Rachel Gerrard ’19

Joslin Diabetes Center, Boston, MA

This summer I worked as a research intern at the Joslin Diabetes Center in Boston, Massachusetts. At Joslin, I worked on two research projects, attended lectures, and shadowed dietitians, providers, and educators in the pediatric clinic.

Rachel holding her certificate of completion on her last day of internship at the Joslin Diabetes Center.
Rachel holding her certificate of completion on her last day of internship at the Joslin Diabetes Center.

The first project examined teen perspectives on type 1 diabetes long-term complications. We sought to learn more about what teens with type 1 diabetes know about long-term complications, how they want their providers to approach discussions about long-term complications, and what information about long-term complications they would like their providers to share. Before I arrived at Joslin, the physician I worked for had already recruited teens with type 1 diabetes and parents of teens with type 1 diabetes for the study and conducted semi structured interviews with the participants. I then analyzed the interview transcripts looking for central themes. I determined that teens in the study had limited knowledge of long-term complications whereas parents had a more thorough understanding. Both teens and parents expressed frustration with outside sources overestimating the risk of diabetes complications. Many participants wanted providers to focus more on how to prevent complications, and to avoid using scare tactics. Some participants felt that providers should discuss complications with other patients, but that they personally did not need to discuss complications with their provider because they had excellent control of their diabetes management. After determining these themes, I made tables with illustrative quotes for each theme and drafted a research manuscript to submit to diabetes journals for publication. The manuscript included specific recommendations for how providers should talk to teens with type 1 diabetes about long-term complications.

Prior research has found that when teens with type 1 diabetes have a better understanding of the complications associated with their condition they maintain better glycemic control and experience less diabetes related distress. We hope that our recommendations will help teens with type 1 diabetes have a better understanding and in turn manage and cope with their condition better.

The second project was a pilot intervention to help teens with type 1 diabetes engage in more heart healthy behaviors such as exercising, eating fruit, vegetables, fiber, and healthy fats. Cardiovascular disease is a common long-term complication of type 1 diabetes, so we hoped that our intervention would help improve participants’ heart health and decrease their likelihood of developing cardiovascular disease in the future. The study included both an intervention and control group. Participants in the intervention group were placed into teams where they had to complete biweekly challenges over a period of 12 weeks for the opportunity to earn points and cash. The challenges included taking over 5,000 steps a day four days a week and eating a serving of fruits and vegetables four days a week. Participants also participated in two one-on-one education sessions where they learned health information such as how to make a workout plan and how to distinguish between healthy fats (avocado, nuts) and unhealthy fats (butter, ice cream). We tracked the participants’ lipids, weight, blood sugar, and other health information in order to see if it improved over the 12 weeks. We also tracked control group members’ health information over the 12 weeks, but this group did not participate in the challenges or educational sessions. For this study I called potential participants and informed them about the study. I also communicated with participants about their daily steps and progress on challenges. Finally, I updated participant information into our online database and study binders. For each participant I recorded dozens of pages of information including their medical history, progress on challenges, contact information, and notes from their educational sessions.

In addition to these projects, I helped with general office work by making copies, taking notes, and filling out forms for Joslin’s institutional review board, a committee that oversees research projects. I also attended lectures along with other summer students where I learned about current diabetes research projects, the biology of the disease, and research methods. In one lecture, a biology Ph.D. taught us about obesity and adipocyte biology. In another lecture, a physician taught us about the cell biology of vascular complications in diabetes. In the clinic, I shadowed physicians, nurse practitioners, and nutritionists and got to see a variety of cases of type 1 diabetes. Through shadowing in the clinic, I learned that diabetes patients often have other autoimmune diseases such as celiac. I learned about the current technology available to help patients maintain glycemic control including various insulin pumps and continuous blood glucose monitors. New technology continued to become available during my eight-week internship and I was impressed to see such rapid improvements. I also learned that diabetes management is as much psychological as it is physical. People living with the condition have to constantly monitor their blood glucose levels and food intake in order to prevent serious complications. This can be very psychologically distressing and exhausting. The providers helped the patients find the best technology options for their lifestyle and develop strategies to mitigate their feelings of distress or burnout with their blood sugar management.

I was incredibly impressed with the people I worked with at Joslin. The physicians and nurse practitioners met with each patient for 45 minutes to an hour. They meticulously read each patients’ blood sugar history searching for patterns and ways to help their patient achieve better control. They met with patients every three months, sometimes more frequently, and personally called patients if they missed an appointment. The pediatric clinic also had a play room where trained diabetes experts taught children about their condition through play. These experts seamlessly incorporated lessons with games so that the children in the clinic did not realize they were being taught. The researchers conducted cutting edge projects that tackled diabetes from a variety of different angles. I did not realize the impact this one diabetes center had on the field until I attended a staff meeting where the chief of pediatrics took a vote whether she should change the name of a prominent diabetes journal. I was in awe that she had that amount of influence over research of the condition. I also formed friendships with some of the research assistants that I hope will continue long after this summer.

This internship has provided me with valuable research skills that I will use in my future science classes at Williams and throughout my career. As a psychology major, I often conduct independent research and I am excited to utilize these new skills in my psychology classes. The internship gave me the opportunity to form connections with mentors and possibly publish my first journal article. (We are still submitting the manuscript to journals.) It also allowed me to learn more about a condition that impacts 9.4% of Americans. After this summer, I am confident that I want to attend medical school and am seriously considering specializing in pediatric diabetes.

Thank you to the Kraft Family and to the ’68 Center for Career Exploration who helped make this internship possible. It was a valuable learning experience that will serve me well throughout my remaining time at Williams and throughout my future career. I would not have been able to have such an enriching summer without the Alumni Sponsored Internship Program.