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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.

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Better Congenital Hypothyroidism Screening

Andrew Norris, MD PhDPost by
Andrew Norris, MD PhD
Director, Pediatric Endocrinology & Diabetes
University of Iowa Stead Family Children’s Hospital

I am excited to report that the Iowa newborn screening program will begin using age-adjusted TSH cut-offs starting March 30, 2020. The purpose is to better screen newborns for congenital hypothyroidism, which is a condition that if untreated leads to profound deficiencies in brain development and body growth. The cutoff changes are expected to improve both the specificity and sensitivity of the screen. Otherwise, in general, there will be no change in workflow as involves endocrinologists and primary care providers. Only the cutoffs are changing. Despite these improvements, the newborn screen remains only a screening test and should not be used as a quantitative test to examine an infant in whom you suspect a thyroid abnormality.

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

“with the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, might this type of research help guide possible interventions?” –Andrew Norris

Dr. Tsalikian

Dr. Tsalikian and collaborators across the country have been studying brain cognitive function in children with and without type 1 diabetes. In a study just published in PLOS Medicine, they report interesting differences. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given tasks. Compared to children without diabetes, those with type 1 diabetes exhibited two differences. One of the observed changes was impaired control of a region towards the back of the brain and this impairment typically leads to diminished task performance. In contrast, there was enhanced activation of a region towards the front of the brain involved in executive control. It appears that these two changes balanced each other, in that the two groups had similar task performance. Simply put, it appears that the brains of children with type 1 diabetes are able to compensate for impairments presumably induced by long-term exposure to high blood sugars. More study is needed to understand this latter point in particular, for example would the pattern normalize if the blood sugars were held to the normal range during the study? Furthermore, more study is needed to understand the broader implications of this work, for example might these or related changes contribute to the increased risk of depression in persons with diabetes? Finally, with the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, might this type of research help delineate important interventions? Also involved in the study from our Division were Dr. Tansey, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.

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Senior Endocrine Fellow Publishes Research Discovering Genes that may Modify 22q11.2 Deletion Syndrome.

Dr. Pinnaro

Dr. Pinnaro, pediatric endocrine fellow, has published her recent research that finds several candidate genes which may modify the phenotype of 22q11.2 syndrome. This genetic syndrome can cause congenital structural heart disease, failure of the parathyroid glands to properly form, and immunodeficiency. Although the effects of the syndrome vary from person to person, the reasons for this variability is unknown. Thus, Dr. Pinnaro set out to understand whether other genetic regions might be the reason. Her findings show that various genes might indeed contribute. She is the lead author on the work which is published in the January 2020 issue of Molecular Genetics & Genomic Medicine. Congratulations to Dr. Pinnaro for the results of her hard work in this area.

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Endocrine Care of Children with Neuromuscular Disorders

Dr. Curtis

Children, adolescents, and young adults with neuromuscular disorders are at risk for various endocrine complications. For example, Duchenne muscular dystrophy is associated with risk of various endocrine conditions including poor bone health, adrenal insufficiency, obesity, pubertal delay, and short stature. To help with these issues, in 2019, Dr. Vanessa Curtis joined the multidisciplinary Neuromuscular team at the University of Iowa to provide endocrine care to patients in this clinic. This week, Dr. Curtis attended the Parent Project MD meeting in San Diego to further her skills in this emerging area of medicine.

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Dr. Pesce to Lead National Endocrine Learning Committee

Dr. Pesce

We are pleased to report that Dr. Liuska Pesce, one of our pediatric endocrine faculty, has been selected to co-chair & then chair the Pediatric Endocrinology Self-assessment Program for the Endocrine Society in 2020 & 2021. As part of this group, she helped publish Pediatric ESAP 2019-2020, ESAP Special Edition: Historical Perspectives for Today’s Clinician, and Pediatric ESAP 2017-   2018.

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Dr. Larson Ode Publishes on the Endocrine Complications of Cystic Fibrosis.

Dr. Larson Ode

It has been a productive fall for Dr. Larson Ode, who has published 5 review articles focused on various endocrine complications of cystic fibrosis. You can find summaries of these works at the following links: one – two – three – four – five. Dr. Larson Ode is a leading expert in the clinical care and clinical research involving persons with cystic fibrosis who have developed diabetes and other endocrine complications. She sees children and adult patients in the cystic fibrosis clinic to help them manage these conditions. On the research side, she coordinates a variety of clinical studies here at Iowa and also at other academic medical centers across the country to better understand these complications. She is also serving as a career and research mentor to several junior endocrinology faculty across the country to further their expertise and research in this important area. Kudos Dr. Larson Ode on your accomplishments!

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Endocrinology & Sports Medicine

Dr. Vanessa Curtis

Sports performance and hormonal systems are closely intertwined. There are several hormonal / endocrine conditions that can greatly impair sports performance. Conversely, exercise can benefit the endocrine system. However, there are times that intense sports participation can adversely affect various hormones. Dr. Vanessa Curtis has interest and expertise in these complex interactions, and treats children and adolescents with such conditions in her clinic. Gender of course has a powerful influence on this interplay. To this end, Dr. Curtis just served as an invited speaker for the 35th Annual University of Iowa Sports Medicine Symposium, speaking on Gender and Sex in Sport. Also along these lines, Dr. Curtis has traveled to various parts of the state of Iowa over the past few years to provide lectures on Athletes with Type 1 Diabetes and Childhood Obesity to residency programs.

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Dr. Larson Ode to Help Mentor Faculty Across the Country.

Dr. Larson Ode

There is a strong need to train endocrinologist to help provide expert care for the endocrine complications experienced by patients with cystic fibrosis. For this reason, the Cystic Fibrosis Foundation has established a program to identify national leaders in this area who can help mentor other endocrinologists. We are proud of Dr. Katie Larson Ode, who has been named one of the selected mentors to help train the future leaders in cystic fibrosis endocrinology. This honor includes grant funds to support her time in these efforts.

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Dr. Sandberg to Serve as Co-leader for the National Education Subcommittee for the Pediatric Endocrine Society

Dr. Sandberg

Dr. Sandberg is an ardent educator regarding training medical professionals at all levels on how to provide compassionate and informed care for highly vulnerable youth with endocrine needs. To this end, Dr. Sandberg serves as the co-leader of the education subcommittee of one of the related special interest groups at the national Pediatric Endocrine Society. We thank her for her important service in this area and for helping educate health care providers how to provide the best care possible.