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Safety of One Year’s Treatment with Inhaled Insulin in Children with Type 1 Diabetes

Dr. Tansey

Our division has contribution to a clinical study recently published in Diabetes Technology & Therapeutics : “Inhaled Technosphere Insulin in Children with Diabetes: The INHALE-1 Extension Study.” One of our Division physicians, Dr. Tansey, served as a co-author on this important research. This paper describes an extension phase to the INHALE-1 trial to better examine long-term safety of an inhaled form of insulin. The results from the first 26-week phase of trial were published several months ago. Inhaled insulin demonstrated similar glucose levels to conventional therapy with injected insulin but greater treatment satisfaction. The extension phase of the trial allowed participants the option to continue inhaled insulin for another 26 weeks to further evaluate safety. Even after one year’s treatment, there were no serious pulmonary complications among the participants. There was a small increase in hemoglobin A1c from week 26 to week 52 (from 8.2 to 8.6%). The manuscript abstract is available on Pubmed. The results show the potential safety of inhaled insulin for children with type 1 diabetes. We especially wish to thank the research coordinators, research participants and their families who made this study possible.

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Developing a New Pediatric Healthy Weight Clinic

Dr. Castaño

Obesity is a prevalent health risk, even among children and adolescents. Several faculty at the University of Iowa are working to help address this issue by creating a new pediatric healthy weight clinic. The faculty involved represent several areas of pediatrics, including endocrinology, gastroenterology, and general pediatrics. The goal is to create a multidisciplinary medical home for children and adolescents who have struggled to maintain a healthy weight. Together, the involved physicians crafted a vision and proposal for the clinic, which has now received startup funding by being selected as a High Impact Proposal in an internal competitive application process. The Pediatric Division of Endocrinology and Diabetes is proud to be represented in this endeavor by Dr. Gabo Castano who helped craft the proposal and will lend his obesity-care expertise to the project.

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Patient Choice Award Recipients – 2025

We are pleased to report that 5 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 with ratings in the top 10% nationally. The recipient physicians were:

Dr. Pesce honored for 5 years of Patient Choice Awards. Here she is joined by her husband who also received a Patient Choice award.
  • Vanessa Curtis, MD
  • Katie Larson Ode, MD
  • Liuska Pesce, MD
  • Akhila Ramakrishna, MD
  • Julie Osterhaus, ARNP

Dr. Pesce was furthermore recognized for having received the award for 5 consecutive years.

The Choice Award was earned by only 276 outpatient 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.

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Balancing Confidentiality and Care: Dr. Kanner Helps Shape Guidelines

Dr. Kanner

We are proud to share that Dr. Kanner has helped author an important new publication in the Journal of Pediatric and Adolescent Gynecology (December 2025 issue). The manuscript, titled “NASPAG Clinical Consensus on Adolescent Pregnancy Testing: Balancing Confidentiality, Consent, and Disclosure” addresses a critical aspect of adolescent reproductive health care.

This consensus document, developed by members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG), provides clinicians with a framework for counseling adolescent patients who present with a positive pregnancy test. It explores the legal, ethical, and clinical considerations involved in guiding patients through the testing process, including strategies for ordering tests, disclosing results, and managing care when a pregnancy is confirmed. The review emphasizes the importance of individualized, patient-centered approaches, mindful of varying clinical, institutional, and legal scenarios. The abstract for this publication is available on PubMed at https://pubmed.ncbi.nlm.nih.gov/41371579/. This work represents a significant contribution to the important ongoing dialogues about adolescent health care. We thank Dr. Kanner for her efforts relating to this challenging topic.

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Drs. Castano & Palmer Pass Boards!

Dr. Palmer
Dr. Castaño

It takes years of training to become a pediatric endocrinologist, requiring at least a decade of studies after college. You could consider this to be the equivalent of completing the “26th grade”. The final step is to pass the Pediatric Endocrinology board exam. We are pleased to report that the two newest doctors in our Division have just passed their Board Exam. Congratulations to Dr. Castano and Dr. Palmer for becoming Board Certified Pediatric Endocrinologists. Their years of hard work and study have enabled them to become fully qualified to diagnose and treat pediatric endocrine conditions.

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Muscle “Recycling Centers” Helps Prevent Type 2 Diabetes

Dr. Norris

A group of researchers have identified a key protein complex in muscle cells that regulates the body’s response to nutrients and helps maintain healthy blood sugar levels. The researchers focused on the role of this complex, known as LRRC8, in muscle lysosomes. Lysosomes are tiny compartments inside cells that act like recycling centers. The researchers found that lysosomal LRRC8 plays a critical role in governing cellular growth and metabolism. When LRRC8 was disrupted in lab-grown muscle cells, lysosomal function was impaired, weakening how muscle cells responded to nutrients and to insulin. Furthermore, mice lacking lysosomal LRRC8 developed increased body fat, insulin resistance, and poor glucose tolerance — conditions closely linked to type 2 diabetes. This research uncovers a previously unknown connection between LRRC8 lysosomal function in muscle cells and whole-body metabolic health, opening new avenues for understanding and potentially treating metabolic diseases such as type 2 diabetes. Dr. Norris from our division was part of the research team and is a co-author on the manuscript. The peer-reviewed findings are published in Science Advances under the title: “Lysosomal LRRC8 complex impacts lysosomal pH, morphology, and systemic glucose metabolism.” The abstract is available on PubMed: https://pubmed.ncbi.nlm.nih.gov/41004571/.

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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.