San Antonio's Texas Diabetes Institute tackles a top disease among Hispanics (2022)

By Bill Zeeble, KERA 90.1FM reporter

Dallas, TX – Bill Zeeble , KERA 90.1 reporter: The Texas Diabetes Institute, or TDI, was a dream for at least 6 years before its doors opened in 1999. Terry De La Haya, Vice President of the institute, says a review of Bexar county hospital records showed 60% of dismissals were tied to diabetes. So with 28 million dollars gathered from federal, state, county and private foundation sources, the 153,000 square-foot Texas Diabetes Institute was built to deal with the community?s number one medical problem. Patients are often indigent; and, other than referrals, it only serves Bexar county residents. The institute went up on the old Lutheran General Hospital site to be near those who need it the most, according the De La Haya.

Terry De La Haya, Vice President, Texas Diabetes Institute: It?s really a neighborhood setting. It?s your non-traditional medical center complex. You can walk across the street and right into a home. It?s the non-traditional atmosphere that many of our patients are looking for. Instead of the sterile white buildings you have to travel far to, to see a physician.

Zeeble: This facility is anything but typical. A third of it?s for education, with a home-ec type kitchen with ovens to teach patients about diet and food preparation. [Ambient sound.] Employees, patients and neighbors maintain a community garden of healthy herbs and vegetables right outside the exercise facility and near the 28-station kidney dialysis unit.

[Ambient sound.]

De La Haya: They use much of what they grow. It?s a form of exercise; it?s a form of community-building; it?s a form of support. We try to do as many things that will provide any kind of support to our patients...

Zeeble: There?s a podiatry wing with 17 treatment rooms, an outpatient operating facility, offices, machines to test walking patterns.

Sabrina Calese, Podiatric Case Manager, Texas Diabetes Institute: I think it?s huge compared to other facilities that are out there concerning podiatry with diabetes.

Zeeble: Sabrina Calese is the case manager of the podiatry clinic. Foot and limb problems are profoundly serious diabetic complications. The disease is responsible for up to 70% of the nation?s amputations every year.

Calese: This facility - when people come from different countries, or just here in the U.S., are amazed what we do here - the way we can work with different specialties hand in hand, the way we treat the patients, follow up patients, the way we try to make sure they?re compliant.

Zeeble: The podiatry division works closely with prosthetics across the hall. Gordon Bosker, director of the artificial limbs department that also oversees construction of braces and special shoes, confirms that close ties to patients and doctors is invaluable. Bosker?s getting off the phone with a podiatrist as I walk into his office.

Gordon Bosker, certified prosthetist/orthodist, Texas Diabetes Institute: She?s coming in Thursday - are you coming in Thursday? ? OK, thanks John. OK, bye. [Bosker off phone.] We talk about a specific patient: ?Hey this is what?s going on. This is what we may need to do.? That?s not uncommon. But it?s so easy for us here ?cause we?re right next door. We have a good rapport with each other. Whether wound care, podiatry, internal medicine downstairs.

Zeeble: Bosker?s been doing this kind of work since finishing his Vietnam tour as an aircraft crew chief, where he said he carried a lot of body bags. This was his way, he said, to pay for his luck of returning unharmed, adding that, ?Once you?re in rehab, you?re in to stay, because you see the positive results.? TDI?s second floor wing has been working overtime for months, and the institute?s only been open about a year and a half

Bosker: We projected that we would see, probably have 250 appointments a month. We?re averaging right now 425. As far as our workload, we?ll go against the best of them. I use the word ?slammed,? ?cause we?re very, very busy.

Zeeble: Bosker walks past a work table strewn with tools; a sand pit for shaping and cooling artificial legs; an oven built to reach 725 degrees; and into a machine shop of sanders and a computer-driven artificial leg carver.

Bosker: What I?d normally do is open this up and put a blank in here. I can just power on. [Ambient sound.] You can see the drill bit coming down. This is going in the ?Y? direction. This is in the ?X? direction. Youll see it rotate, goes into the ?Z? direction, and it?s actually carving something out. We?re on the cutting edge of a lot of things. I refer to us here as being in the trenches. We still give shoes, arch supports, things given for many years. The difference is we?re dealing with different materials and different follow-ups. It?s very important. If we don?t follow up, we take a chance of ulceration. Any time a diabetic develops an open sore, it takes a lot of time to heal. Plus we could be opening ourselves up to an amputation. That?s what we don?t want.

Zeeble: Lucinda Contreras has already lost four toes on her right foot. At 55, she?s had Type 2 diabetes for 20 years. That means her body still makes insulin, which converts blood sugar into energy. But her blood sugars run too high. That stresses the body and, over time, damages circulation to the feet and toes. With special shoes and fittings, though, she?s still able to walk. But she?s developed a hard-to-heal sore on her foot. So she?s back for adjustments to her inserts.

Lucinda Contreras, patient: They keep me walking, take pressure off my toes, evens out my foot to walk better.

Zeeble: Before TDI was here, where would you get your special shoes?

Contreras: I wasn?t getting any shoes until I came here. They sent me over from podiatry.

Zeeble: Kathleen Satterfield, TDI?S Director of Podiatry Research, can help patients like Contreras thanks to new computer technology that pinpoints hot spots on people?s feet. Before she came here from Vermont, Satterfield had no idea how valuable this facility would be. She was used to seeing 65 and 75 year old diabetic patients

Kathleen Satterfield, Director of Podiatry Research, Texas Diabetes Institute: In my first week here, I saw a 28 year old woman with Type 2 diabetes, what we think of as adult onset. She already had an amputated leg, she was blind, and she was on dialysis. That?s the difference between the rest of the United States, and those areas, San Antonio included, that have a high Hispanic population.

Zeeble: Some of Satterfield?s patients, and other diabetics with hard-to-heal wounds, are occasionally sent next door, to the hyperbarics unit. Best known for curing the bends - a condition affecting divers who surface too fast from deep water - hyperbaric chambers have also been used on diabetics. Under increased pressure at the equivalent of 33 feet under water, more oxygen reaches slow-healing and infected wounds that often lead to amputations.

Dr. Adrian Strickland-Smith, Director of Hyperbarics, Texas Diabetes Institute: Hyperbaric therapy causes granulation tissue to grow faster. It also acts as a mild antibiotic; by increasing activity of white blood cells, it helps denature some toxins from various organisms that keep infection occurring in a diabetic wound.

[Ambient sound.]

Zeeble: Dr. Adrian Strickland-Smith runs the hyperbarics unit at the Texas Diabetes Institute

Strickland-Smith: It also oxygenates tissue and causes fiberblast to grow faster and causes blood vessels to grow faster. What I believe we?re achieving is a faster rate of healing, and it helps to keep infection from coming back, and swelling is decreased.

Zeeble: Controversy accompanies hyperbaric treatments, because objective scientific tests don?t yet exist. Some are currently under way. Others have been tried in the past. But as soon as patients saw fellow test members improve, they opted out of their own group for the other one, ending the study too soon. Despite a dearth of scientific evidence, TDI?s Podiatry Director John Seinberg says he and the institute are convinced treatments are worth the $500 a dive, where a minimum of 20 are usually required.

John Steinberg, Medical Director, Texas Diabetes Institute?s podiatry unit: We found it to be well worth the expense ?cause if we?re closing the wounds quicker and more reliably, we?re lessening the chance of infection and amputation. In essence we?re saving the system money by spending it on the front end.

Zeeble: Steinberg believes TDI?s stance on this therapy, and the hospital?s coordination of nearly all aspects of diabetes care, set the hospital apart from any other diabetes facility in the country. So does Dr. Christopher Saudek, Medical Professor at Johns Hopkins University and incoming President of the American Diabetes Association.

Christopher Saudek, Medical Professor, Johns Hopkins University, and incoming President, American Diabetes Association: I?m not aware of anything like it anywhere. There are a number of state programs sponsored by the CDC, but I don?t know of any that have come to the level of TDI, and I think it?s terrific.

Zeeble: The physicians who work here say they wish the whole operation could go out of business - meaning, they wish there were no need to treat so many ill, diabetic patients. But they expect the number of diabetics will keep rising, especially among Hispanics and other people of color. The Texas Diabetes Institute, called a one-stop shop for diabetes education, research, prevention and treatment, may be the model for treatment facilities of the future, if the epidemic of diabetes diagnoses continues to soar. For KERA 90.1, I?m Bill ZeebleThis story and series were funded in part by the Kaiser Family Foundation.

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