Enrico Cagliero, M.D.

Management of type 1 and type 2 diabetes

My research focus is on clinical care in the area of treatment of type 1 and type 2 diabetes. I am currently engaged in the following projects:

1.Clinical care for diabetic patients in hospitalized setting and in primary care
I have been conducting several studies on the status of inpatient diabetic subjects at MGH, the role of HbA1c testing in the Emergency Department, and developed a set of structured insulin orders that are integrated in the MGH electronic order sets. I am currently conducting a clinical trial on the effectiveness of such orders. I have also worked together with the General Medicine Division on assessing and improving the care for type 2 diabetic patients in primary care. We have studied the level of care received by patients in primary and specialist care at Massachusetts General Hospital, and completed two randomized trials of a web-based diabetes management application (that we designed in collaboration with the Laboratory of Computer Sciences) that showed improvements in outcomes of diabetes care. The diabetes management application is now part of the Partners clinical tools.

2. Islet Transplantation in Type 1 Diabetes.
I am currently collaborating with Dr. James Markmann, Division Chief of Transplant Surgery on a new protocol on islet cell transplant for type 1 diabetic patients recipient of kidney allografts. I am also currently the PI of a research grant aiming at improving islet cell function post transplant using Exenatide, and a member of the MGH Transplant Center.

3. Management of diabetes in patients with mental health issues
Over the last few years I have collaborated with Dr. David Henderson of the department of Psychiatry on several studies on the relationship between atypical antipsychotic agents and diabetes. We have performed two epidemiological studies (new onset of diabetes and new onset of diabetic ketoacidosis in schizophrenic patients given atypical antipsychotic agents) as well as two pathogenesis studies on insulin resistance and the use of these drugs. I am currently collaborating with Dr. Safren and Dr. Gonzalez of the Behavioral Medicine Service in a clinical trial of cognitive behavioral therapy in patients with depression and type 2 diabetes.

4. Diabetes Prevention
I have a member of the Diabetes Prevention Program since its inception several years ago and I am still actively following the patient cohort as part of the Diabetes Prevention Program Observational Study.

 References:
  1. Grant RW, Cagliero E, Sullivan CM, Dubey AK, Estey GA, Weil EM, Gesmundo J, Nathan DM, Singer DE, Chueh HC, Meigs JB: A controlled trial of population management. Diabetes Mellitus: Putting Evidence into Practice (DM-PEP). Diabetes Care 2004; 27:2299-2305

  2. Henderson DC, Cagliero E, Copeland PM, Borba C, Evins E, Hayden D, Weber MT, Anderson EJ, Allison D, Daley T, Schoenfeld D, Nathan D, Goff DC: Glucose metabolism in schizophrenia patients treated with atypical antipsychotics: a frequent samples intravenous glucose tolerance test and minimal model analysis. Arch Gen Psyc 2005; 62:19-28

  3. Wexler DJ, Grant RW, Meigs JB, Nathan DM, Cagliero E: Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes mellitus. Diabetes Care 2005; 28:514-520

  4. Wexler DJ, Grant EW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, Blais MA, Meigs, JB: Correlates of health-related quality of life in type 2 diabetes. Diabetologia 2006; 49:1489-97

  5. Weiss AP, Henderson DC, Weilburg JB, Goff, DC, Meigs JB, Cagliero E, Grant RW: Treatment of cardiac risk factors among patients with schizophrenia and diabetes. Psychiatr Serv 2006; 57:1145-1152

  6. Henderson DC, Copeland PM, Borba CP, Daley TB, Nguyen DD, Cagliero E, Evins AE, Zhang H , Hayden D, Freudenreich O, Cather C, Schoenfeld D, Goff DC. Glucose metabolism in patients with schizophrenia treated with olanzapine or quetiapine: a frequently sampled intravenous glucose tolerance test and minimal model analysis. J Clin Psychiatry 2006; 67:789-797

  7. Shapiro AMJ, Ricordi C, Hering BJ, Auchincloss H, Lindblad R, Robertson RP, Secchi A, Brendel MD, Berney T, Brennan DC, Cagliero E, Alejandro R, Ryan EA, DiMercurio B, Morel P, Polonsky KS, Reems JA, Bretzel RG, Bertuzzi F, Froud T, Kanaswamy R, Sutherland DER, Eisenbarth G, Segal M, Preiksaitis J, Korbutt GS, Barton FB, Viviano L, Seyfert-Margolis V, Bluestone J, Lakey JRT: International Multicenter trial of Islet Transplantation in Type 1 Diabetes. N Engl J Med 2006; 355:1318-1330

  8. Crivera C, Suh DC, Huang ES, Cagliero E, Grant RW, Vo L, Shin HC, Meigs JB: The incremental costs of recommended therapy versus real world therapy in type 2 diabetes patients. Curr Med Res Opin 2006;22:2301-2311

  9. Delahanty LM, Grant RW, Wittenberg E, Bosch JL, Wexler DJ, Cagliero E, Meigs JB: Association of diabetes-related emotional distress with diabetes treatment in primary care patients with type 2 diabetes. Diabet Med 2007; 24:48-54

  10. Wexler DJ, Meigs JB, Cagliero E, Nathan DM, Grant RW: Prevalence of hyper- and hypoglycemia among inpatients with diabetes: a national survey of 44 U.S. hospitals. Diabetes Care 2007; 30:367-69

  11. Grant RW, Wexler DJ, Watson AJ, Lester WT, Cagliero E, Campbell EG, Nathan DM: How do doctors choose medications to treat type 2 diabetes? A national survey of specialists and academic generalists. Diabetes Care 2007; 30:1448-53

  12. Henderson DC, Cagliero E, Copeland PM, Louie PM, Borba CP, Fan X, Freudenreich O, Goff DC: Elevated hemoglobin A1c as a possible indicator of diabetes mellitus and diabetic ketoacidosis in schizophrenia patients receiving atypical antipsychotics. J Clin Psych 2007; 68:533-541

  13. Gonzalez J, Safren S, Cagliero E, Wexler DJ; Delahanty LM, Wittenberg E, Blais MA, Meigs JB; Grant RW: Depression, Self-Care, and Medication Adherence in Type 2 Diabetes: Relationships Across the Full Range of Symptom Severity. Diabetes Care 2007; 30:2222-27

  14. Lorenzi M, Feke GT, Cagliero E, Pitler L, Schaumberg DA, Berisha F, Nathan DM, McMeel JW: Retinal haemodynamics in well-controlled type 1 diabetic subjects. Diabetologia 2008; 51:361-4

  15. Larkin ME, Capasso VA, Chen CL, Mahoney EK, Hazard B, Cagliero E, Nathan DM: Measuring psychological insulin resistance: barriers to insulin use. Diabetes Educator 2008; 34: 511-17

  16. Smith RN, Kent SC, Nagle J, Selig M, Iafrate J, Najafian N, Hafler D, Auchincloss H, Orban T, Cagliero E: Pathology of an islet transplant two years after transplantation: evidence for a non-immunological loss. Transplantation 2008; 86:54-62

  17. Ginde AA, Cagliero E, Nathan DM, Camargo A: Value of risk stratification to increase the predictive validity of HbA1c screening for undiagnosed diabetes in the U.S. population. J Gen Intern Med 2008; 23:1346-53

  18. Wexler DJ, Nathan DM, Grant RW, Regan S, Van Leuvan AL, Cagliero E: Prevalence of elevated HbA1c Among Patients admitted to the hospital without a diagnosis of diabetes. J Clin End Metab 2008; 93:4238-4244

  19. Ginde AA, Cagliero E, Nathan DM, Camargo CA Jr: Point-of-care glucose and hemoglobin A1c in emergency department patients without known diabetes: implications for opportunistic screening. Acad Emerg Med 2008; 15:1241-47
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