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Normal SARS-CoV-2 Immunity in Children with Type 1 Diabetes, Including after Vaccination

Dr. Pinnaro
Dr. Tansey
Dr. Norris

Persons with diabetes can have weakened immune systems that are unable to fight off infections. Vaccination response depends on the immune system creating protective immunity after exposure to an antigen. Indeed, under some circumstances persons with diabetes fail to develop immunity after vaccination. Most data to date however have focused on adults. In particular, no studies have examined the response of children with diabetes to COVID vaccination. In a collaboration between the Microbiology Department, our Division set out to address this knowledge gap. Both antibody levels and cellular immunity against the COVID virus were compared between children with and without type 1 diabetes. The levels were also compared between the children that had versus had-not received COVID booster vaccination. Importantly, the children with diabetes exhibited normal levels of immunity that matched those of children without diabetes. This result shows that children with diabetes have normal immune responses, at least as regards protection against COVID, including before and after booster vaccination. Surprisingly, COVID booster vaccination did not statistically raise immunity against the Omicron COVID variant in either group of children. One possible reason for this may have been that the children groups appeared to already have a degree of immunity against Omicron even without booster vaccination, though the study was not designed to properly address this possibility. By contrast, adults were also studied and experienced a robust enhancement of immunity in response to booster vaccination. Members of our Division who helped create and conduct the study were Drs. Pinnaro, Tansey, and Norris, as well as research manager Shannon Christensen. The publication can be found at this Pubmed link. The authors wish to thank the children and families who volunteered for the study.

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Diabetes Camp Hertko Hollow 2023 – Wonderful Summer Sessions

Some of the volunteer staff at Camp Hertko Hollow, 2023 (L-R): Drs. Lindower, Tansey, Palmer, Radig, Pinnaro, and Parra Villasmil.

Diabetes Camps are a summer highlight for many kids who live with diabetes. Camp represents a chance to experience outdoor fun, make new friends who understand what it is like to have diabetes and learn more about diabetes self-care, all while under the watchful eye of diabetes-knowledgeable camp counselors and staff. Several of the staff in our Division help support Camp Hertko Hollow (click for link), a diabetes camp in central Iowa with access to 400 acres of forest / outdoor recreation space. Dr. Pinnaro and Dr. Tansey serve to provide medical direction for the camp, and diabetes nurse Susan Huff has long volunteered to support the camp. Kids Week (ages 8-12) ran June 25-July 1 and Teen Week (ages 13-17) ran July 3-9. Also see the Camp website (link above) for details about Mini Camp and Family Camp opportunities. The doctors and nurses from our Division who have volunteered their time in camp this year: Dr. Pinnaro, Dr. Tansey, Dr. Parra Villasmil, Dr. Palmer, Dr. Tuttle and nurse Sue Huff.

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Patient Choice Award Recipients

We are pleased to report that 6 of the pediatric endocrinology providers in our division have received Patient Choice Awards. These awards are given out by UI Health Care to recognize physicians for consistently providing patients with an excellent healthcare experience. The recipient physicians were:

  • Lauren Kanner
  • Katie Larson Ode
  • Julie Osterhaus
  • Liuska Pesce
  • Catherina Pinnaro
  • Mike Tansey

The Award was given to only 174 providers across the entire institution. The Award recognizes those who scored in the top 10% nationally in response to patient surveys asking whether the physician showed concern for patient questions or worries, gave explanations about problem or condition, made efforts to include the patient in care decisions, discussed proposed treatments (options, risks, benefits, etc), and whether they would be likely to recommend the care provider to others. Our division is fortunate to have these Award winning physicians on our team. We thank each of them for their wonderful work. Find more about the awards at this link.

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Double Jeopardy: Two Dangerous Medical Emergencies Associated with Type 1 Diabetes Can Occur Simultaneously

  • Dr. Parra Villasmil
  • Dr. Tansey

Medical emergencies associated with diabetes include diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and severe hypoglycemia. DKA occurs when the body’s insulin levels are too low, allowing excessive ketone production to the point that acidosis occurs in the blood. HHS occurs when blood glucose levels rise to extremely high levels and the body becomes dehydrated causing body fluids to become concentrated to the point that brain function declines. Children with type 1 diabetes are often susceptible to the development of DKA. Although HHS can occur in children with type 1 diabetes, it is not common. Importantly, both conditions are reversible with proper medical treatment, even though both conditions can be fatal if treatment is not started promptly. Occasionally, a child with type 1 diabetes can develop both DKA and HHS simultaneously. This is a very dangerous predicament, requiring immediate and expert/judicious treatment. Dr. Parra Villasmil and Dr. Tansey from our Division, in conjunction with members of the Pediatric Intensive Care Unit team, have just published a report of such a case. In this publication, they describe the critical condition of the child on arrival to the hospital and the subsequent careful interventions that were made to resolve the two conditions. The report can be found in the journal Cureus (Pubmed link).

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Hybrid Closed-Loop Insulin Pumps Might Protect Childhood Brain Development from the Adverse Effects of Type 1 Diabetes

  • Dr. Tsalikian
  • Dr. Tansey

Over the past decade, evidence has emerged indicating that high blood sugars in type 1 diabetes cause adverse brain changes in children. The adverse changes include abnormal brain structural alterations and reduced functioning on some cognitive tests. Over the past few years, hybrid closed-loop insulin pumps have become commercially available. These devices combine a continuous glucose monitor (CGM) with an insulin pump that is controlled by an algorithm that uses the CGM data to inform insulin delivery. The hybrid closed-loop insulin pumps aim to keep blood sugar in the low 100s (mg/dL). These systems can often improve average blood sugars and reduce the severity and frequency of low and high blood sugars. It is thus natural to ask whether the improved blood sugar control offered by a hybrid closed-loop insulin pumps might reduce the adverse brain effects of type 1 diabetes in children. Dr. Mike Tansey and Dr. Eva Tsalikian from our Division were among a small group of diabetes physicians across the United States who designed such a study to answer this very question. The initial results from the study were just published in the prestigious journal Nature Communications (click for PubMed link). Their randomized clinical study involved 42 adolescents with type 1 diabetes who were randomized to a hybrid closed-loop insulin pump versus conventional therapy. They were studied 6 months later, undergoing a brain MRI and cognitive testing. Although this study was considered a pilot trial, the results showed significantly less adverse impacts in those randomized to the hybrid closed-loop insulin pumps. The hybrid closed-loop insulin pump group performed better on a cognitive test of perceptual reasoning and had fewer abnormal structural brain changes. These results add to the growing evidence showing that excessive hyperglycemia is damaging to the developing brain during childhood. Thus study shows the important positive impact that hybrid closed-loop insulin pumps can make in improving blood sugar levels and long term outcomes in children with diabetes.

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Diabetes Camp Hertko Hollow Reopens!

Some of the volunteer staff at Camp Herkto Hollow, Kids Week 2022, including those from our Division: Dr. Tansey (far left), Dr. Pinnaro (2nd from right), Dr. Parra Villasmil (far right).

Diabetes Camps are a summer highlight for many kids who have diabetes. Camp represents a chance to have non-stop outdoor fun, make new friends who understand what it is like to have diabetes and learn more about diabetes self-care, all while under the watchful eye of diabetes-knowledgeable camp counselors and staff. Several of the staff in our Division help support Camp Hertko Hollow (click for link), a diabetes camp in central Iowa with access to 400 acres of forest / outdoor recreation space. Dr. Pinnaro and Dr. Tansey serve to provide medical direction for the camp, and diabetes nurse Susan Huff has long volunteered to support the camp. Unfortunately, Camp Hertko Hollow, like most diabetes camps across the country, closed in 2020 and 2021 due to the COVID pandemic. This year, Drs. Pinnaro and Tansey were determined to help Camp Hertko Hollow reopen despite the challenges of ongoing COVID transmission. We are pleased to report that their efforts are paying off. Kids Week (ages 8-12) is off to a great start June 26-July 2, and Teen Week (ages 13-17) will run July 3-9. Also see the Camp website (link above) for details about Mini Camp and Family Camp opportunities. The doctors and nurses from our Division who have volunteered their time in camp this week and/or next week include: Dr. Pinnaro, Dr. Tansey, Dr. Parra Villasmil, Dr. Tuttle, Dr. Palmer, and nurse Sue Huff.

“Our first year back at camp Hertko has been a great one. I’m so grateful to our dedicated and flexible volunteers who adapted to swiftly to our Covid-related protocols.”

Dr. Catherina Pinnaro
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University of Iowa F.O.E. Diabetes Research Center Featured in New Video

The Fraternal Order of Eagles Diabetes Research Center

Each June, the American Diabetes Association hosts its annual scientific meeting. This meeting is the world’s largest and most important gathering focused on diabetes research, attracting over 10,000 attendees who come from across the world to hear the latest cutting edge research. This year, the University of Iowa was featured in a short video film shown at the meeting. The video focused on how the Fraternal Order of Eagles Diabetes Research Center (FOE-DRC) is advancing diabetes research . The FOE-DRC was created in 2008 when the Fraternal Order of Eagles pledged $25 million to establish a diabetes research center at the University of Iowa. With this gift, the FOE-DRC has grown to include over 100 faculty researchers from across the University. Collectively, these faculty conduct over $30 million of NIH-funded research annually. Several members of our Division are faculty in the FOE-DRC: Drs. Curtis, Larson Ode, Norris, Pinnaro, Tansey, and Tsalikian. Earlier this year, the American Diabetes Association requested that investigators at the University of Iowa help create a short video highlighting the work of the FOE-DRC. The video is now available on youtube (link to video here). The video highlights work by two members of our Division: Dr. Larson Ode and Dr. Norris, as well as several colleagues in the Division of (Adult) Metabolism and Diabetes and in the FOE-DRC.

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Patient Choice Award Recipients

We are pleased to report that 6 of the pediatric endocrinology physicians in our division have received Patient Choice Awards. These awards are given out by UI Health Care to recognize physicians for consistently providing patients with an excellent healthcare experience. The recipient physicians were:

  • Lauren Kanner
  • Katie Larson Ode
  • Liuska Pesce
  • Catherina Pinnaro
  • Mike Tansey
  • Eva Tsalikian

The Award was given to only 156 providers across the entire institution. The Award recognizes those who scored in the top 10% nationally in response to patient surveys asking whether the physician showed concern for patient questions or worries, gave explanations about problem or condition, made efforts to include the patient in care decisions, discussed proposed treatments (options, risks, benefits, etc), and whether they would be likely to recommend the care provider to others. Our division is fortunate to have these Award winning physicians on our team. We thank each of them for their wonderful work. Find more about the awards at this link.

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Benefits of Home Review of Blood-sugar Data in Youth with Type 1 Diabetes

Dr. Catherina Pinnaro

Dr. Catherina Pinnaro and her research team have just published a new report indicating benefits to reviewing diabetes device blood sugar data. The article is entitled “Diabetes Device Downloading: Benefits and Barriers Among Youth with Type 1 Diabetes”, and was just published as a peer reviewed research article in the Journal of Diabetes Science and Technology (pubmed Link; doi Link). Importantly, the data suggest that blood sugar levels improve when patients/families make insulin plan adjustments based on review of recent blood sugar patterns. Co-authors on the work from our division included Drs. Tansey, Tsalikian, and Norris. Also contributing as the lead author was future pediatric endocrinologist Dr. Benjamin Palmer.

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Celebrating 100 Years of Insulin Therapy

  • Dr. Pinnaro
  • Dr. Tansey

Before 1922 type 1 diabetes was a rapidly fatal disease. That changed in the span of a few history-changing months. In the summer of 1921 four scientists at the University of Toronto began studying how to extract insulin from the pancreas and made quick progress. The first injection occurred on January 11, 1922, when an experimental insulin extract was administered to an adolescent who was dying of type 1 diabetes, saving his life. Soon thereafter commercial insulin production began and insulin use became widespread. However, there were many shortcomings of early insulin therapy, which was “regular” insulin extracted from cow and pig pancreases. These insulin preparations did not work in a uniform way from person-to-person. Extreme blood sugar swings were common and complications abounded. Thankfully, in the intervening century numerous improvements to insulin preparations and insulin delivery have been made. Dr. Pinnaro and Dr. Tansey from our division have just published an overview of these improvements in the Journal of Diabetes Mellitus. Their review is entitled “The Evolution of Insulin Administration in Type 1 Diabetes” (click on title for link to the article). Despite these improvements, insulin delivery for patients with type 1 diabetes remains imperfect. Importantly to this end, the article also discusses anticipated improvements that may help future generations of persons with type 1 diabetes. We are thankful for all those who worked to discover and improve insulin therapy, and look forward to future improvements! We thus thank all the diabetes research teams who are working tirelessly to improve diabetes care. This includes the Pediatric Diabetes research team here at the University of Iowa, whose dedication and expertise has helped advance diabetes care through carefully run studies. Finally, to those youth and families affected by type 1 diabetes, know that we look forward to every opportunity to work with you to optimize your insulin delivery and diabetes care. Advances in insulin therapy are happening rapidly. If your diabetes control is not what you think it should be, we would love for you to reach out to us to discuss options.