It was a book about hormones that Michael Koren, MD, read as a teenager that first piqued his interest in endocrinology. He was intrigued with how minute amounts of chemicals have tremendous impact on the human body — determining how tall or short, obese or thin, or even how happy or depressed a person will be.
This led Dr. Koren to begin studying endocrinology, a field in which he has now been practicing for 13 years. “Hormones were very fascinating to me back then, and they’re still fascinating to me right now,” he says.
Recently, Dr. Koren joined Western Reserve Hospital Physicians, Inc. Endocrinology, where he provides general endocrinology care. This includes diabetes care, the management of thyroid and parathyroid disease, pituitary disorders, adrenal gland disorders, osteoporosis, low testosterone and other endocrine conditions.
“Diabetes is dangerous not just because blood sugars can go too high or low — those are medical emergencies that can endanger a patient’s life in a short period of time — but also because of its long-term complications,” says Dr. Koren.
When patients have uncontrolled diabetes over the extended period of time, the health of their blood vessels and nerves becomes compromised.
For example, in the lower extremities, a patient might first develop diabetic neuropathy, or nerve damage, when they lose sensation in their feet. This can then expose them to trauma or injury to their feet, which can then result in infection. The infection may spread into the bones, putting the patient at risk for osteomyelitis, which can be difficult to treat.
“Sometimes, amputation becomes a necessity at that point,” Dr. Koren explains. “Diabetes is actually the leading cause of non-traumatic amputations in the United States.”
One of the leading causes for type 2 diabetes is obesity. According to the Centers for Disease Control and Prevention, more than a third of American adults are obese, increasing people’s risks for diabetes, as well as heart disease and certain types of cancer. Part of the reason, Dr. Koren explains, is genetic makeup.
“Our bodies are designed to deal reasonably well with insufficient food intake. We can store calories in our bodies, so we are prepared for a period of famine during however many days or hours it takes to hunt and find the next meal. But our bodies are not designed to have excessive food around us. Therefore, part of the problem is biological genetic makeup, and there’s not much we can do about it,” he says.
The other part of the problem, Dr. Koren points out, is sedentary lifestyles. When people move from physically demanding jobs to industrialized or technology-based jobs, they become less active. Westernized diet is a big part of the problem, as well.
“Their genetic makeup does not change. It stays the same but their lifestyle changes, so that’s what triggers diabetes in those patients,” he says.
Although genetic makeup can’t be changed, physicians can promote healthier lifestyles for patients.
“We can also change our communities with bike lanes and pavement because in some places, you cannot walk even if you want to walk,” Dr. Koren suggests. “I don’t advocate for everyone to give up their personal cars, but we need to create opportunities for using stairs rather than elevators and escalators, walking and biking to work and stores, and promote the culture of movement.”
The Future of Endocrinology
Like many fields of medicine, technological innovations are providing new methods and treatment options.
“Within my practice, I try to use all recent developments that are commercially available and approved by the FDA,” says Dr. Koren. But there are also new technologies being developed that will significantly impact future endocrinology care.
“The first one that comes to mind, because it’s very relevant to our large population of patients with diabetes, is the evolving technology of artificial pancreas. We do not have it yet, but we do have technology that combines the delivery of insulin through the insulin pump with the continuous blood glucose monitoring with the help of specially designed sensors.”
Dr. Koren says there is still much to learn about endocrinology. ”Almost every day, I see patients with Hashimoto disease — a very common thyroid endocrine condition in which the immune system attacks the thyroid gland and leads to the development of hypothyroidism. We still don’t know what exactly triggers it. We don’t know how to prevent it or stop the immune system from attacking the thyroid gland or insulin-producing cells like in type 1 diabetes.”
However, he feels that this is a very exciting time to be an endocrinologist. “As we understand more and more about the causes of disease, our treatments will significantly improve.”
Dr. Michael Koren sees patients at two locations: 5655 Hudson Drive, Suite 110, in Hudson, Ohio, and 3033 State Road, Suite 203, in Cuyahoga Falls, Ohio. As a member of Western Reserve Hospital Physicians, Inc. Endocrinology, he practices with endocrinologists Dr. Jennifer Wojtowicz and Dr. Manjinder Kaur, and registered dietitian and certified diabetes educator Susan Iannicca, CNP. For more information or to refer a patient, call 330-926-3545.