Paul C. Davidson, M.D., has worked in the field of diabetes care for 57 years, and has contributed bench research, medical editing and writing, academic and professional teaching, treatment protocols, computerized instruments, clinical research, and staff and patient education and training. He has pursued tight blood glucose control through analysis of data.
At West Virginia University Dr. Davidson established radio immune assays for insulin, glucagon, and free insulin. His 1965 research on insulin and triglyceride measurement laid the foundation for subsequent identification of the insulin resistance syndrome. At WVU, he was a principal investigator in the University Group Diabetes Program. This work inspired his early advocacy of team-based patient education in an era when blood glucose self-checking instruments were not yet available.
Trained in research and medical journalism, Dr. Davidson became in-house full-time Associate Editor of the Annals of Internal Medicine in Philadelphia. He later moved to Emory University to work with the pioneer of team management of diabetes, John K. Davidson.
At Emory, Dr. Davidson developed and researched his IV insulin protocol. There with Dr. Dennis Steed, engineer and endocrinologist, he developed Glucommander, the original computerized insulin titration instrument. In 2006, a study at Piedmont Hospital cardiovascular surgery found Glucommander yielded a mean post-operative BG of 103 mg/dl with no cases of hypoglycemia. More recently, a multicenter study by Drs. Guillermo Umpierrez and Chris Newton et al., in all ICUs reported only 3.9 percent severe hypoglycemic episodes and later no severe hypoglycemia in cardiac surgery during Glucommander IV titration. The Glucommander system is now commercially available under the name Glytec.
Dr. Davidson’s “1500 Rule” and Dr. Steed’s Carbohydrate Insulin Ratio were widely used. Their development had been clinical and anecdotal. To systematize and statistically refine them against his large pool of patient data, Dr. Davidson engaged Harry Hebblewhite, MS. Their resulting Accurate Insulin Management system, AIM, is based on models that are adaptable to new data. Their application to Dr. Davidson’s large data pool revised the rules to “1700” and “2.8” rules. AIM also integrates with Glucommander’s model and can be used to facilitate seamless transition from IV to subcutaneous management.
Subcutaneous insulin administration by pump had been a focus for Dr. Davidson since 1979. He has also studied the implantable pump for Medtronic with Dr. Christopher Saudek. Atlanta Diabetes Associates, the practice he founded in 1984 with protégés Drs. Bruce Bode and Dennis Steed, became the largest private practice of insulin pump therapy in the world. Dr. Davidson’s data pool includes greater than 7,000 subcutaneous pump patient records.
Analyzing these records, Dr. Davidson and Hebblewhite have now developed PumpMaster, their computerized program for subcutaneous insulin dosing, useful with pump or multiple dose injection by clinicians who are naïve to pump therapy. The lowest A1C achieved by individual PumpMaster patients was a median 6.7 percent.
Dr. Davidson and Hebblewhite developed a mathematical model describing the theoretical relationship between A1C and frequency of patients’ blood glucose monitoring. They tested the model against retrospective data from pump, multiple dose injection, and non-insulin treatments. Their results demonstrated the association of frequency of BG monitoring and optimization of A1C. Also, it showed the suitability of this mathematical model for prospective randomized controlled trials.
Patients’ aggressive self BG management necessitates their thorough education. To this end, Dr. Davidson has trained nurses, patients, physicians, diabetes educators, and nutritionists to apply and teach his protocols. His longtime nurse practitioner Pat Richardson, MS, contributed to education outreach. In 1984, Dr. Davidson was an early recruit of Diabetes Treatment Centers of America, a company promoting multidisciplinary patient education. As a medical director, he brought his chosen team with him. For 20 years in 100 sites, DTCA emphasized the team approach to diabetes management. Drs. Davidson and Steed allowed DTCA the use of Glucommander.
Dr. Davidson continues to practice with Atlanta Diabetes Associates. He is a husband to a clinical psychologist, father of five (including three physicians), and grandfather of eight.