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Camilla Levister, MS, ANP-C, CDCES is a nurse practitioner at the Icahn School of Medicine at Mount Sinai Hospital in New York City. Levister is a Certified Diabetes Care and Education Specialist (CDCES) providing comprehensive care in the Division of Endocrinology, Metabolism, and Bone Disease.
As an investigator and sub-investigator in numerous diabetes-related research studies, Levister is making positive contributions to high-risk prediabetes, type 1 and type 2 diabetes, and diabetes care in pregnancy.
Interview with Camilla Levister, MS, ANP-C, CDCES
In this interview, Levister discusses her expertise in supporting people with type 1 diabetes (T1D) and working to improve patient care through the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
The T1DX-QI was established in 2016 — with the support of The Leona M. and Harry B. Helmsley Charitable Trust — in an effort to refine best practices and improve daily life for people with type 1 diabetes (T1D). Growth has been tremendous, with 54 endocrine clinics from across the U.S. participating in the Collaborative.
Fueled by top leaders in diabetes care, the T1DX-QI has become an engine of innovation and inspiration. By engaging with the shared, data-driven, and systematic methods of the T1DX-QI, clinics have seen unprecedented success in their approach to diabetes management.
With members working closely together to identify gaps in care, discover and refine best practices, and share research — the process has become knowledge-sharing at its very best. While collated data gives clinics a clear sense of “where they are,” it also demonstrates “where they can be,” by applying shared, evidence-based methods for improving care.
What led you to nursing and diabetes care?
“At diagnosis, I was admitted to CHOP in Philadelphia for three days and received intense education — so I assumed everyone else did, too,” explained Levister, who was diagnosed with T1D at age 12. “I was naively surprised by the lack of education and support other people with diabetes were facing.”
After graduating with an English and Spanish literature degree, Levister traveled through Argentina, Chile, and Peru. While in South America, she discovered that many people living with T2D were receiving inadequate diabetes education. She found herself in the unlikely position of providing healthcare counseling.
During this time, Levister also had a friend struggling with an eating disorder and T1D, who felt like her providers had given up on her, said Levister, who shared similar sentiments from her younger years.
“My endocrinologist gave me the ‘death talk,’ essentially saying, ‘If you don’t manage your blood sugars, this, that, or the other thing is going to happen.’ It’s a depressing visit when there’s no talk of positive outcomes,” explained Levister.
When conversing with a friend, Levister shared how much these situations bothered her.
“My friend said to me, ‘Well, why don’t you do something about it?’ It may sound cliche, but a lightbulb went off, and I was like — ‘Oh yeah, of course, why don’t I?’”
By then, Levister was a year or two out of college and began applying to nursing school. In 2008, she graduated with a Bachelor of Science in Nursing degree and went on to receive an Adult Primary Care Nurse Practice degree, in 2013, from New York University.
What do you enjoy most about your work?
“Education,” said Levister with a bright smile when reflecting on what she enjoys most about her work in diabetes patient care.
“Teaching is what I enjoy most about my work — it’s been my motivating factor,” said Levister, whose aspiration to support individuals living with diabetes has been heart-centered and unwavering.
“My intention with nursing has always been to work with people who have diabetes. That’s been my main drive,” said Levister. “People will often say to me, ‘You get it — you have it,’ in recognition that I live with diabetes and have a patient perspective, too.”
NYU and T1DX-QI
“As a person living with diabetes, I became aware of the T1D Exchange early on, participating in online surveys and questionnaires for the T1D Exchange Registry. At the time, I was doing HIV work, and wasn’t aware of its relationship to the wider T1DX-QI program,” said Levister, whose professional involvement in T1DX-QI work at Sinai has been more recent.
“We love being a part of the Collaborative. It’s given us insights into system improvements that we wouldn’t otherwise have,” said Levister, whose quality team at Sinai includes Carol Levy, MD, who serves as the PI, Grenye O’Malley, MD, Selassie Ogyaadu, MD, Nirali Shah, MD, and David Lam, MD.
“At Sinai, we currently have a few QI initiatives underway. They include a basal insulin pen project to improve backup insulin prescription rates for people on pumps, and preconception counseling for patients with pregestational diabetes,” said Levister. In addition, Dr. O’Malley will share a poster presentation, Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), at the American Diabetes Association’s recent 83rd Scientific Sessions in San Diego.
T1DX-QI projects: Preconception counseling and basal insulin
“Through our QI research, we’ve discovered deficits and inadequacies in preconception counseling with diabetes,” explained Levister. “It’s clear, more contraceptive and pregnancy planning education is needed, as well as overall knowledge about pregnancy and diabetes.”
“By studying 50 T1DX-QI sites (17 pediatric and 33 adult clinics) throughout the U.S., we were able to uncover the percentage of sites offering preconception counseling — and how often it’s provided,” explained Levister. “On the patient side, we collected data on the percent of sexually active people, individuals at-risk for pregnancy or on contraception, and those with A1C values under 7 percent.”
“After analyzing the available T1DX-QI data, it highlighted preconception counseling as an area that needs a deeper dive and dedicated work. Moving forward, we hope to address best practices and implement formal preconception counseling programs,” said Levister.
Inspired by O’Malley’s QI work on the adult side, Levister has similar ambitions in the pediatric space. While data has helped to spearhead the initial effort, it will also provide backing for project approval on the pediatric side.
“There’s a lot to take into consideration so everyone has a safe, comfortable place to converse,” explained Levister.
In terms of the basal insulin program, Sinai is having measured successes in backup insulin prescription rates for those on insulin pumps, a 26 percent increase to date.
With the implementation of the first cycle, clinic MAs were asking pump wearers if they had backup, long-acting insulin during the check-in process. In the second cycle, posters were added to engage and prompt patients with a primary question: “If you are an insulin pump user, do you have backup long-acting insulin?”
The final and current phase is focused on improved provider consistency of entering coding in the EMR to identify insulin pump users, which sits at 79 percent to date. In turn, this allows for effective MyChart messaging through the EMR.
“Patients are asked if they have a prescription, and if they don’t, the provider is aware of that before their next visit,” said Levister.
“In 2023, we’ve completed T1DX-QI data mapping for A1C, CGM and blood glucose monitoring, MDI use, and depression screening data,” said Levister, who also said this gathered data has helped to shape and prioritize future QI projects.
Looking forward, the QI team at Sinai will focus their efforts on improving depression screening and intervention, food insecurity and social determinants of health screening, increasing access and use of ketone meters, and EMR tracking for the adult diabetes population.
As an innovative nurse leader with a commitment to education, Levister is interested in exploring group education.
“Educating in groups is an effective way to provide tailored information, in a safe space, while fostering community with others who share similar life situations,” said Levister.
What do you enjoy outside of work? `
Outside of work, Levister enjoys biking around NYC, singing, time spent with family, learning Hebrew to converse with nieces and nephews, keeping her house plants alive and thriving, traveling, and snorkeling. Levister is a dedicated volunteer for the Belize Diabetes Association of New York and serves as a global advocate for the people of Belize living with diabetes. As a worldwide hiker, some of her favorites include the Valley of Desolation in Dominica, Wadi Rum in Jordan, and the Adirondacks in the fall.
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