Manisha Chandalia, M.D.
Manisha Chandalia, M.D.
Fellowship Program Director
Director, Stark Diabetes Center
Division of Endocrinology and Metabolism
Department of Internal Medicine
University of Texas Medical Branch
8.138 Medical Research Building
Galveston, TX 77555-1060
Although obesity is strongly associated with type 2 diabetes and cardiovascular disease, there is marked inter-individual variation in susceptibility to these metabolic complications. Variability in metabolic complications of weight gain is particularly accentuated in ethnic minorities, including Asians, African Americans and Hispanics. Dysfunction of adipose tissue typically occurs in obesity but we have reported evidence of significant adipose tissue dysfunction in non-obese insulin resistant persons. There is a need to better understand mechanisms leading from excessive adipose tissue content to metabolic complications leading to the two major obesity-associated chronic diseases of our society: type 2 diabetes (T2DM) and cardiovascular disease (CVD).
Our lab has been involved for years in clinical investigation on the causes of insulin resistance in relation to adipose tissue mass, distribution, and adipose tissue function. Heterogeneity in response to fat mass increase among ethnic groups has allowed us to define the role of adipose tissue function on insulin resistance in Asian Indians and Caucasians. Using measurements of insulin resistance by euglycemic-hyperinsulinemic clamp and measurements of regional fat content by MRI of the entire abdomen, we have shown that Asian Indians have excessive insulin resistance, higher plasma concentrations of the adipose tissue metabolites leptin and non-esterified fatty acid (NEFA) and lower concentration of adiponectin and higher plasma High sensitive C-reactive protein (Hs-CRP) a marker of low grade systemic inflammation compared to Caucasians matched for total and abdominal (subcutaneous as well as visceral) body fat. These apparently healthy insulin resistant Asian Indians had larger adipocytes compared to Caucasians with similar degree of adiposity. Taken together our previous studies have added to the growing acceptance of adipose tissue function as a major determinant of metabolic complications, independently of adipose tissue mass and BMI.
I am currently exploring the role of adipose tissue extracellular matrix and collagen on adipose tissue inflammation and insulin resistance, a precursor of metabolic complications of obesity.
I am also involved in exploring role of nutrients in management of metabolic complications such as dyslipidemia and hyperglycemia in humans.
Besides clinical translational research, I spend considerable time with direct patient care, mainly managing complex cases of hyperlipidemia, diabetes, metabolic syndrome and obesity.
I am deeply committed to advancing excellent evidence based training in Endocrinology and Metabolism to medical Students, residents, Endocrinology fellows and physicians. As fellowship program director, I spend considerable time in education and mentoring of trainees.
The department of internal medicine is developing evidence based clinical protocols which will be available in EPIC (as order sets) for use when admitting patients with these diagnoses. Their AIM is to standardize care and decrease length of stay and readmission rates.Currently available protocols are:
- CAP - Community Acquired Pneumonia Orderset
- Congestive Heart Failure (CHF)
- Chronic Obstructive Pulmonary Disease (COPD)
- Diabetic Ketoacidosis Adult, ICU
- General Medicine Admission
- Immunodeficiency Flow Panel
- MICU/CCU Admission Order Set
- Oral Analgesic Medicaitons
- Parenteral Opioids
- Sepsis, Adult ICU
All protocols can be found in the EPIC order set section.
The department of Internal Medicine has a large role in the Meaningful Use Initiative. Our participation is key for the success of the initiative. Please visit the meaningful use website for important communication and updates from the Meaningful Use Initiative.