How Novant Health CEO Carl Armato's Type 1 diabetes changed the lives of more than 6,000 patients

Novant Health System President and CEO Carl Armato was diagnosed with Type 1 diabetes at 18 months old. After living with the disease for more than 50 years, he credits diabetes for shaping him as a person and informing his strategy for preventive healthcare.

Shortly after Mr. Armato was diagnosed, his family learned to monitor blood glucose levels with a chemistry set — glucometers and insulin pumps didn't exist — and careful observation of how his body reacted to environmental factors like food, exercise and stress.

"[My family] really guided me, taught me and armed me with skills to succeed and the attitude to take on challenges and obstacles, which obviously diabetes can be," he said. "What my family was able to do for me was take a Type 1 diagnosis and turn it into a way to help others. I'm sitting in healthcare today, I think, because of that journey."

Mr. Armato leads Winston-Salem, N.C.-based Novant Health, an integrated healthcare network that spans four states. At Novant Health, Mr. Armato successfully implemented a program to find and treat undiagnosed diabetic patients — uncovering 6,000 people who were unknowingly living with the disease. He also just published a book, A Future with Hope, about his personal journey with diabetes.

Becker's caught up with Mr. Armato to talk about the message behind his book and how he turned a diabetes diagnosis into a motivator for change as a healthcare administrator.

Note: Responses have been edited lightly for length and clarity.

Question: What is your philosophy behind your management of diabetes?

Carl Armato: First, you must have knowledge about the disease. My biggest thing, even from a very young age, was fully understanding the disease itself. I consider myself somewhat lucky. Growing up without all the diabetes management technology and support that exist today, I was forced to really learn how my body reacts to food and activities, and how that's changed over the years.

There are times when the technology isn't perfect, so I monitor blood sugar levels constantly, focus on what I eat closely and the exercise I do. Before I had my insulin pump and 670G sensor, I was testing blood glucose every two hours just to stay on top of it, understand trends and make sure I knew what direction my blood sugar was headed. Particularly as I get on stage to talk to people publicly and internally, I try to get my blood sugar up to around 130 so I can ensure I'm at my very best. After that, I bring it back down to a much more normal range.

I'm constantly focusing on what's going on in the environment, how that might impact my blood sugar, and I plan a lot and proactively prepare. For example, we have something called "No-meeting Wednesdays" where I'm rounding and I'm out and about for hours. While I'm rounding, I stop to check blood sugar levels and watch how many stairs I'm going up and down. It's a constant monitoring, but over the years, I am confident I've figured out how to manage it effectively.

Q: Was there ever a point in your life when you worried diabetes would hold you back?

CA: Absolutely. It started really young for me. I was at a young age when I started reading about the disease and trying to figure out what exactly I was dealing with. I would go to the library and check out books on diabetes. I saw, back in those days, a lot of limbs with gangrene that were always part of the definition of diabetes.

Even with my strong support system, I encountered challenges in my early adolescence. I told one of my coaches I was a diabetic. He didn't fully understand it, and he just quit playing me. I think it was more out of fear — he was worried as I was running up and down the court that I could pass out or have a problem, so he began to sit me. What was unfortunate is that coach ended up moving on, and I didn't tell the next coach about my diabetes. I began to start again, play and "be normal," as you would consider it. A lot of those events would occur, which made me retreat for a long period of time and not want to talk about the fact that I had Type 1 diabetes. I was worried how people would react and what that would mean for me later in life. For example, I had a girlfriend who I opened up to about the disease and the monitoring that I had to do. Even the girlfriend said she didn't know if that was something she wanted to deal with.

It was experiences like those, though, that only made me stronger and made me really want to show that if you have Type 1 diabetes you can thrive and realize your dreams. It forced me to be very cautious about who was in the inner circle and who I share the details with about my chronic disease.

Q: When you started as CEO at Novant, you didn't share your status as a diabetic right away. What made you change your mind and share that information with staff?

CA: As I looked at what was going on in the healthcare industry, increasingly I saw a demand, and even an expectation, for transparency. It was a great approach for me to help create a culture of transparency. Sharing the fact that I am a Type 1 diabetic created more open dialogue, and our team members saw the human side of me. It helped the entire organization appreciate that openness, and it allowed us to really build on what I believe is authentic transparency. That's where I started the conversation internally. But it was really as I started to talk to more juvenile diabetics at local events when I saw that many were really looking for hope, which led me to the book.   

Q: So you just published A Future of Hope about your journey with diabetes. What do you hope readers take away from the book?

CA: Simply, the book is about hope. I wrote it to show an example of what Type 1 diabetics can accomplish. When I was diagnosed as a Type 1 diabetic, I heard a lot about what I shouldn't do. I heard a lot about what I might want to reconsider because it might be too hard. The book lets people with Type 1 diabetes not only see that they can realize their dreams, but it's also got a path for how you might be able to accomplish them. 

You might wonder why I wrote the book in the first place. For years, I took notes because I was worried my grandchildren or greatgrandchildren might be diagnosed with Type 1 diabetes in the future. Whether I'm around or not, I wanted to make sure they would know things about my experience that they might not learn in a physician's office or a diabetes Type 1 class.

Then I was at an event where I had the privilege of being nominated by the Juvenile Diabetes Research Foundation's Piedmont Triad Chapter. I was honored because I had a 50-year journey at that moment with Type 1 diabetes. After the event, there was a line of young adults who came to see me. There was this one young girl who came to visit with me and she had tears in her eyes. She said that she had been going to these juvenile diabetes research events and she hadn't heard anyone be so positive about thriving with diabetes. It was really at that moment that I decided to write this book. I went back and gathered my notes to make sure the book would be available to all people — not just my family, but anyone.  

Q: In the book, you say diabetes has made you the person you are today. How do you think living with diabetes has changed you for the better?

CA: Very early in life, my parents — particularly my father — spent a lot of time helping me see that yes, I had a chronic disease, but that other people were also dealing with a lot of different complex issues in life. In healthcare, it's really helped me to walk into meetings or round in a Novant Health hospital or clinic and see things with a pretty unique perspective. It's beyond numbers on a spreadsheet or discussions in a boardroom, it's really about being able to look at a decision and see the impact it's going to have through a patient lens. As someone who has a chronic disease, I can maybe see something and uncover a gap or opportunity to improve care for many other people who may otherwise be missed. Just imagine that every meeting I walk into, every decision I make and have made since I've been in healthcare, has been through the eyes of someone with chronic disease. It helps me to be a better healthcare leader; it allows me to truly keep the patient experience and the impact on patients at the forefront of each and every decision. 

Q: You mentioned the importance of having a strong support system and making sure the people in your immediate circle are part of that. How do you decide who to surround yourself with at work?

CA: Healthcare has so many people who are there because they want to be compassionate care givers. Whether they're in an administrative role, at the bedside or in a clinic, there's so many team members who just want to help. I'm surrounded by people who are really focused on compassionate, remarkable care. Whether it's my assistant, who makes sure lunch is there at the right time for me, or my chief of staff, who's watching the schedule to make sure there's time so I can exercise and balance work with my personal life.

What's wonderful is I'm surrounded by amazing people. Of course, when you look at my executive team — all my direct reports from physicians to administrative folks — they all not only know about my Type 1 diabetes, but I've also taught them things to look for. If I ever ask for or need glucose or something to help me manage my blood sugar, they respond immediately in a very helpful way. It took me a long time to do that — to just be comfortable sharing that I'm a Type 1 diabetic and educate people about how they can help.

Obviously, I've got wonderful support family-wise. I've got a wonderful wife who's there for me day in and day out. My three children are always there if I ever need something. But to now have my team members at Novant Health be there in case I ever need something makes me feel a lot more confident that I'm not managing it alone.

Q: Is there anything else you'd like to share with our readers?

CA: The other thing I would like to share is the impact at Novant Health. As a healthcare leader, you are always pushing yourself to ask what else can you do to help people. At Novant Health, we conducted a search and rescue. It was a 3-year program to find people who had diabetes but weren’t yet diagnosed. We tested every hospital admission. The amazing thing is we uncovered more than 6,000 undiagnosed cases of diabetes. Now many of those patients choose to get their diabetes treated at Novant Health. I think they are healthier today because we went after that search and rescue.

We serve more than 90,000 people with diabetes. When I look in our EHR at the records for those 90,000 diabetics, 68 percent are in the normal ranges for hemoglobin A1C, their blood pressure control and their cholesterol control. What I'm excited about is we lead the industry — but that's not enough —because I want all of them in normal ranges.


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