During seven years as chief of the Division of Endocrinology, Jill Crandall, MD, professor of medicine and Anita and Jack Saltz Chair in Diabetes Research, led her team through a major transition and unparalleled growth in the division’s clinical offerings. "Dr. Crandall has  transformed our division during her tenure as chief,” says Vafa Tabatabaie, MD, professor in the division and now the interim chief. “Under her thoughtful guidance, our division not only weathered the tough years of the COVID pandemic but also grew and flourished into a powerhouse with expertise in every field of endocrinology and a referral center for complex patients across the region. Her mentorship has been instrumental in my career, and I am thankful for the strong foundation she has built.”

After handing over the leadership reins, Dr. Crandall is looking forward to returning her full focus to clinical and translational research. After having a front row seat to remarkable advances in patient care for diabetes, she shares a look back, and forward, in this Q & A.

How did you become interested in medicine?
Dr. Crandall: I grew up near Albany; my father was a machinist, and my mother trained to be a teacher before deciding to stay at home with me and my brothers. I was interested in healthcare, but medical school never crossed my mind. There were no professional role models in my family, and it wasn't as common then for women to go into medicine. At college at the State University of New York (SUNY) at Binghamton, I heard about a new career path of becoming a physician assistant and decided that sounded good. So I went to PA school and was in one of the first few classes to graduate from my program at SUNY Stony Brook.

What changed your mind about becoming a physician?
Dr. Crandall: I worked as a PA for about eight years in various settings, including a Federally Qualified Health Center in Queens. At that point I realized it was going to be challenging for me to stay in the PA role for the rest of my career—I wanted to do more. So, I returned to school and took all my pre-med courses while I was working full time and applied to medical school. I started when I was 32.

How did you get interested in endocrinology?
Dr. Crandall: My mother had what we now call type 1 diabetes. So I grew up around this illness back in the days when she would be boiling her insulin syringes in the morning and testing her urine in the bathroom, prior to any of the technology that we have now. I developed an appreciation for the burden that this disease has for patients who live with it. It seemed like a natural direction for me to go in.

I joined the faculty at Einstein in 2001, and from the beginning my work here has been a mixture of clinical research and patient care. Dr. Harry Shamoon, who retired a few years ago, was a pivotal research mentor for me. He was the Einstein site primary investigator for the Diabetes Prevention Program and other important clinical research. He was incredibly generous in getting me involved in these studies and encouraging me to take on a leadership role.

There's still a tremendous burden on patients with diabetes. If we can understand better what each specific patient needs, we may be able to alleviate some of that treatment burden.

—Dr. Jill Crandall, MD, professor of medicine and Anita and Jack Saltz Chair in Diabetes Research

What made you want to take on the leadership of the division?
Dr. Crandall: When I became chief in 2018, I took over from Dr. Norman Fleischer, a towering figure in endocrinology who had been at the helm for 30 years. One of my motivations was that I sensed it was a major turning point. The strength of our division traditionally was in research; our clinical operation was not comparable to the size and reputation of our research program. We had just a handful of physicians who were active clinically. We needed to become more robust in patient care to meet the needs of our community. 

Fortunately, Dr. Yaron Tomer, chair of medicine at the time and now the dean, shared that same vision. So I took that goal as my challenge, and we’ve been very successful. We have a net gain of more than a dozen clinical faculty including many early-career physicians, just out of fellowship, who are here to make their mark in endocrinology. Access to quality care for our patients has improved tremendously.

What are some of the new programs or initiatives you’re most proud of?
Dr. Crandall: The SEAD Program established by Dr. Shivani Agarwal, which supports emerging adults with type 1 diabetes, gives us a much stronger foundation for type 1 diabetes treatment in general. We were able to recruit Dr. Sriram Machineni, an expert in obesity management, and he's done a phenomenal job of establishing a brand new and much needed clinical program in that area. We also extended our clinical footprint to the Montefiore Einstein Advanced Care location in Westchester.

We expanded the inpatient diabetes management service by hiring advanced practice providers for all three of our hospital locations. We also expanded fellowship training, from three fellows a year to four. Several of the most promising have stayed on as faculty, which is always a nice thing.

You also maintained an active role as a researcher while leading the division.
Dr. Crandall: While it’s been a challenge to balance it all, I have stayed involved with several large, multicenter clinical trials in the area of diabetes and aging, including one that is especially near and dear to my heart, the Diabetes Prevention Program. Our research participants joined 30 years ago thinking it was going to be a three-year study. We’ve kept getting our funding renewed, adding new outcomes along the way. It's been extremely rewarding professionally to be involved with leading diabetes experts across the country, but also to develop these longstanding relationships with the patients who have volunteered their time in the interest of helping us learn more about diabetes. As they have aged, now we're primarily focused on looking at the relationship between diabetes and pre-diabetes and cognitive impairment.

I’ve also been involved in the GRADE study, another multicenter, NIH-funded project that is a comparative effectiveness study of different diabetes medications. The scientific productivity of both studies has been substantial. Lots of papers are still being published and we're continuing to analyze the data. They have a legacy of important work that I hope we can continue.

What are you looking forward to now that you have transitioned away from the chief role?
Dr. Crandall: I'm part of the national leadership of the Diabetes Prevention Program Outcome Study and have the opportunity to contribute to many of the papers and projects emanating scientifically from it, and I look forward to spending more time with that work.

Here at Montefiore Einstein, I hope to continue work with the translational research core for our Diabetes Center, which provides resources and support, especially for young investigators who need guidance to help get them started. I also plan to continue teaching in the medical student endocrine course and precepting trainees in our diabetes clinic.

What are you most excited about on the horizon in diabetes research and treatment?
Dr. Crandall: Precision medicine. And by that I mean, we say people have type 1 or type 2 diabetes. But really there's a huge spectrum of what diabetes looks like and how it manifests in different people. There is growing interest in pinpointing who is most at risk for complications and to personalize treatment approaches accordingly. I'm optimistic that we will learn things over the next 10 or 15 years that may help us develop a better understanding of the physiology of each patient, so that we can prioritize what’s most important for their care.

There's still a tremendous burden on patients with diabetes. We ask them to follow a diet, maintain a certain weight, exercise, take multiple medications and monitor blood sugar.  For people who are struggling with social and financial issues, housing, or food insecurity, it’s very hard to manage their diabetes on top of everything else. If we can understand better what each specific patient needs, we may be able to alleviate some of that treatment burden.