Lois Jovanovič, MD, MACE:Pioneer in the Field of Diabetesand Pregnancy and BeyondDiabetes Care 2019;42:359–363 | https://doi.org/10.2337/dci18-0056

Lois Jovanovič is a name that has becomesynonymous with good pregnancy out-comes for women with type 1 diabetes.Having type 1 diabetes herself and ex-periencing the challenges it poses for thepregnant woman, Dr. Jovanovič devotedher career to helping women with diabe-tes prepare for pregnancy and experiencesuccessful outcomes. She always empha-sized the importance of being in excellentmetabolic balance before becoming preg-nant and always told her patients thatthey were “not allowed to get pregnantuntil she gave them permission.”As newer insulin analogs became avail-

able, they were only approved for useoutside of pregnancy. Dr. Jovanovič pio-neered testing these analogs in preg-nancy, proving that not only werethey safe for pregnant women and theirbabies but resulted in improved diabe-tes control throughout the pregnancy.Dr. Jovanovič developed an algorithm forinsulin use that she taught her patientsso they could more easily manage theirdiabetes during the stress of pregnancy(1). She was very proud of how success-ful the outcome could be when a preg-nancy was meticulously managed and foryears kept a picture of each newbornwhose mother she had worked withthrough the pregnancy.Dr. Jovanovič was passionate about

her patientsdmore than one was

overheard saying “Dr. Lois is the firstdiabetes doctor who really understoodwhat I’m going through.” Others sworethey are only mothers because of Dr. Lois;she was their devoted “cheerleader” (herterm) as she kept in close touch with hermoms throughout their pregnancies,including through daily faxed glucosediaries and phone calls. Dr. Jovanovičauthored or coauthored numerous textsand monographs to help women andtheir physicians better understand thediabetic pregnancy. These included Di-abetes & Pregnancy: What to Expect (2)and Gestational Diabetes: What to Ex-pect (3), which the American DiabetesAssociation relied on for years alongwithupdates as new methods of treatmentand management became available.

Dr. Jovanovič diedatherhome inSantaBarbara, California, on 18 September2018. She would wish to be rememberedfor her passion and determination, andthat goes without saying. She was a pio-neer, an advocate, and amentor to many.

Early Life and Training

Lois Gretchen Blaustone was born 2May1947 in Minneapolis, Minnesota. Shegrew up in a working-class OrthodoxJewish neighborhood. After losing herfather at a young age to the ravages oftype 1 diabetes, she was raised by hersingle mother.

Early on, Lois showed her determina-tion: she honed her legendary memori-zation skills as a young girl to ensure thatshewould always be prepared. Lois couldalways memorize anything and wouldremember it always!

Lois Blaustone (Jovanovič) as a young girl inMinnesota.

Sansum Diabetes Research Institute, Santa Barbara, CA

Corresponding author: David J. Pettitt, djpettittret@gmail.com§Retired

This article is part of a special article collection available at http://care.diabetesjournals.org/gdm-new-evidence.

© 2019 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit,and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

David J. Pettitt § and

Alison Okada Wollitzer §

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Her dream was to be a ballerina, andshe was classically trained at the Amer-ican Ballet Theatre. Her diminutive heightwas a barrier, so she moved on to med-icine, her second-choice career, whilemaintaining a lifelong love of ballet.Lois earned a bachelor of science de-

gree in biology from Columbia Universityin 1969, while simultaneously earning abachelor’s degree in Hebrew literaturefrom The Jewish Theological Seminary.The following year, she began andcompleted a master’s degree in Hebrewliterature, also from The Jewish Theo-logical Seminary, while simultaneouslyenrolled in the Albert Einstein Collegeof Medicine. She earned her doctor ofmedicine degree in 1973.Dr. Jovanovič then trained at the New

York Hospital–Cornell UniversityMedicalCollege, completing her internal medi-cine residency in 1975. She stayed onfor a senior resident year and then anendocrinology fellowship, which shecompleted in 1978.During this time, she became a

mother, hiding her pregnancies as longas possible because motherhood wasnot readily accommodated for doctors-in-training in those days. She would tellstories of tucking her babies under thenursing station while she conductedrounds.

Choice of Diabetes and Pregnancy

Lois’s interest in finding a cure for di-abetes began with watching her father

suffer, but after she developed type 1diabetes herself as a young woman shefocused on treating diabetes in womenduring pregnancy. Her groundbreakingwork began with the premise that awoman with diabetes should have thesame chance of having a healthy baby asa healthy woman without diabetes, aslong as she could achieve normoglyce-mia prior to and throughout pregnancy.During her fellowship at the New YorkHospital–Cornell University Medical Col-lege, she conducted a study showing thatstrict monitoring and absolute normali-zation of blood glucose could yield healthybabies (4). A year later, she published alarger trial of 52 women that showedconclusively that women with diabetes,even those with severe disease, couldhave healthy babies (5).

Dr. Jovanovič served as the originalprincipal investigator for the New YorkHospital–Cornell University Medical Col-lege site of the Diabetes in Early Preg-nancy Study (DIEP) (6). This landmarkstudy, which enrolled women after theybecame pregnant, showed that evenwithout prepregnancy stabilization, in-tervention early in pregnancy reducedthe rate of malformations (7). It alsodemonstrated that, among the changesin insulin requirement during the courseof pregnancy, there was a decreasedneed for insulin in the late first trimester(8).

She was also the original principalinvestigator for the New York Hospital–Cornell University Medical Collegecenter of the Diabetes Control andComplications Trial (DCCT), a decade-long

multicenter clinical trial that showed thatstrict glucose control could reduce therisk of long-term complications (9–11).

Dr. Jovanovič was interested early onin automating insulin delivery. While inNew York, she pioneered the use of theoriginal Glucose-Controlled Insulin Infu-sion System (Biostator) in labor and de-livery (12), a prototype for her later workon the artificial pancreas. She was alsoone of the creators of the Pocket Docinsulin dosage calculator (13).

Sansum Diabetes Research Institute

In 1984, Dr. Jovanovič joined what is nowSansum Diabetes Research Institute inSanta Barbara, California. In 1996, shewas appointed Chief Executive Officerand Chief Scientific Officer, a post sheheld until 2013. During her tenure,Sansum Diabetes Research Institute be-came known worldwide as a center ofexcellence, thanks to her tireless work toimprove the lives of people with diabe-tes through research, education, andcare.

Although the rapid-acting insulin ana-logs hadonly been tested innonpregnant

Lois Blaustone (Jovanovič) during her medicalschool years.

Lois Jovanovič, MD, at her graduation.

Dr. Jovanovič, Chief Executive Officer and ChiefScientific Officer of Sansum Diabetes ResearchInstitute (1996–2013).

360 Profiles in Progress Diabetes Care Volume 42, March 2019

individuals when first approved for use,Dr. Jovanovič was convinced that theywould be safe for use during pregnancy.Her first studies, randomized trials ofthe analog versus standard recombinantinsulin, were conducted in women withgestational diabetes mellitus. As expected,outcomes with the analogs were just asgood as with standard insulins, and thewomen enjoyed the flexibility of use(14,15). Working with other investigatorsin a multicenter retrospective study ofwomen who had used a rapid-actinginsulin analog before pregnancy andthroughout the first trimester, shehelped demonstrate that rates of con-genital anomalies were not increased(16).She was also one of the principal

investigators on a trial using a long-acting basal insulin analog during preg-nancy. This study again demonstratedthe safety of the analog for use duringpregnancy and, because of the greaterstability of the analog, women expe-rienced fewer hypoglycemic events(17). Because of this work, many preg-nant women with diabetes now enjoythe convenience and improved controlthat comes with the use of theseanalogs.Dr. Jovanovič and two of her close

international colleagues drafted a studydesign to test the impact of continuousglucose monitoring (CGM) on outcomesof pregnancies in women with type 1diabetes, which became the basis forthe Continuous Glucose Monitoringin Women with Type 1 Diabetes in Preg-nancy Trial (CONCEPTT) (18). This mul-ticenter international study randomizedwomen with type 1 diabetes to eitherCGM along with capillary glucose mon-itoring or to capillary glucose monitoringalone and demonstrated that with CGMwomen spent more time within theirglucose target range and had fewerhyperglycemic episodes. This resultedin a modest but significant improvementin A1C and, importantly, was associatedwith better neonatal outcomes. The new-borns of the CGMgroupwere less likely tobe large for gestational age, spent lesstime in the neonatal intensive care unit,had fewer hypoglycemic episodes, andleft the hospital an average of 1 dayearlier (19). Once again, Dr. Jovanovičwas at the forefront of demonstratingthat better diabetes control results inbetter pregnancy outcomes.

Dr. Jovanovič also advocated for andtreated pregnant women with type 2diabetes or with gestational diabetesmellitus. Throughout her career inSanta Barbara, she attended the weeklydiabetes-in-pregnancy clinic at the SantaBarbara County health facility. Many ofher patients spoke only Spanish, andalthough Dr. Jovanovič always said thather Spanish was rudimentary, she wasclearlyfluentenough to run the clinic. Likeher patients with type 1 diabetes, thesewomen with type 2 diabetes or gesta-tional diabetes mellitus, many of whomwere low-income minority women, hadimproved pregnancy results (20).

Artificial Pancreas

Dr. Jovanovič’s dream, short of a cure,was to be able to automate insulin de-livery. She participated in numerous in-dustry trials that tested various methodsof continuous glucose sensing and auto-mated insulin delivery, including earlyversions of an implantable pump. Shetested run-to-run control algorithms as apotential key in automating insulin de-livery in type 1 diabetes (21,22). She wasprincipal investigator and later coinves-tigator at the Santa Barbara site of theJDRF- and National Institutes of Health–funded Artificial Pancreas Project (23–29).She was named in nine U.S. patent sub-missions related to insulin dosage algo-rithms and automated insulin deliverydevices, of which four were granted(30–33).

Legacy

Dr. Jovanovič was the recipient of mul-tiple awards and tributes (Table 1). Of allher awards, the ones she cherished themost were her honorary membership inthe Diabetic Pregnancy Study Group ofthe European Association for the Studyof Diabetes and all the awards that ac-knowledged her as a teacher. In additionto keeping a very busy clinical and re-search schedule, Dr. Jovanovič madetime to serve on the Diabetes Careeditorial board from 1982 to 1990 aswell as from 2000 to 2002, and she servedas an associate editor for Diabetes Carefrom 2002 to 2008.

Always committed to her role asmentor/teacher, Dr. Jovanovič helpedtrain generations of medical students,residents, and endocrine fellows. Shewas especially proud of her youngprotégées who chose to specialize indiabetes and pregnancy, whom shefondly referred to as “Little Loises.”She was sought after as a lecturer atsymposia and grand rounds through-out the world. At the time of her death,she had commitments to speak in thecoming months.

Dr. Jovanovič’s legacy also includesgenerations of babies, many of whomwere named Lois by their gratefulparents.

Both of her children, Kevin Jovanovic,MD, and Larisa Taylor, MD, entered themedical field in obstetrics and gynecol-ogy. She left behind four cherished

Dr. Jovanovič with one of numerous grateful mothers who gave birth to a healthy baby.

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grandchildren, one ofwhom, following inhis grandmother’s footsteps, enrolled inthe School of American Ballet.

Acknowledgments. The authors wish to ac-knowledge the assistance of Dr. Jovanovič’sdaughter Larisa Taylor, MD, private practice,and Jeannine Glockler, Sansum Diabetes Re-search Institute.

References1. California Diabetes and Pregnancy Program.Insulin for gestational and pregestational diabe-tes [Internet], 2002. Available from http://perinatology.com/Reference/CDAPP%20SS%20Guidelines%202002.pdf. Accessed 13 October20182. American Diabetes Association. Diabetes &Pregnancy: What to Expect. 4th ed. Alexandria,VA, American Diabetes Association, 20003. American Diabetes Association. GestationalDiabetes:What to Expect. 5th ed. Alexandria, VA,American Diabetes Association, 20054. Jovanovič L, Peterson CM, Saxena BB, DawoodMY, SaudekCD. Feasibility ofmaintaining normalglucose profiles in insulin-dependent diabeticwomen. Am J Med 1980;68:105–1125. Jovanovič L, Druzin M, Peterson CM. Effect ofeuglycemia on the outcome of pregnancy ininsulin-dependent diabetic women as compared

with normal control subjects. Am J Med 1981;71:921–9276. Jovanovič L, Singh M, Saxena BB, et al.;NICHD-DIEP Study Group. Verification of earlypregnancy tests in a multicenter trial. Proc SocExp Biol Med 1987;184:201–2057. Mills JL, Knopp RH, Simpson JL, et al.; NationalInstitute of Child Health and Human Develop-ment Diabetes in Early Pregnancy Study. Lack ofrelation of increased malformation rates in in-fants of diabetic mothers to glycemic controlduring organogenesis. N Engl J Med 1988;318:671–6768. Jovanovič L, Knopp RH, Brown Z, et al.; Na-tional Institute of Child Health and Human De-velopment Diabetes in Early Pregnancy StudyGroup. Declining insulin requirement in the latefirst trimester of diabetic pregnancy. DiabetesCare 2001;24:1130–11369. The DCCT Research Group. The DiabetesControl and Complications Trial (DCCT): designand methodologic considerations for the feasi-bility phase. Diabetes 1986;35:530–54510. The DCCT Research Group. Diabetes Con-trol and Complications Trial (DCCT): resultsof feasibility study. Diabetes Care 1987;10:1–1911. Nathan DM, Genuth S, Lachin J, et al.; Di-abetes Control and Complications Trial ResearchGroup. The effect of intensive treatment ofdiabetes on the development and progressionof long-term complications in insulin-dependent

diabetes mellitus. N Engl J Med 1993;329:977–98612. Chanoch L, Jovanovič L, Peterson CM. Theevaluation of a pocket computer as an aid toinsulin dose determination by patients. DiabetesCare 1985;8:172–17613. Jovanovič L. The PocketDoc: howcomputersmay prescribe insulin doses. Diabetes Self-Management, November/December 1986: p. 8–914. Jovanovič L, Ilic S, Pettitt DJ, et al. Metabolicand immunologic effects of insulin lispro ingestational diabetes. Diabetes Care 1999;22:1422–142715. Pettitt DJ, Ospina P, Kolaczynski JW,Jovanovič L. Comparison of an insulin analog,insulin aspart, and regular human insulin with noinsulin in gestational diabetes mellitus. DiabetesCare 2003;26:183–18616. Wyatt JW, Frias JL, Hoyme HE, et al.; IONSstudy group. Congenital anomaly rate in off-spring of mothers with diabetes treated withinsulin lispro during pregnancy. Diabet Med2005;22:803–80717. Mathiesen ER, Damm P, Jovanovič L, et al.Basal insulin analogues in diabetic pregnancy:a literature review and baseline results of arandomised, controlled trial in type 1 diabetes.Diabetes Metab Res Rev 2011;27:543–55118. Feig DS, Asztalos E, Corcoy R, et al.;CONCEPTT Collaborative Group. CONCEPTT: Con-tinuous Glucose Monitoring in Women withType 1Diabetes in Pregnancy Trial: amulti-center,

Table 1—Awards and honorsScientific and medical honor societies Honorary member, Diabetic Pregnancy Study Group of the European Association for the

Study of Diabetes, 1989–2018Member, Royal Academy of Medicine, Spain, 1994

American Diabetes Association Outstanding Physician-Clinician Award, 1995The Norbert Freinkel Award for scholarship in the field of diabetes and pregnancy, 2001

Teacher/scientist Andrew W. Mellon Teacher-Scientist Award, 1978Outstanding Teacher of the Year, SantaBarbara CottageHospital, 1990, 1991, 1992, 1994, 1995,

1997, 1998, 2001, 2005, 2008Pfizer Visiting Professorship Award, TempleUniversity School ofMedicine, 1997, andUniversity

of Texas Health Science Center at Houston, 1998Roche Diagnostics/The Zitter Group Diabetes Disease Management Leadership Award, 1998Josiah Kirby Lilly, Sr. Distinguished Service Award, 2006Jorgen Pedersen Lecturer (Lifetime Achievement Award from the Diabetic Pregnancy Study

Group of the European Association for the Study of Diabetes), 2007W.D. Sansum Award for Excellence in Science, 2014

Other Santa Barbara Diabetes Association Tribute Dinner Awardee, 1992Clintec Award for Excellence in Clinical Nutrition, The American College of Nutrition, 1992Woman of Distinction Award in the Field of Health, Soroptimist International, 1994Distinguished Physician Award, Santa Barbara Cottage Hospital, 1994Mount Sinai School of Medicine Second Annual Stanley Mirsky, MD Lectureship Award, 2008Tres Condados Woman of Distinction Award in the Field of Health, 1996Santa Barbara Council on Alcoholism and Drug Abuse Woman of Distinction, 1996Women’s Economic Ventures, BusinessWomenof the Year Awards: Professional Services, 2002March of Dimes Agnes Higgins Award to honor distinguished achievement in maternal-fetal

nutrition, 2003Albert Einstein College of Medicine Distinguished Alumnus/a Award, 2003The Ray A. and Robert L. Kroc Lectureship in the College ofMedicine, TheOhio State University,

2004Honorary Member, Diabetes Treatment Centers of America, Advisory BoardSanta Barbara Neighborhood Clinics Community Hero, 2005Distinguished Service Award, National Disease Research Interchange/JDRF, 2011Santa Barbara Region Chamber of Commerce Woman of the Year, 2011

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http://perinatology.com/Reference/CDAPP%20SS%20Guidelines%202002.pdfhttp://perinatology.com/Reference/CDAPP%20SS%20Guidelines%202002.pdfhttp://perinatology.com/Reference/CDAPP%20SS%20Guidelines%202002.pdf

multi-national, randomized controlled trialdstudy protocol. BMC Pregnancy Childbirth2016;16:167–17419. Feig DS, Donovan LE, Corcoy R, et al.;CONCEPTT Collaborative Group. Continuous glu-cose monitoring in pregnant women with type 1diabetes (CONCEPTT): a multicentre internationalrandomised controlled trial. Lancet 2017;390:2347–235920. Jovanovic-Peterson L, Bevier W, PetersonCM. The Santa Barbara County Health Care Serv-ices program: birth weight change concomitantwith screening for and treatment of glucose-intolerance of pregnancy: a potential cost-effectiveintervention? Am J Perinatol 1997;14:221–22821. Zisser H, Jovanovič L, Doyle F III, Ospina P,Owens C. Run-to-run control of meal-relatedinsulin dosing. Diabetes Technol Ther 2005;7:48–5722. Owens C, Zisser H, Jovanovič L, Srinivasan B,BonvinD,Doyle FJ III. Run-to-run control of bloodglucose concentrations for people with type 1diabetes mellitus. IEEE Trans Biomed Eng 2006;53:996–100523. Palerm CC, Zisser H, Jovanovič L, Doyle FJ III.A run-to-run control strategy to adjust basal

insulin infusion rates in type 1 diabetes. J ProcessContr 2008;18:258–26524. Dassau E, Zisser H, Palerm CC, BuckinghamBB, Jovanovič L, Doyle FJ III. Modular artificialb-cell system: a prototype for clinical research.J Diabetes Sci Technol 2008;2:863–87225. Dassau E, Palerm CC, Zisser H, BuckinghamBA, Jovanovič L, Doyle FJ III. In silico evaluationplatform for artificial pancreatic b-cell devel-opmentda dynamic simulator for closed-loopcontrol with hardware-in-the-loop. DiabetesTechnol Ther 2009;11:187–19426. Percival MW, Dassau E, Zisser H, Jovanovič L,Doyle FJ III. Practical approach to design andimplementation of a control algorithm in anartificial pancreatic beta cell. Ind Eng ChemRes 2009;48:6059–606727. Wang Y, Percival MW, Dassau E, Zisser HC,Jovanovič L, Doyle FJ III. A novel adaptive basaltherapy based on the value and rate of change ofblood glucose. J Diabetes Sci Technol 2009;3:1099–110828. Finan DA, Doyle FJ III, Palerm CC, et al.Experimental evaluation of a recursive modelidentification technique for type 1 diabetes. JDiabetes Sci Technol 2009;3:1192–1202

29. Harvey RA, Wang Y, Grosman B, et al. Questfor the artificial pancreas: combining technol-ogy with treatment. IEEE Eng Med Biol Mag2010;29:53–6230. Doyle FJ III, Jovanovič L, inventors; TheRegents of the University of California, assignee.Method and apparatus for glucose control andinsulin dosing for diabetics. U.S. patent7,651,845, filed 12 May 2005 and issued 26 Jan-uary 201031. Zivitz M, Galley P, Jovanovič L, inventors;Roche Diagnostics Operations, Inc., assignee.Mask algorithms for health management sys-tems. U.S. patent 7,998,069, filed 11 September2007 and issued 16 August 201132. Zivitz M, Jovanovič L, inventors; RocheDiagnostics Operations, Inc., assignee. Deviceand method for insulin dosing. U.S. patent8,251,904, filed 7 June 2006 and issued 28 Au-gust 201233. Doyle FJ III, Grosman B, Dassau E, JovanovičL, Zisser H, inventors; The Regents of the Uni-versity of California, assignee. Maintaining mul-tiple defined physiological zones using modelpredictive control. U.S. patent 9,700,708, filed2 April 2013 and issued 11 July 2017

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