Four messages regarding COVID-19 & pediatric endocrinology

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We remain available 24/7: Please know that we are here for our patients. We and other centers have noticed that patients are often sicker than in the past when they come for medical care, presumably because they have delayed seeking care out of fear of contracting COVID-19. Importantly, please know that our medical center remains one of the safest places. All visitors are screened, including by temperature scanning cameras, and all staff maintain strict precautions. If you have questions or concerns about managing your endocrine condition, please contact us by phone/email/fax. If you are ill and might benefit from endocrine advice, we will work hard with you over the phone to help keep you from needing to come to the hospital. As of May 4, we have carefully re-opened our outpatient clinic for routine visits, in accordance with policies set by the State of Iowa. Additionally, we can conduct selected routine visits not requiring physical examination via video-chat. Contact us and we will help you arrange a clinic visit. Further information can be found at our official clinical website.


A reassuring note: The healthcare community is learning more about the effects of COVID-19 on specific patients. You may have read that diabetes is a risk factor for severe COVID-19. Please know however that this data regards adults, mainly older adults. On March 25th, our European colleagues reported their impression that pediatric-aged patients with diabetes are not at increased risk of severe COVID-19. Likewise, initial data reports from the US have not mentioned diabetes as a pediatric-aged risk factor. On May 29, a peer-reviewed French scientific article reported similar findings. See this blog post for more details. It would be reasonable to assume the same is likely true for pediatric-aged patients with various endocrine disease, though we have yet to see any data. In any case, it remains important to be careful with your diabetes and endocrine medications. For youth with diabetes, aim to control your blood sugars as best possible, make sure to take your long-acting insulin / keep your insulin pump in good working order. The reason to keep your blood sugars in range as best possible is that persons with diabetes have a higher risk of needing to be hospitalized with COVID if their blood sugar have been running higher (see our review of this data). For youth with adrenal insufficiency, make sure to take your prescribed hydrocortisone or other steroids, and give stress dose steroids if ill etc as instructed. Keep your prescriptions up. Be sure to minimize exposures, practice social distancing, frequent hand washing, etc. See our hospital COVID-19 website for additional information.


COVID-19 increases risk of DKA: Data has now been published showing that many persons with type 1 diabetes who develop COVID-19 will develop diabetic ketoacidosis (DKA). Our summary of the study can be found here (link). If you or your loved one has type 1 diabetes, and develops symptoms of COVID-19, be sure to contact your diabetes doctor to help provide advice on how to prevent DKA. Fluids, carbohydrates, ketone checks, and extra insulin are very important in this regard. We remain on call 24×7 to assist.


Adrenal insufficiency may increase COVID-19 risk: Several endocrine sources have published opinions suggesting that adrenal insufficiency may predispose persons to severe COVID-19. Our summary of these opinions can be found here (link). If you or your loved one has adrenal insufficiency, it might be important to minimize COVID-19 exposures, wear protective masks, practice social distancing and frequent hand washing, etc. If you have questions or concerns, we are happy to discuss. If you think you have developed COVID-19, please know that we remain on call 24×7 to assist.

Off To College Class to be held July 14, 2021, 5-6 pm

Dr. Kanner

Save The Date! Dr. Lauren Kanner has announced that she will host our annual Off To College Class on July 14, 2021 at 5-6 pm. In past years, the class has been held in person, but like in 2020 this year will be held via Zoom. Students, parents, future roommates, and any others interested are welcomed to attend. If you are interested, contact us, either through the email link at Dr. Kanner’s webpage (link) or by contacting our diabetes nursing team.

The Importance of Newborn Screening for Congenital Hypothyroidism

Dr. Pesce

For the past several decades, infants born in the USA are screened for congenital hypothyroidism. Like many beneficial programs, it is human nature to take the importance of this screening for granted. Dr. Pesce has just published an opinion piece that helps bring home the importance of newborn screening for congenital hypothyroidism. In this piece, she reflects on a child with congenital hypothyroidism who asks “what would have happened if I had not been screened?” Dr. Pesce then reflects on the consequences of untreated congenital hypothyroidism, including impaired mental development and impaired growth. She also notes how diagnosis of congenital hypothyroidism is typically delayed in the absence of screening. You can find her informative blog piece here.

Children with type 1 diabetes can require hospitalization with COVID, largely due to diabetic ketoacidosis.

Dr. Catherina Pinnaro

An important question during the COVID-19 pandemic has been whether children and adolescents with type 1 diabetes have increased risk of severe COVID-19. Dr. Pinnaro from our Division was one of a group of pediatric endocrinologist across the country who sought to help answer this important question. Their findings have now been published in the Journal of Diabetes (link to article). Briefly, they found that children and adolescents with type 1 diabetes who developed COVID-19 were at roughly 20% risk of being hospitalized while infected. Importantly, however, the cause of hospitalization was typically related to diabetes, less so than due to severe manifestations of COVID-19 such as lung dysfunction. Diabetes ketoacidosis was the most frequent cause of hospitalization. This is not uncharted territory, because a variety of viral infections can also precipitate a variety of diabetes emergencies, including ketoacidosis , leading to hospitalization. Also importantly, it appears that type 1 diabetes does not strongly increase the risk of severe COVID. For youth with type 1 diabetes who developed COVID-19, the basics of sick day management become important, including glucose and ketone checking, supplemental insulin when needed, and copious fluids, just as with any infection. Please know that our group of diabetes nurses and doctors remain available 24/7 to assist with sick days. Join us in thanking Dr. Pinnaro for her hard work and research.

Type 1 diabetes, hyperglycemia, and structural brain changes in children.

It has previously been observed that young children with type 1 diabetes have changes in brain structure, when compared to children without diabetes. However, it has not been known how these differences in brain structure might change over time. To help address this knowledge gap, Drs. Tsalikian and Tansey have helped conduct a multicenter longitudinal trial following over 100 children with type 1 diabetes. The children underwent repeated brain imaging with MRI over an average span of 6 years time. The results from this study have now been published in the prestigious journal Diabetes Care (link). The study found that the brains of children with type 1 diabetes exhibited smaller volume, and that this difference became greater over time. Importantly, higher blood sugar levels were correlated with greater loss of brain volume. These results lend further credence to the notion that loss of brain tissue is a complication of childhood diabetic hyperglycemia. Furthermore, the results suggest that meticulous glycemic control might prevent these structural brain changes. Since the study was correlative, these conclusions are not fully definitive and further study is needed. It remains crucial that children with diabetes be followed by an expert pediatric endocrinology team, such as at the University of Iowa. Several other of our division members contributed to this work, including study coordinators Julie Coffey MSN and Rachel Bisbee. We also thank the families and children who volunteered as participants in this study.

Diabetes Research Center Highlighted

The University of Iowa Fraternal Order of Eagle Diabetes Research Center

The University of Iowa Fraternal Order of Eagles Diabetes Research Center (FOEDRC) is being highlight this month in Iowa Magazine (link). You can read about work from the FOEDRC aimed at better treating and preventing diabetes. Our faculty members Drs. Norris, Tansey, and Tsalikian are mentioned.

Dr. Larson Ode Interviewed by WeAreIowa-TV

Dr. Larson Ode

We are proud of Dr. Larson Ode for sharing her experience and expertise on short notice with TV station WeAreIowa. In particular, she reflects succinctly on how the physician’s guiding principle of “do no harm” impacts medical decision making regarding transgender care in youth. Her statements also reflect current medical consensus guidelines on the topic. You can find the interview clip at the WeAreIowa website, here.

A Novel Approach that Might Prevent “Belly Fat”

Dr. Akhila Ramakrishna

Perhaps the worst place to gain fat is inside your abdomen. This type of fat is called visceral fat, and contribute to risk of cardiovascular disease, type 2 diabetes, and a host of related complications. Unfortunately, it is also a common place to gain fat. Dr. Ramakrishna has just published new research that has identified a potential new strategy to prevent visceral fat. She used two approaches in mice to reduce the amounts of a protein called PAPP-A. This was accomplished using a genetic and a neutralizing antibody approach respectively. These treatments reduced the amounts of visceral fat that the mice developed while on a high fa diet. Not only was the amount of visceral fat reduced, but the treatments helped prevent fatty liver. She published the work in the journal Endocrinology (link to paper). We look forward to further development of this approach.

Dr. Pinnaro Earns Masters of Science in Translational Biomedicine

Dr. Catherina Pinnaro

Congratulations to Dr. Catherina Pinnaro, who has just fulfilled the requirements of the Masters in Translational Biomedicine at the University of Iowa. This was no easy accomplishment, as she worked on the degree while simultaneous initially being a Pediatric Endocrine Fellow and most recently while being a full time faculty member. Additionally, the degree required original research of publishable quality. Dr. Pinnaro will be using her newly acquired skills and knowledge to advance a research program aimed at better understanding the genetic modifiers of endocrine diseases.

Treatment-Induced Neuropathy of Diabetes in Pediatric Aged Patients

Dr. Eirene Alexandrou

Treatment-Induced Neuropathy of Diabetes (TIND) is a insufficiently recognized complication, usually temporary, that can occur after rapid correction of severe hyperglycemia. Its occurrence in the pediatric-aged population has not been well studied. Dr. Eirene Alexandrou has just published a paper describing 7 cases of TIND among children and young adults. She published the work in the Journal of the Endocrine Society (link to paper). The cases occurred in both type 1 and type 2 diabetes, and in each case followed a rapid improvement from severe hyperglycemia. All but 1 of the cases were transient. Symptoms included pain, often burning in nature, numbness, and autonomic disturbance. Management included stabilization of glycemia and medical therapy.

Glucose Control and COVID Hospitalization Risk in Persons with Type 1 Diabetes

Yesterday, data were published indicating that among persons with type 1 diabetes, higher average glucose levels are associated with increased risk of requiring hospitalization for COVID infection. The peer reviewed data was published in the Journal of Clinical Endocrinology and Metabolism ( doi permanent link ; pubmed link ). The data were collected via the national T1D Exchange study consortium. Drs. Pinnaro and Tansey from our division are part of this consortium and helped author the article. The data indicate that if you have type 1 diabetes, you should keep your blood sugars in range as much as possible to help prevent severe COVID. We remain happy to help you achieve this goal; our contact information can be found by clicking on the “clinical website” at the top of our links page.