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Mary Pat Gallagher, MD, is a pediatric endocrinologist and an Associate Professor in the Department of Pediatrics at NYU Grossman School of Medicine, where she serves as the Division Director of Pediatric Endocrinology and Diabetes. Dr. Gallagher is also the Medical Director of the Fink Ambulatory Care Center and the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone in New York City.
Interview with Mary Pat Gallagher, MD
In this interview, Dr. Gallagher discusses her involvement with the T1D Exchange Quality Improvement Collaborative (T1DX-QI) as a pediatric endocrinologist and scientist focused on improving the lives of children and adolescents 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 over 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 its shared, data-driven, and systematic methods, 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 brought you to endocrinology?
“Endocrinology unfolded sort of slowly for me. As a medical student, I honestly had no idea it would be my specialty,” said Gallagher.
“In my pediatrics rotation, I knew right away I was meant to be a pediatrician.” That said, “I also knew early on that I wouldn’t be a good general pediatrician because I enjoy the ‘nitty-gritty’ of things.”
“With pediatric endocrinology, I love the combination of getting to know children and families over time — in addition to the content. Hormones are like a puzzle, so endocrinology is intellectually stimulating on that level.”
“After finishing my fellowship in endocrinology, I saw a variety of endocrine conditions and specifically enjoyed neuroendocrinology — which I found fascinating — and now we know there’s a lot of neuroendocrinology even in diabetes.”
“I narrowed my focus about five years later to all forms of hyperglycemia and diabetes,” explained Gallagher, who, as a diabetologist, cherishes the long-lasting relationships she’s developed with children and their families while becoming an expert in her field.
What are the most valuable takeaways from patient and family interactions?
“It’s important to hear things from the patient and family perspective. I constantly learn from them,” said Gallagher. “When a family member says, ‘Oh, I didn’t know that,’ I usually respond, ‘I’ve been doing this for 20 years, and I learn something new every day, too!’”
Gallagher, whose clinic interactions are hallmarked by her warm smile and authentic, non-judgmental approach, encourages others to feel comfortable sharing in a similar vein.
“I appreciate the willingness of children and families to share openly about their experiences and difficulties. While we can work on some of them and help, others are ‘just what they are’ — and may simply need acknowledgment,” said Gallagher, who is always at the ready with a listening ear and kind heart.
“Shared experiences about glucose management, sensors that won’t stop beeping, or a pod that won’t quit alarming help me understand how difficult it is to do the things that we’re asking — even with hybrid closed-loop systems,” said Gallagher. “There’s no doubt they’re great tools, but T1D is still a burden, and it’s a lot to do, especially for children who are still developing.”
“I remind the caregivers of growing children that every few years, it’s like they’re being re-diagnosed,” said Gallagher. “Being a 2-year-old with T1D or a kindergartener is a very different experience than being in fifth grade or high school. So, it’s important for me to make sure they understand that while they’ve been living with T1D for years, their child is still developmentally processing it again and again — as a child, adolescent, and young adult.”
T1DX-QI and the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone Health
“I had previously worked with the T1D Exchange while I was at Columbia University Medical Center, which was a part of the original Clinical Registry, and I was interested in the new version of the Collaborative that was focusing on a QI approach,” said Gallagher.
“As we opened our pediatric diabetes center in 2016, I wanted to know how our outcomes compared to other pediatric diabetes centers and joined an international registry called SWEET to have some benchmarks for comparison,” explained Gallagher. “Then, I became very interested in T1D Exchange as they launched their newer QI collaborative. I wanted to be a part of that, and I was able to connect with them in early 2020 at an Advanced Technologies & Treatments for Diabetes (ATTD) meeting in Madrid.”
“Within weeks of ATTD, the whole country shut down. NYC got hit particularly hard with COVID, and it was fantastic to have diabetes institutions around the country talking with one another,” said Gallagher. “We felt so fortunate to be a part of these collaborative interactions.”
Gallagher went on to serve as a PI for the T1DX-QI COVID-19 project, and subsequently, the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone joined the T1DX-QI in 2020.
“That was the beginning of my true appreciation for what could be accomplished with this type of QI work,” said Gallagher, who now serves as the PI for the Pediatric Diabetes Center at Hassenfeld Children’s Hospital, along with Dr. Lauren Golden, who is the PI on the adult side at NYU Langone Health.
“Hearing about what other centers are doing is so motivating, and we’re telling one another, ‘Here, try this,’” said Gallagher. “No one is trying to keep their learnings for themselves.”
“We’re all involved in improving the health, well-being, and quality of life for everyone affected by T1D. There isn’t a ‘my center is doing this’ mentality, and because of this, I’ve learned so much as a member of the T1DX-QI.”
What research do you have underway?
“I have several different project areas in both type 1 and type 2 research,” explained Gallagher, who dedicates the majority of her time to academic research but continues to allocate time clinically as a pediatric endocrinologist.
“First, we’ve received our notice of award from the NIH for a study in neurocognitive development in prepubertal children with T1D. It’s a multicenter consortium with eleven sites, and we will be one of them.”
“Over the past year and a half, I’ve also been part of a multi-site NIH study on type 2 diabetes (T2D) in youth, looking at why certain children will develop T2D while others will not — given the same risk factors.
“Most children with T2D risk factors that we currently recognize don’t go on to develop youth-onset T2D,” explained Gallagher, whose focus has been mainly on T1D research, and while at Columbia was a co-investigator in a dozen intervention studies through TrialNet.
“We also have several small studies on integrated behavioral health support, which I think is critical.
Our center offers essential neuropsychology, psychology, social work, child life, and child and adolescent psychiatry space for consultation,” said Gallagher. “If there are more significant needs, we’ll work to connect them with child and adolescent psychiatrists outside of the center.”
“We had a few posters at the American Diabetes Association Scientific Sessions, one of which looked at the neuropsychology evaluations of kids and their quality of life — not just diabetes distress, but also family conflict surrounding diabetes.”
In terms of T1DX-QI work, “The Pediatric Diabetes Center at Hassenfeld Children’s Hospital is part of a project about to launch EHR alerts for equity. We’re trying to see if having an alert in place will help increase diabetes technology prescriptions and access to the diabetes technology itself. The system will alert the provider, who will have to answer, for example, ‘Why doesn’t this person wear a sensor?’”
“Perhaps it’s been prescribed, and someone doesn’t want to wear it. Another potential answer is that insurance won’t cover it. If someone has public insurance, not every state covers it — in NY, luckily, they’re covered. In other places, there may be different reasons.”
Let’s talk about GLP-1 research
“In one study, we began treating adolescents and young adults with GLP1s who had T1D, an elevated BMI and met the criteria for weight management interventions. While we didn’t plan it this way, all participants were on hybrid closed-loop systems,” said Gallagher.
“Everyone received a GLP-1 receptor agonist, and we examined their metabolic function over time. The results were dramatic: Blood pressure, LDL, BMI, and insulin requirements were lowered, while time in range increased significantly.”
When asked about GLP-1 prescribing habits in people living with T1D, Gallagher explained, “We also presented a poster at ADA about the attitudes of prescribing GLP-1s by both adult and pediatric endocrinologists.”
“Our findings showed that 75 percent of adult centers and 50 percent of pediatric centers are prescribing GLP-1s off-label for people living with T1D,” said Gallagher. “And that’s significant.”
What’s next? What’s your hope for the future?
“Again, I’m excited about the two NIH research projects — they’re focus areas for us that involve our younger faculty, including Dr. Breitbart and Dr. Berman from NYU.”
“I’m looking forward to using other types of medications for T1D youth as they become approved or more readily available and examine how they can help bring glucose levels closer to target, decrease hypoglycemia episodes, and improve A1C levels and other health metrics.”
“I also believe beta cell replacement will get closer to prime time in the not-too-distant future, and I think we need to keep an eye on that and see how we can help,” said Gallagher.
“Finally, we’re studying and identifying the emerging stages of T1D diagnosis and management. We recently published Consensus Guidance for Monitoring Individuals With Islet Autoantibody–Positive Pre-Stage 3 Type 1 Diabetes, which includes recommendations for following these kids over time to discover when we should intervene. There’s no data right now—just a lot of expert recommendations,” said Gallagher.
“It’s a great opportunity to collect data and track when someone screens positive, starts insulin, and if they get Tepluzimab or another drug that will be FDA approved in the future — which I’m sure is coming.”
“That will help us—to say, for example, 30 percent of people who screened positive were eligible for and treated with teplizumab, and then report on their outcomes over time,” said Gallagher.
What do you like to do outside of work?
Outside of work, Dr. Gallagher enjoys spending time outdoors with her family and French bulldog, Stitch. When she’s not exploring outside, you’ll likely find her comfortably curled up with a book or watching a movie.