Grazia Aleppo, MD, is a Professor of Medicine and Associate Chief for Clinical Affairs in the Division of Endocrinology, Metabolism, and Molecular Medicine at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. She also serves as the Medical Director of Northwestern Medicine Diabetes, Training, and Education Program and as co-chair of Quality Improvement in the Department of Medicine at Northwestern University.

In addition, Dr. Aleppo is Associate Editor of Diabetes Technology and Therapeutics and a member of the Editorial Board of BMJ Open Access Diabetes and Research Care. 

Interview with Grazia Aleppo, MD

In this interview, Dr. Aleppo discusses her involvement with the T1D Exchange Quality Improvement Collaborative (T1DX-QI) as an endocrinologist, researcher, and recognized national leader in the field of diabetes. Specifically in the implementation of diabetes technology to optimize care and outcomes for adults living with diabetes.

The T1DX-QI was established in 2016— with the support of The Leona M. and Harry B. Helmsley Charitable Trust — to refine best practices and improve the quality of care and outcomes for individuals living with T1D. Growth has been tremendous, with 60 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 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 endocrinology? 

“I went to medical school in Catania, Italy — where the sun always shines, it’s 90 degrees today, and it never snows,” said Aleppo, with a big smile.

“In my hometown of Sicily, I’m the granddaughter of a famous pastry chef, and the funny thing is, I provide diabetes care,” said Aleppo, laughingly. “What was I thinking?”

“While it’s taken me a while to get here, I’ve wanted to do this for a long time,” said Aleppo.

“After medical school, there weren’t endocrinology fellowship spots available at my alma mater. Despite being very interested in endocrinology, I got an invitation to do neuroendocrine research — which I did for three years,” said Aleppo.

“Then, I came to the U.S. for a three-year postdoc research fellowship at the University of Illinois in Chicago. Afterward, I had to retake the board exams to get into residency in the States,” said Aleppo. 

“While doing basic research, I began to find that I missed human interactions and had thoughts of practicing clinically. So I did another internship, residency, and an endocrinology fellowship,” said Aleppo. “When one day in clinic, I saw a young T1D athlete who was struggling, and I thought, ’What are we missing here?’”

“I don’t know what happened to me. I was thunderstruck and fell in love with diabetes,” said Aleppo, who would, ironically, meet and marry the love of her life — who also lives with T1D. 

What do you like best about what you do? 

“That I can really make a difference with my patients,” said Aleppo, who divides her time between clinical practice and research. 

“I laugh with my patients, I cry with my patients, and I will never give up on them,” said Aleppo. 

“It’s a huge privilege to care for my patients,” said Aleppo. “When someone tells me they’ve come from an hour away to see me, I feel very honored — and I mean that.” 

What’s your drive behind diabetes research?

“It’s my desire to enhance the care of diabetes everywhere I can,” said Aleppo, who is leading pivotal trials for pharma and diabetes device companies. 

“The moment I graduated from fellowship, I was totally gung-ho,” said Aleppo. “I started by using the first CGM, the old one with the cable, which I brought to Advocate Christ Medical Center affiliated with the University of Illinois. We were first to use CGM, Glucowatch, the initial Medtronic pump with integrated CGM, and many others.”

“Then, I came to Northwestern and brought my love of CGM here, too. We went from having no CGM program to becoming the largest pump and sensor center in Chicago,” said Aleppo, whose momentum has resulted in thousands of patients on pumps and sensors at Northwestern.

“I’ve led major CGM clinical trials, and was the protocol chair for the Replace-BG trial,” said Aleppo. “The Replace-BG trial proved it was safe to use CGM without a confirmatory finger stick, leading to FDA approval and ‘no-calibration’ CGM use in the U.S.,” explained Aleppo.

Northwestern and T1DX-QI

“In 2010, I had the greatest fortune to become involved in the T1D Registry,” said Aleppo, who now serves as the site PI at Northwestern after joining the T1DX-QI in 2018. 

“The T1DX-QI has opened my career to research and has offered so many opportunities for trials and studies. You name it, and we’ve likely done it,” said Aleppo, who recently finished the InPen project and is looking forward to future objectives including quality improvements in access to care for minorities. 

“Being part of the Collaborative is very important for our institution as we continue to examine ways to improve our delivery of care,” said Aleppo. “By utilizing available resources, and applying them internally, it puts our QI team in the Department of Medicine steps ahead with EMR improvements to more effectively track our data.”

“If we can capture who is using technology, we can better understand who our cohort is,” said Aleppo. “While there are some surrogate ways to find that, it’s difficult to achieve. By identifying who is using tech, and who isn’t, we can encourage greater uptake of these tools.”

What’s the most valuable thing that you’ve learned from your patients?

“I’ve learned diabetes is one thing in a book and another thing in life,” said Aleppo. “What I know is in the brain, but I approach patients from my heart.”

“Unless you understand what someone is going through, you truly know nothing about diabetes,” explained Aleppo. 

What’s next? What’s your hope for the future?

“First, I would love to do an inpatient CGM study,” said Aleppo. “Second, I’d like to see CGM use expanded, especially by primary care, as there are so few endocrine providers.”

“Because of this, a colleague and I recently published a step-wise approach to interpreting CGM for primary care, knowing if results are easily understandable, CGM will be used more widely,” explained Aleppo.

“At Northwestern, we have a pilot underway to improve CGM data accessibility with integration in the EMR — with the simple click of a button. Plus, we’ve implemented training for our colleagues in an attempt to expand CGM internally,” said Aleppo. “I’m proud of all  the things we’re doing for the future of diabetes care.” 

Outside of work

Dr. Aleppo loves listening to classical music, which she refers to as her ‘therapy.” While in medical school, Dr. Aleppo also attended a music conservatory in Italy, holding an aspiration to become a pianist. When she isn’t working, you’ll likely find her cooking traditional Italian meals, baking, or playing the piano.