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Scientific Workshop on Cystic Fibrosis Related Diabetes

The National Institutes of Health and the Cystic Fibrosis Foundation held a 3-day workshop devoted to cystic fibrosis related diabetes from June 23-25 (workshop link). The workshop was attended by interested physicians, scientists, and affected families and persons, and also was open to the public. The purpose of the workshop was to discuss the current state of knowledge about this form of diabetes, and to help inform future research directions. Dr. Larson Ode and Dr. Norris from our division both spoke on their areas of related expertise, with talks entitled “Glycemic Abnormalities in Young Children” and “Innervation of the CF Pancreas” respectively. The University of Iowa was also represented by two other speakers, gene therapy expert John Engelhardt PhD and pediatric gastroenterologist Aliye Uc MD. Drs. Engelhardt and Norris were also part of the workshop planning committee, along with other experts from Children’s Hospital of Philadelphia and Boston Children’s Hospital.

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Exemplifying Cardiometabolic Health Maintenance.

Congratulations to Dr. Vanessa Curtis for recently winning her division in the Sylvan Island Stampede bike race. The race was held in April on an island on the Mississippi River near Moline Illinois. Despite working full time as a Pediatric Endocrinologist, Dr. Curtis is also a competitive cyclist. She is an example of cardiometabolic health maintenance to us all.

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

Our Division has been rated among the Best Children’s Hospitals for Diabetes & Endocrinology Care by the US News & World Report 15th annual national report, where we were ranked #41 nationwide. Other top ranked specialties at the University of Iowa Stead Family Children’s Hospital included neonatology, pediatric orthopedics, pediatric nephrology, and pediatric neurology and neurosurgery.

“Our national ranking is a testament to the dedication and expertise of our pediatric endocrine physicians, nurse practitioners, specialty nurses, diabetes educators, researchers, medical assistants, dieticians, pharmacists, and all teams members. We remain devoted to provide the best 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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Potential Exocrine-Endocrine Pancreas Crosstalk

Pancreatic islets are the cells that produce insulin and glucagon, and are otherwise known as the endocrine pancreas. The islets are surrounded by the exocrine pancreas. The exocrine pancreas is a gland that creates digestive juices for the intestine. It has long been postulated that the exocrine pancreas cells help support the function and existence of the islets. The corollary is that a diseased exocrine pancreas might have negative influence on islet function. This postulated biology may be at play in cystic fibrosis related diabetes (CFRD), a unique form of diabetes that afflicts many persons who have cystic fibrosis. To test this possibility, researchers at the University of Iowa have studied exocrine pancreas cells grown in cell culture from ferrets with and without cystic fibrosis. The researchers found that the exocrine cells affected by cystic fibrosis secrete different proteins than the healthy cells. Furthermore, some of the differences are expected to impact islet function. The results were published in the Journal of Cystic Fibrosis. Dr. Norris from our division was one of the study authors, along with other scientists.

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Modeling Pancreatitis-induced Islet Dysfunction.

Pancreatitis often leads to hyperglycemia. However, there have been major limitations in understanding the involved pathophysiology. Several collaborators at the University of Iowa have now created a model to help understand the process. The research team found that cerulein injections led to pancretitis with elevated amylase and lipase. Acute accompanied the acute pancreatitis, with both impaired insulin levels and evidence of insulin resistance. Glucose tolerance normalized by 3 months. The research team included our Dr. Andrew Norris, but also pediatric gastroenterologist Aliye Uc and researchers and faculty from the Department of Anatomy and Cell Biology.

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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.

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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.

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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.

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Type 1 Diabetes, Hyperglycemia, and Structural Brain Changes in Children.

  • Dr. Tansey
  • Dr. Tsalikian

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.

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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.