Watching the Brain Remember: Differences Between Children with and without Type 1 Diabetes

With the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions.” –Andrew Norris

Dr. Tansey

Dr. Tansey and collaborators across the country have been studying brain function in children with and without type 1 diabetes. In a study published today (link) in the prestigious journal Diabetes, they report important differences between these two groups. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given memory tasks. Compared to children without diabetes, those with type 1 diabetes exhibited decreased memory performance relative to children without diabetes. Interestingly the children with type 1 diabetes showed greater increases in brain activation with harder tasks than those without diabetes, suggesting that their brains were working harder to compensate. More research is needed to understand how these effects of diabetes occur and how they might be modulated. With the recent advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions. Also involved in the study from our Division were Dr. Tsalikian, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.

Dr. Tansey Helps Answer the Challenges of Type 1 Diabetes Care During COVID-19

Dr. Tansey

As the COVID-19 pandemic began impacting the region in March 2020, it quickly became apparent that the pandemic would impact our Division of Pediatric Endocrinology & Diabetes ability to provide healthcare and would adversely impact many of the children and families for whom we provide care. In response to this arising situation, the Leona M. And Harry B. Helmsley Charitable Trust issued a call for grant proposals aimed at providing local solutions relating to type 1 diabetes care. Dr. Tansey answered this call, writing a proposal to aid with delivery of healthcare for those with type 1 diabetes cared for by our clinic. The goal of the Helmsley program is to “improve the lives of all people living with type 1 diabetes (T1D). Working closely with key players across the T1D ecosystem – patients, physicians, caregivers, researchers, government agencies, funders, pharmaceutical companies, device makers, insurers, and community organizations – we seek to improve care and ultimately prevent the disease.” I am pleased to announce that the proposal created by Dr. Tansey has been approved and funded, as of today. The funds will help our team provide services to our patients with type 1 diabetes, through improved telemedicine education opportunities, and will help provide services to those whom have been directly affected by COVID-19. My deepest gratitude to Dr. Tansey for taking the initiative and rapidly helping answer the challenges imposed by the COVID-19 pandemic.

Dr. Tansey elected to the American Pediatric Society

Dr. Tansey

The American Pediatric Society (APS) was founded in 1888 and remains the most prestigious pediatric academic organization in North America. Election to the APS is highly selective, recognizing those pediatricians who have exhibited leading excellence in their pediatric-focused scholarship, advocacy, education, and leadership. We are thus quite proud to announce that our own Dr. Mike Tansey has been elected to the APS, effective January 1st, 2020. Dr. Tansey received his medical training at Loyola School of Medicine. He then completed a pediatric residency followed by a pediatric endocrinology fellowship at the University of Iowa. While a pediatric endocrinology fellow he became interested in diabetes-focused clinical research. He quickly showed great aptitude for the design of important and practical research studies to help address key knowledge gaps in how we manage diabetes in pediatric patients. He has developed nationally recognized expertise in continuous glucose monitoring and the impact of exercise on glucose levels in children with type 1 diabetes. He has given invited lectures at the annual American Diabetes Association scientific sessions. Dr. Tansey is an important contributor at the University of Iowa, where is an active clinical member of our pediatric endocrinology and diabetes program, but also serves as the Associate Vice Chair for Faculty Development in Pediatrics, and as the Interim-Chair Health Information Management Subcommittee. He also is the director of the Pediatric Endocrinology fellowship program. Finally, he provides important service to the state and region by being the (volunteer) Medical Director for Hertko Hollow Diabetes Camp for children, located in central Iowa. Congratulations Dr. Tansey for this well earned honor of being elected to the APS.

Continuous glucose monitoring in persons without diabetes

Dr. Tansey

We have entered a new era whereby wearable continuous glucose monitors (CGMs) can provide a reasonable representation of a person’s blood glucose for days on end. These devices have been very useful for persons with diabetes. However, one difficulty has been understanding what glucose levels reported by these devices represent normal. To better addressed this knowledge gap, our own Dr. Tansey helped direct a study assessing CGM data collected from healthy persons without diabetes. The results are now published in the prestigious Journal of Clinical Endocrinology and Metabolism. The results from this study will be very useful, especially when assessing persons who might be in the process of developing diabetes to determine when their blood glucose levels deviate from normal patterns.

Slowing down type 1 diabetes

A recent study published Aug 2019 in the New England Journal of Medicine (abstract link here) has shown that a drug called teplizumab can delay the onset of type 1 diabetes by 2 years on average in persons at risk. Teplizumab is a monoclonal anti-CD3 antibody, and as such interferes with the activation of T cells involved in attacking beta-cells of the pancreas. This is a significant step towards meaningful strategies to prevent type 1 diabetes. Not only are we thrilled at this development, but we are also proud that one of the senior faculty in our Division, Dr. Eva Tsalikian, helped conduct the research and write the article. Other staff in Iowa involved with the study included division faculty Dr. Michael Tansey, and research coordinators Joanne Cabbage & Julie Coffey.

Effects of metformin on insulin sensitivity in persons with type 1 diabetes

Metformin is a first-line medication used to treat type 2 diabetes, where its main action is to improve insulin sensitivity and ultimately to decrease complication rates. In persons with type 1 diabetes, metformin alone is not effective treatment, because it can not replace the profound lack of insulin that occurs in this disease. However, some patients with type 1 diabetes, especially those who are obese, develop insulin resistance. Dr. Tansey and Dr. Tsalikian helped direct a recent study which found that 3 months of metformin treatment (in addition to insulin treatment) in these patients led to improvements in insulin sensitivity. Differing from type 2 diabetes however, hepatic insulin sensitivity was not improved. The results from this study are now published in the prestigious Journal of Clinical Endocrinology and Metabolism.

The effects of diabetes on the developing brain.

It has long been wondered what effects diabetes in kids may have on the developing brain. Recent studies suggest that higher glucose levels found in poorly controlled diabetes alter brain development. Dr. Tsalikian is an author on a recent manuscript (link) published in the prestigious journal Diabetologia furthering these observations. The multicenter observational trial found that among children with diabetes, those with higher average glucose levels had greater degrees of persistent disruption of their brain white matter, and that the changes in white matter were associated with worsened cognitive performance. These results suggest that good glucose control is important for future brain function in children with diabetes. However, since the study was observational and correlative, these conclusions are not truly 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 Dr. Tansey, along with study coordinators Julie Coffey MSN, Joanne Cabbage, and Sara Salamati.

Does diabeteic ketoacidosis impact brain development in children?

Dr. Tsalikian has helped author a recent manuscript aimed at better understanding whether diabetic ketoacidosis might impact brain development in children. This manuscript was published this month in the prestigious journal Diabetes Care (permanent link to manuscript, link to public free version). They found that children who had experienced moderate-to-severe diabetic ketoacidosis had altered brain dimensions and lower cognitive scores. These results, though only correlative, suggest that moderate-to-severe diabetic ketoacidosis has an adverse impact on the developing brain. Several other of our division members contributed to this work, including Dr. Tansey, along with study coordinators Julie Coffey MSN, Joanne Cabbage, and Sara Salamati.