Portal de Periódicos da CAPES

Lois Gretchen Jovanovic

2018; Elsevier BV; Volume: 392; Issue: 10157 Linguagem: Inglês

10.1016/s0140-6736(18)32550-9

1474-547X

Geoff Watts,

Gestational Diabetes Research and Management

Leader in diabetic pregnancy care. She was born in Minneapolis, MN, USA, on May 2, 1947, and died in Santa Barbara, CA, USA, on Sept 18, 2018, aged 71 years. In choosing to specialise in diabetes, you could say that physician Lois Jovanovic was confronting her family history of the illness and, unwittingly, its possible consequences for women. Jovanovic's father and grandmother both had type 1 diabetes, and it was the experience of seeing her father's disablement and premature death at the age of 51 years that prompted her to study medicine, and diabetes in particular. It was known that type 1 diabetes could result in problems during pregnancy. These dangers almost certainly deterred some women from having children. Jovanovic chose to take a more optimistic stance. She believed that it was not diabetes per se that caused problems but the failure to adequately normalise the woman's blood sugar. Get that right, she argued, and a safe and healthy pregnancy should be perfectly feasible. It was only after the birth of her second child, who had to spend 3 months in a respirator, that Jovanovic herself was found to have type 1 diabetes. As a student, Jovanovic enrolled in New York's Albert Einstein College of Medicine, graduated in 1973, did her residency and specialist training in endocrinology at the then Cornell University Medical College, and then went on to work there and at Rockefeller University Hospital. It was during this period that she began accumulating evidence to show how strict monitoring and rigorous normalisation of blood sugar paid off. “She was able to demonstrate that if women with type 1 diabetes work really hard to normalise their blood sugar they can have a healthy pregnancy with a complication rate similar to that found in women without diabetes”, says Kristin Castorino, an internist and principal investigator at the Sansum Diabetes Research Institute (SDRI) in Santa Barbara, CA, USA. Work that Jovanovic published in the American Journal of Medicine in 1981 showed that this could be the case even for women with severe diabetes. She developed protocols for round the clock monitoring and insulin delivery that set a standard for glucose control. She also acted as Cornell's principal investigator in the decade-long multicentre Diabetes Control and Complications Trial (DCCT). From the mid-1980s onwards, Jovanovic based herself on America's West Coast, working variously at the University of California, the Santa Barbara Cottage Hospital, and, above all, at SDRI. Her initial contact with the last of these had been as a guest investigator. In 1996, she became SDRI's Chief Executive Officer and Chief Scientific Officer, posts she held until 2011 and 2013, respectively. It was during this time that she became involved in new technologies for closed loop systems of diabetic control to continuously monitor patients' blood sugar and automatically inject insulin accordingly. Eyal Dassau, now Director of the Biomedical Systems Engineering Research Group at Harvard University, is also an adjunct senior investigator at SDRI, which he joined in 2006 to work on the development of an artificial pancreas. Jovanovic, he says, “really was passionate about diabetes in pregnancy…Her dream was to try [the closed loop system] in pregnancy to see how automation could help”. Dassau adds that taking this project forward depended on getting a grant to finance the next study. “I spoke with her the day before [her death] to give her the news that we had just received the grant.” Ideas that challenge established views or ways of doing things are seldom accepted overnight. “A lot of Lois's career was spent spreading the word”, says Castorino, “getting people to focus on normalising sugar”. For this task, she was well equipped. Dassau describes Jovanovic as “kind and easy to speak with, eager to share knowledge and educate others”. Castorino speaks of her as brave and tenacious: “She believed that if you wanted to change the world you had to be a bit dramatic.” Professionally speaking, Jovanovic was always keen to achieve a little more, and almost to the end talked of what she wanted to do next to “to push the bar forward”, as Dassau describes it. Castorino puts it another way: “There was a part of her that was never quite content.” Jovanovic leaves a son Kevin Jovanovic and a daughter Larisa Taylor, both doctors, and four grandchildren.