Doing primary care is difficult. We must manage multiple chronic conditions for every patient in a patient-centered way. I work with multiple different national organizations to help primary care doctors redesign their practices towards better outcomes.

One of my primary focuses has been on diabetes quality improvement. In order to provider optimal chronic disease care (such as for diabetes) patients need to understand the disease as well as their roll in managing it and their medications. Adherence to any management plan depends on simplicity, perceived benefits to the patient, tolerability and cost.

The intersection of my interest in quality improvement and beta cell physiology is synergistic. While I attempt to empower patients with knowledge and skills I also need to be able to prescribe medications that work (with excellent A1C reductions), are tolerable (with few side effects), safe (with low rates of hypoglycemia or strain on other organs) and cost effective. These are the outcomes patients care about. As our knowledge of the beta cell and the pharmacologic manipulation of the beta cell advances we will continue to identify therapies that hit this patient centered "sweet spot." Normal physiology allows us to eat what we need to, exercise when we wish and live without wide fluctuations of glucose. Smarter pharmacotherapeutic options for diabetes will become increasingly able to replicate the natural action of the pancreas and thus allow our patient to live more normal lives. When viewed through the quality improvement lens this physiologic based approach has the potential to improve outcomes through greater adherence and simplification of approach.