood glucose, 12% with newly diagnosed with stress related hyperglycemia, and 20 plus percent were patient with diabetes, and those patients have increased mortality and increased complications rate.

Even those with newly diagnosed diabetes, they have more complications than those with previously known diabetes. The other thing that we learned is that the glycemic control was terrible. In the 2000, oh my goodness, people go around, even with bypass surgery, with glucose in the 200s. So, we implemented inpatient diabetes care, we wrote some protocols trying to change the outcome, and I continue to do this. We're lucky to get good faculty, junior faculty joining us. Most of them are extremely successful with [inaudible 00:12:26] to R1 now, and they have their own line of investigation. But I think I have been blessed by having good people in a good institution.

Dr. Lansang:

I remember that article that you mentioned, and I have cited it several times myself. I think it really pushed the envelope towards better inpatient diabetes management, and many hospitals now have dedicated teams just to see patients with diabetes and not necessarily endocrine.

Dr. Umpierrez:

And if I tell you something, I mean, this is life, that's right. In 2001, Greet Van den Berghe, who is a good friend of mine now, published the paper of the surgical patients in the ICU. We came with this paper, more or less, at the same time with just a couple of months different. Of course, that's when everybody became very interested in patient diabetes care, greatly in the ICU, our team in the non ICU setting. Lucky me.

Dr. Lansang:

Yes, great partnerships all along. That's great. So, when you're not thinking of medicine, what do you do? What are your hobbies? Where have you been going? What are your favorite places to visit in the world?

Dr. Umpierrez:

My hobbies are going to the gym or walking or running, and I try to do exercise at least five, six days a week, if I can every day, I guess. That's my main hobby, I guess, exercising and, unfortunately, working, I guess, or spending time with family. Last few years, our granddaughters now are growing, so we try to take them to different trips within the United States and abroad. Because of diabetes research, I've been invited to give lectures all around the world, so I travel maybe too much according to my wife, but I do enjoy traveling a lot. If you ask me what's my favorite place, it would be a battle between Euro and Latin America, I guess.

Dr. Lansang:

Yeah. No, that's good. So, do you have any parting words for the people who are trying to, again, forge through their careers in medicine? What would be your take home message for them?

Dr. Umpierrez:

Yeah. Well, especially for the fellows, and I meet with them and I tell them about academic medicine, and the same like myself, when I finished my fellowship, I was offered a job to do research, and said, "No, I'm a clinician. I'm a clinician educator."? Of course, I didn't want to spend, at that time at life, writing papers and grants with study, so I was mostly dedicated to do education and patient care at Grady, but of course, some research, and I was happy to just publish a couple papers a year, but that number increased with time. I think the fellows need to know that diabetes in academic medicine is important, because it allows you to do education patient care and research. For most fellows, I believe when they finish their training, they are very comfortable in patient cares and education, but if you find the right person and the right environment to do research within your institution or outside your institution, then you can start doing research.

Very few people have great ideas when you're a fellow. That doesn't happen too often, so take in consideration that is going to be several years until you're an independent investigator. That's what we have practiced, and we have had, I think, like seven or eight awardees in the last ten years in our institution, because we work as a group. The other thing is that, for junior faculties, is join a group of people who are willing to invest in education, teaching, and research, because in that way, you have more ideas, and try to meet for research in your institution at least once a month to discuss ideas. Unfortunately, most institutions that I visit, that doesn't happen, so you have to do research. You need to have a good environment, a good team, supportive team to be able to take off with research projects.

Dr. Lansang:

I think it is great if you're surrounded by people who are invested in your academic career, so I'm glad to hear that you are passing it to the next generation. Again, what you have done and what you continue to do inspires many people, so thank you. It was a pleasure conducting this interview with you. Thank you, Guillermo.

Dr. Umpierrez:

Thank you so much for the opportunity to share my little experience in life. The other thing for junior faculty is that, enjoy what you do, and celebrate your little successes of a little paper or big paper, because that will keep you going.

Dr. Lansang:

No. That's good advice, because it can't always be just the large, multi-center grants that will make your day, so thank you.

Dr. Umpierrez:

Thank you.

Speaker 1:

Thanks for listening to another great AACE podcast. Join us for another episode at aace.com/podcasts and help us in our mission to elevate clinical endocrinology. Together we are AACE.