from the division director
Save The Date! Dr. Kanner has announced that she will host our annual College Preparation Event on April 15, 2024 at 5 pm. The event focuses on preparation for college success for those with type 1 diabetes. 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 event’s flyer is immediately below.
On February 16th, 2024, Drs. Kanner, Ramakrishna, and Parra Villasmil jointly delivered Pediatric Grand Rounds. Their talk was entitled “When Overnutrition Becomes an Endocrine Problem…Food for Thought“. They focused on the endocrine complications that can occur as a consequence of overweight and obesity in children and adolescents. Additionally, they touched on the practicalities of providing care to obese youth.
In the United States, nearly 1 in 5 children and adolescents are obese. In Iowa alone, over 50,000 youth are obese, per 2019 estimates (reference). Due to these high numbers, specialized obesity clinics are not a currently tenable solution. While most obese youth won’t develop endocrine complications, some may experience conditions such as type 2 diabetes, dyslipidemia, or polycystic ovarian syndrome.
Our Division accept referrals when these endocrine complications arise. Additionally, we welcome referrals for those rare cases where obesity is linked to endocrine conditions such as hypothyroidism or Cushing syndrome. Another reason for referral to endocrinology is when an obese adolescent and their family are prepared for the arduous process of bariatric surgery.
We extend our thanks to Drs. Kanner, Ramakrishna, and Parra Villasmil for sharing their expertise!
Almost 10 years ago, investigators from our Division determined that young kids with cystic fibrosis (CF), less than 5 years of age, often have high blood sugars in response to a standardized sugary drink. However, the long term importance of these findings is unknown. Furthermore, we don’t know if this issue occurs when young kids are eating their usual foods and drink. To address this shortcoming, Dr. Katie Larson Ode of our Division, has partnered with other researchers across the country to create a study using wearable continuous glucose monitors. In one part of the study, they are using these monitors to determine what blood sugars do in young kids with CF in their usual environment (home, school, etc). However, so little is known about what blood sugars do in healthy young kids that it is difficult to know exactly what is normal. To address this, Dr. Larson Ode and her research partners will also study young, healthy kids. Dr. Larson Ode has just received grant funding to conduct the study, entitled “BEGIN Substudy: Continuous Glucose Monitoring in Healthy Children“. We thank Dr. Larson Ode and her research volunteers for their work to help advance knowledge.
Dr. Ramakrishna from our division has worked diligently with with several other pediatric sub-specialties to create the regions first clinic for children with DSD (differences in sex development). DSD represent a collection of conditions whereby the usual processes of sexual development have not occurred in the usual fashion. The usual anatomic, functional, hormonal, and/or reproductive functions are altered, absent, or mixed. DSDs are often evident at or even before birth, but some forms are not diagnosed until adulthood. Dr. Ramakrishna has partnered with pediatric urologist Dr. Gina Lockwood and clinical psychologist Dr. Laura Fuller to create the Iowa Gender Multi-Specialty (iGeMS) clinic. The clinic works to maximize the physical and emotional health of youth with DSD, using a multidisciplinary approach. The clinic additionally is staffed by clinical geneticists, pediatric radiologists, with support from reproductive endocrinology and clinical pharmacy services. Referral and appointment requests can be made as outlined on Dr. Ramakrishna’s clinical webpage (link).
We are delighted to report that Dr. Pinnaro from our division has been recognized by the Corridor Business Journal for her significant impact on her community and business. The award is reserved for early career impact, with a criteria that the person be under age 40. Forty individuals in the Cedar Rapids / Iowa City corridor region are selected annually. Dr. Pinnaro is a physician scientist, dividing her professional time between taking care of patients and directing a research program aimed at better understand health and disease. Her clinical work is focused on caring for pediatric patients with diabetes or other endocrine disorders. Her research program is focused on better understanding diabetes in persons with Turner syndrome and honing technology-based treatments for diabetes. In describing her approach to medicine and research, she relates that “I am motivated by trying to solve dynamic problems that may need out-of-the-box strategies.” She and the other recipients were recognized at an awards dinner on October 19th. We are fortunate to have Dr. Pinnaro on our team and congratulate her for her achievement.
Dr. Pinnaro is part of the leadership team that has created a new national registry to track the health of persons with Turner syndrome. The initiative has been named the “Inspiring New Science to Guide Healthcare in Turner Syndrome (InsighTS)” Registry. The leadership group of the InsighTS Registry has now published their study’s design and goals. The publication’s abstract can be found on PubMed at the following link. Persons with Turner syndrome have unique health risks, and ideally should be seen regularly in a clinic with Turner syndrome expertise, such as the one at the University of Iowa Stead Family Children’s Hospital (2023 link to the Turner syndrome clinic) headed by Dr. Alexandrou and Dr. Pinnaro.
Persons with Turner syndrome are at higher risk than normal to develop diabetes. It would be ideal to screen for diabetes to allow treatment early in the disease process. The natural history of diabetes in persons with Turner syndrome is not well understood. Likewise, the optimal screening approach is not known. To help address this knowledge gap, Dr. Pinnaro from our division led a team that compared results between multiple types of screening tests for diabetes assessed concurrently in persons with Turner syndrome. The screening tests compared were fasting plasma glucose, oral glucose tolerance test, and hemoglobin A1c. The results showed only partial concordance between the different tests. Interpreted conservatively, the data suggest that various hemoglobin A1c thresholds could be used to indicate need for closer evaluation for diabetes. The results are published in the journal Hormone Research in Paediatrics as an article entitled “Screening for Turner syndrome-associated hyperglycemia: Evaluating hemoglobin A1c and fasting blood glucose”. Study authors from our division were Drs. Pinnaro, Parra Villasmil, and Norris. The article’s Pubmed abstract can be found at this link.
Sirtuin1 is a protein that is essential for health. Insulin resistance results when sirtuin1 is lost from skeletal muscle. A team at the University of Iowa led by Drs. Kaiko Irani and Qiuxia Li investigated the impact of sirtuin1 in the vasculature. To accomplish this they knocked out sirtuin1 from the cells that line the inside of blood vessels. As expected, the resulting blood vessels were dysfunctional. Typically, skeletal muscle will become insulin resistant when blood vessels are dysfunctional . However, in this case, the skeletal muscles of the mice lacking blood vessel sirtuin1 were unexpectedly more sensitive to insulin. Importantly, to understand this surprising finding the investigative team identified the mechanism that increases muscle insulin sensitivity. Specifically, the loss of sirtuin1 caused the blood vessel cells to secrete thymosin beta-4, an enhancer of insulin sensitivity in skeletal muscle. These findings highlight the complex actions of sirtuin1 on insulin sensitivity. The publication resulting from the work is entitled “Deficiency of endothelial sirtuin1 in mice stimulates skeletal muscle insulin sensitivity by modifying the secretome”, is published in the journal Nature Communications, and can be found at this link. Dr. Norris from our division is a co-author on the manuscript and contributed to the work by helping direct the studies measuring muscle insulin sensitivity.
Potential endocrine problems are under studied in children with pancreatitis. Dr. Larson Ode from our division is part of a multicenter team that is investigating endocrine complications in children with pancreatitis (either chronic or acute recurrent). They have just published results from a study examining height and bone density in children with pancreatitis. Their manuscript is published in the journal Pancreatology (link to manuscript). The found an excess portion of children with pancreatitis had low height and/or low bone mineral density. These results indicate that children with pancreatitis need closer attention to their growth and to their bone health. It would be ideal for such children to be followed in a multidisciplinary clinic devoted to children with pancreatitis, such as the nationally recognized Pancreatitis Clinic at the University of Iowa Stead Family Children’s Hospital (link).
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.