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Advancing Expert Diagnosis and Care for Pancreatogenic Diabetes

Dr. Larson Ode
Dr. Norris

Pancreatogenic diabetes is an underrecognized form of diabetes that develops as a consequence of diseases affecting the exocrine pancreas. Though often overshadowed by type 1 and type 2 diabetes, pancreatogenic diabetes is estimated to account for 1–9% of all diabetes cases, making it a significant contributor to global health burden. This condition can arise from a range of pancreatic disorders, including pancreatitis, pancreatic cancer, cystic fibrosis, surgical removal of the pancreas, and fibrocalculous pancreatic disease. Each of these conditions presents unique diagnostic and therapeutic challenges, underscoring the need for heightened clinical awareness. Two faculty members from our Division, Dr. Larson Ode and Dr. Norris, have authored a comprehensive clinical review on this topic, recently accepted for publication in the Journal of Clinical Endocrinology and Metabolism (JCEM), one of the leading journals in the field.

Their article, titled “Approach to the Patient with Pancreatogenic Diabetes,” synthesizes current evidence and offers practical guidance for clinicians managing these complex cases. The work was co-authored by adult endocrinologist Dr. Yumi Imai. The review emphasizes the importance of timely diagnosis and tailored treatment. For instance, diabetes can be an early warning sign of pancreatic cancer—a disease with poor prognosis and no reliable biomarkers—making clinical suspicion critical. In cystic fibrosis, even mild diabetes can worsen lung function and increase mortality risk, highlighting the need for proactive screening. The authors also discuss the frequent coexistence of exocrine pancreatic insufficiency in these patients, noting that in these cases pancreatic enzyme replacement therapy may improve glycemic control.

We are glad that these authors have been able to bring their recognized expertise in pancreatogenic diabetes to this work, providing clinicians with actionable insights into evolving screening and treatment strategies. The article’s abstract can be found on PubMed (https://pubmed.ncbi.nlm.nih.gov/41252284/), where there are links to the open access full manuscript.

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What Mechanisms Drive Diabetes-Risk in Youth with Pancreatitis?

Dr. Larson Ode
Dr. Catherina Pinnaro

Why does diabetes happen in some children who have experienced pancreatitis? A new study from Dr. Larson Ode and Dr. Pinnaro, along with a former research fellow Dr. Parra Villasmil, delves into this very question, uncovering unexpected patterns. Their work has been just published in the Journal of Pediatric Gastroenterology and Nutrition. The manuscript, titled “Early mechanisms of diabetes development in pediatric pancreatitis – a pilot study”, explores the complex interplay between pancreatitis and diabetes risk in children. Diabetes is a serious complication for children with pancreatitis, affecting nearly 9% during childhood and up to half over a lifetime. Despite this high risk, little is known about the underlying mechanisms or biomarkers that predict which children are most vulnerable. This study takes an important step toward filling that gap. Their findings revealed that 35% of participants exhibited dysglycemia, often linked to insulin resistance. Could insulin resistance be the key mechanism that drives diabetes risk? Another surprise finding was that dysglycemia was associated with higher pancreatic polypeptide levels. These results will help inform future studies that could pave the way for earlier detection and/or targeted interventions to prevent diabetes in this high-risk population. The manuscript is indexed on PubMed at this URL.

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Inhaled Insulin Shows Some Benefits for Children with Type 1 Diabetes in Landmark Clinical Trial

Dr. Tansey

We are proud to announce our division’s contribution to a major clinical study recently published in Diabetes Care: “INHALE-1, A Multicenter Randomized Trial of Inhaled Technosphere Insulin in Children With Type 1 Diabetes.” One of our Division physicians, Dr. Tansey, served as a co-author on this important research. The INHALE-1 trial examined the safety and effectiveness of an inhaled form of insulin compared to standard rapid-acting insulin injections in 230 children and adolescents aged 4 to 17 living with diabetes. Over a 26-week period, participants continued their long-acting basal insulin and used continuous glucose monitoring while receiving either inhaled or injected rapid acting insulin. Compared to the injected insulin group, the inhaled insulin group experienced a similar hemoglobin A1c, similar continuous glucose monitor readings, and lung function. Children using TI reported greater treatment satisfaction and experienced less weight gain compared to those on injected insulin. These findings suggest that inhaled insulin could become a valuable option for some pediatric patients. It is important to note that the study did not compare inhaled insulin to insulin pump-based therapy. The manuscript abstract is available on Pubmed. We especially wish to thank the research coordinators, research participants and their families who made this study possible.

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Our Program Ranked Among the Best Children’s Diabetes & Endocrinology Programs Nationally

We are excited to share that our Division has been rated among the Best Children’s Hospitals for Diabetes & Endocrinology Care by the US News 2025-2026 annual national report, where we were ranked #33 nationwide. Other top ranked specialties at the University of Iowa Stead Family Children’s Hospital included neonatology (#19), nephrology, urology, pediatric cancer, and behavioral health.

“Our ongoing strong national ranking is a testament to the steadfast dedication and expertise of our pediatric endocrine physicians, nurse practitioners, specialty nurses, diabetes educators, psychologists, researchers, medical assistants, dieticians, pharmacists, social workers, and all teams members. We remain devoted to provide the best endocrine and diabetes care for the children and adolescents in the region and beyond.”

Andrew Norris, M.D. Ph.D.
Director, Division of Endocrinology and Diabetes
UI Stead Family Children’s Hospital

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Lifestyle Counseling for Adolescents by Physicians

Dr. Kanner

Lifestyle interventions can be a very powerful means to impact adolescent obesity. However lifestyle counseling of adolescence is notoriously difficult. Physicians are often poorly trained to meet this challenge. These discussions are fraught with some risk that insensitive approaches might trigger disordered eating and/or disturbed body image. To help physicians address these challenges, Dr. Lauren Kanner from our division is part of a team delivering a lecture entitled “Neither Feast nor Famine: Weight-Inclusive Approaches to Counseling Youth with Higher BMIs”. This lecture aims to provide physicians with strategies to effectively counsel adolescents to enact positive lifestyle changes. The lecture will be delivered by Dr. Kanner in conjunction with Dr. Maya Kumar from Rady Children’s Hospital. The lecture is co-sponsored by Society for Adolescent Health and Medicine (SAHM) and the North American Society for Pediatric & Adolescent Gynecology (NASPAG). The webinar will occur on October 8, 2025. See this link to sign up to view the webinar.

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Grand Rounds: Medical and Psychological Care for DSD

Dr. Akhila Ramakrishna

On September 19th, Dr. Ramakrishna from our division co-presented Pediatric Grand Rounds along with pediatric psychologist Dr. Laura Fuller. Their talk, entitled “Treating Patients with Differences of Sexual Development: The Intersection of Medicine and Psychology”, explored the complexities of the medical and psychological healthcare of Differences of Sexual Development (DSD).

DSDs encompass a group of conditions in which the typical processes of sexual development—anatomical, hormonal, functional, and reproductive—do not follow the usual male or female patterns. These variations may be apparent at birth or even prenatally, though some forms may not be diagnosed until adolescence or adulthood.

The primary goal of pediatric DSD care is to support the physical and emotional well-being of affected individuals during youth. During their presentation, Drs. Ramakrishna and Fuller provided an overview of the various types of DSDs and illustrated the unique medical and psychosocial needs of patients through case examples. They emphasized the importance of a multidisciplinary approach to care.

Drs. Ramakrishna and Fuller lead a multidisplinary DSD clinic that includes pediatric endocrinologists, pediatric urologists, clinical geneticists, and pediatric radiologists, with support from reproductive endocrinology and clinical pharmacy services.

We extend our sincere thanks to Drs. Ramakrishna and Fuller for their insightful presentation and for their leadership in delivering expert, compassionate DSD care through their multidisciplinary team.

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Caring for the Mental Health of those with Turner Syndrome

Dr. Eirene Alexandrou

On September 23, Dr. Alexandrou from our division will be helping present psychiatry grand rounds on the topic of “mental health care/screening in Turner’s syndrome“. Dr. Alexandrou will have a co-speaker on the topic, Dr. Erin Olufs, who is a child psychologist. They will be speaking about the importance of screening for mental health issues in youth and young adults with Turner syndrome. Research has shown that women with Turner syndrome have increased risk of a variety of mental health concerns, including anxiety, depression, and autism spectrum disorders among others. Screening for these conditions is important and early and skilled intervention can be helpful. We are grateful that Drs. Alexandrou and Olufs will be able to share their expertise and experience in this important area of health care.

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Investiture: Celebration of Dr. Tansey’s appointment to the Gary D. Hughes Professorship in Pediatric Endocrinology

Dr. Tansey

In 2017, Gary D. Hughes established a philanthropic gift dedicated to finding a cure for type 1 diabetes and improving the lives of children with this disease. The gift has established the Gary D. Hughes Professorship in Pediatric Endocrinology, which is held by Michael Tansey, MD. Dr. Tansey is an ideal recipient for the Professorship, as he has devoted his career to the advancement of type 1 diabetes care and treatment. Having published over 60 manuscripts, primarily focused on type 1 diabetes, Dr. Tansey has contributed to knowledge about continuous glucose monitors, insulin pumps, and emerging treatments that can forestall the onset of type 1 diabetes. Today, the University honored Dr. Tansey and Gary D. Hughes for this partnership that has and will continue to benefit children with diabetes.

Dr. Tansey honored as the Gary D. Hughes Professorship in Pediatric Endocrinology
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New Podcast: Endocrine Disorders in Infants and Young Children

Dr. Kanner

We’re pleased to share that Dr. Kanner from our division was recently featured in a YouTube podcast hosted by pediatrician and author Dr. Carole Keim. In their 40-minute conversation, Dr. Kanner provides expert insights into a range of endocrine conditions that can affect infants and young children.

The discussion begins with congenital hypothyroidism, a serious but treatable condition that can be identified through routine newborn screening. Dr. Kanner then explores disorders related to growth abnormalities, including both insufficient and excessive growth patterns.

The conversation also covers the various forms of pediatric diabetes, highlighting key symptoms that caregivers should watch for. The episode concludes with practical advice on promoting healthy nutrition and physical activity habits in children to support long-term endocrine health.

We invite you to watch this informative and accessible interview here: the podcast on YouTube.

Thank you, Dr. Kanner, for sharing your expertise and helping to raise awareness about these important pediatric health issues.

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Announcing New Faculty: Ben Palmer, MD

Dr. Palmer

We are pleased to announce that Dr. Benjamin Palmer is starting as a new pediatric endocrinologist in our division. He received his Medical Doctorate from the University of Iowa Carver College of Medicine, completed pediatric residency at the University of Iowa Stead Family Children’s Hospital, where he also just completed fellowship in pediatric endocrinology. He has published expertise in several aspects of diabetes care in youth. His ongoing clinical interests revolve around diabetes, including diabetes and sports/exercise, and the rapidly advancing field of diabetes technology. In clinic, his initial practice will include general pediatric endocrinology and diabetes, as well as outreach services in Cedar Rapids and Dubuque. Welcome Dr. Palmer!