A Patient-Centered Approach

PHOTO ABOVE: David Robbins, M.D. Cray Diabetes Professor of Medicine and director of the KU Diabetes Institute and the Cray Diabetes Self-Management Center
 


Cray Diabetes Center focuses on lifestyle, not just medicine


Sally Cray knew first-hand the importance of diabetes education. She had the chronic disease that results in high blood sugar levels.

Because of her experiences during treatment, Sally and her husband, Cloud “Bud” Cray of Atchison, Kan., decided to fund a diabetes care center at KU Medical Center that has reimagined care for patients.  

At the time of Sally Cray’s diagnosis, in the early 1950s, not much was known about the disease, of which there are two types: type 1 and type 2. The pancreas does not produce enough insulin with type 1 diabetes. With type 2, the more common form of diabetes, the body isn’t able to use the insulin it has correctly. There is no known cure for either type. 

The model for diabetes treatment and education back then meant a quick meeting with a doctor and a prescription for medication. And that didn’t satisfy the Crays. They knew there was a better way, and they set out to start a center that focused on broader aspects of care — not just medicine but also lifestyle.  

“Diabetes is a very complex disease that involves what you eat, how you exercise — it’s constantly there,” said endocrinologist David Robbins, who directs the Cray Diabetes Self-Management Center at KU Medical Center. “The disease can cause a real impairment on a patient’s quality of life.”

The Crays established the Cray Diabetes Center at KU Medical Center in 1979 with just one doctor, Joseph Kyner, and nurse practitioner George Ann Eaks on staff to provide patient education. 

The center is now known as the Cray Diabetes Self-Management Center, and the team has evolved to include endocrinologists, physician assistants and dietitians, some of whom are also certified diabetes educators. It provides about 6,500 patient visits a year.

Karen Seaberg, of Atchison, Kan., is vice president of the board of directors for the Cray Medical Research Foundation and Bud and Sally Cray’s daughter. She said her mother, Kyner and Eaks worked as a team. 

“The three of them developed this model where, when treating a patient with diabetes, it’s more than just a doctor visit,” Seaberg said. “It’s about conversations, listening and problem solving.” 

Sally Cray died in 2010, but the Crays’ contribution to the health of diabetes patients in the Kansas City area and beyond has continued. 

“The Cray gift is what makes this model possible,” Robbins said. “The Crays’ marching orders to us were to not have hurried medicine.” 

The modern, team-style approach to diabetes care at the Cray Center means that patients are seen by an advance practice provider, typically a nurse practitioner or physician assistant, a registered dietician and a certified diabetes educator. Physicians follow up with patients when appropriate. 

The center has classes and one-on-one educational opportunities for patients on topics ranging from foods that affect blood sugars to using an insulin pump. The center also coordinates a monthly diabetes support group that meets in Leawood, Kan. 

“We focus on self-management, teaching patients the skills they need to feel confident in taking care of themselves,” Robbins said. “In a way, we’re trying to work ourselves out of a job, although we never quite get there.”

Even diabetes patients with a history of excellent medical care find something new to learn about themselves and their disease at the Cray Center. 

Jeff Novack, of Kansas City, Mo., was 18 when his late father, an internist in New York, diagnosed his type 1 diabetes. He has lived with the disease for 44 years and always benefited from excellent care. However, he said, Robbins and the staff at the center have helped him find a more “human” perspective on his disease. 

“They have helped me control my own tendency to obsess over controlling my diabetes,” Novack said. “That control is always important, but I’ve learned to loosen up a bit.” 

The Cray Center is outgrowing its current office space. It serves patients at two locations, at KU Medical Center in Kansas City, Kan., and in Overland Park. Another satellite office is opening in Gladstone, Mo., in a KU clinic that had space available.

“We have to triage our waiting list of patients; we’ve outpaced our ability to see patients because of our limitation on physical space,” Robbins said. 

Robbins said the Crays’ mandate involves not just KU patients, but the health of patients across the state of Kansas and beyond. 

“We have been reaching out to some of the partner hospitals of The University of Kansas Health System, such as St. Joseph, Mo., and Hays and Great Bend, that are now affiliating with us,” Robbins said. “We are taking the lessons we’ve learned and sharing with these organizations.” 

Bruce Armstrong, of Kansas City, Mo., has been reaping the benefits of care at the Cray Center for more than 20 years. Diagnosed with type 1 diabetes in his mid 20s, he has experienced many ups and downs in the more than 40 years since then. With support and education from the center, he uses an insulin pump and has much more control over his disease than he’s ever had. 

“The staff here has always been supportive and tried to help me understand things if I wanted to explore something related to my disease,” Armstrong said. “They care about me as a person.”

MICHELLE TEVIS

AHEAD OF THEIR TIME: Cloud “Bud” Cray and the late Sally Cray worked with medical professionals to develop a whole lifestyle approach to treating diabetes after Sally was diagnosed with the disease. The Cray Diabetes Self-Management Center is nearing its 40th anniversary and carries on the couple’s legacy today.
CARING ADVICE: Andrea Dohlman, nurse practitioner and certified diabetes educator, talks with patient Bruce Armstrong about taking care of his feet during an appointment at the Cray Center in Kansas City, Kan.

A LEGACY OF SUPPORT 

For almost 40 years, Cloud “Bud” Cray and the late Sally Cray have supported diabetes care and research at KU Medical Center. 

The Cray Diabetes Center opened in 1979. In 1981, the Crays, of Atchison, Kan., established the Cray Medical Research Foundation. The foundation has supported the center, now known as the Cray Diabetes Self-Management Center, and ongoing diabetes research through the Cray Diabetes Institute. 

Bud Cray, a native of Bloomfield Hills, Mich., earned a chemical engineering degree at Case Institute of Technology in Cleveland. He joined MGP Ingredients in Atchison, Kan., in 1947 and in 1962, he succeeded his father, Cloud Cray, Sr., as president of the company. He retired in 2015. 

Sally Cray, a native of Cleveland, Ohio, attended Case Western Reserve/Flora Stone Mather College for two years and married Bud in 1944. Soon afterward they moved to Atchison, where they worked, raised their family and served the community. She died in 2010. 

In April, the foundation’s gift of $2 million established the Bud and Sally Cray Diabetes Professorship, which will support the Endocrinology, Metabolism & Genetics Division of the Internal Medicine Department at KU Medical Center. David Robbins, professor of medicine and director of the KU Diabetes Institute and the Cray Center, is the first recipient of the professorship.
 


 

EDUCATION AT THE CRAY CENTER

Classes and educational opportunities at the Cray Diabetes Self-Management Center cover a variety of topics related to diabetes care and management. One-on-one educational meetings are also available. 

Classes typically meet monthly and include:

Diabetes Survival Skills, offered weekly, gets to the heart of basic needs for people with diabetes.

Carbohydrate Counting takes a close look at how food affects blood sugar and teaches patients how to estimate the amount of carbs eaten and the amount needed. 

Pump and Sensor Preview gives those curious about insulin pumps, which deliver insulin continually, a chance to learn more. 

Hypoglycemia Unawareness teaches attendees how to identify hypoglycemia (a condition caused by low blood sugar) how it develops, and how to restore awareness.