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Vitamin D Repletion in People with Cystic Fibrosis

Dr. Larson Ode

Cystic fibrosis often disrupts gastrointestinal function, impairing the absorption of fat-soluble vitamins such as vitamin D. As a result, individuals with cystic fibrosis are at increased risk for vitamin D deficiency. While daily supplementation is a common corrective strategy, it adds to the already significant treatment burden faced by these patients.

An alternative approach known as stoss dosing involves administering a single, very high dose of vitamin D. This method is effective because vitamin D remains active in the body for several weeks, potentially reducing the need for daily supplementation.

To evaluate the effectiveness of stoss dosing, researchers analyzed the medical records of 58 individuals with cystic fibrosis who received this treatment. Their findings showed that vitamin D levels were increased by the therapy, as measured three months after the dose administration. However, only about half of the patients reached the target vitamin D levels, suggesting that while stoss dosing is likely beneficial, further research and optimization are necessary.

Dr. Larson Ode from our division contributed to the research, which has been peer-reviewed, published in Health Science Report and is publicly available in the PubMed Central repository (link).

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Sugar Surge: Rates of Pediatric Type 2 Diabetes More than Doubled During the Pandemic

Dr. Catherina Pinnaro

Early in the pandemic, pediatric endocrinologists began noticing a rise in new cases of diabetes among youth. To investigate this trend, a group of specialists formed a national consortium representing 23 pediatric centers across the country. Their findings revealed a significant increase in new diagnoses of type 2 diabetes during the pandemic, with cases more than doubling. This increase was observed across all sampled regions of the United States. In contrast, the rise in new-onset type 1 diabetes was less pronounced and did not reach statistical significance.

Encouragingly, the number of new type 2 diabetes cases appeared to return to baseline by the end of the pandemic’s second year.

While the study was not designed to determine the exact causes of the type 2 diabetes surge, the results suggest that the major contributing factors were transient in nature. These temporary factors may have included reduced physical activity, disrupted daily routines and eating habits, and increased psychosocial stress. Perhaps less likely to play a major role would be the physiological effects of the SARS-CoV2 virus itself.

The consortium has now published these findings in the Journal of Clinical Endocrinology and Metabolism. Dr. Pinnaro, from our division, was involved with the consortium’s creation, this research and the writing of the published manuscript. The abstract can be found on PubMed at this link.

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Adrenal Insufficiency after Pediatric ICU

Dr. Radig

Children admitted to the Pediatric Intensive Care Unit (PICU) often receive glucocorticoid steroids as part of their treatment. While these medications can be highly effective in managing critical illness, prolonged use may lead to adrenal insufficiency—a dangerous but treatable condition in which the body cannot produce adequate levels of cortisol. To better understand the risks, researchers reviewed the medical records of 530 pediatric patients who received steroids during their PICU stay. Among these patients, 2.3% were diagnosed with adrenal insufficiency. The study identified several key risk factors including the following: younger age, higher cumulative dose of steroids and the use of steroids specifically for treating excess inflammation. These findings aim to improve the identification of pediatric patients at risk for adrenal insufficiency following critical illness. The study has been published in the Journal of Intensive Care Medicine. The lead author, Dr. Radig, will soon join our Division as a pediatric endocrinology fellow. Also contributing to the the research was Dr. Curtis, also from our Division. The abstract is available on PubMed at the following link.

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Long-Term Study Links Elevated Glucose Levels to Persistent Brain Changes in Children with Type 1 Diabetes

Dr. Tsalikian
Dr. Tansey

In 2018, faculty from our division participated in a multicenter, observational study that added to growing evidence linking elevated glucose levels in children with type 1 diabetes to changes in brain structure. While the initial findings highlighted these associations, they could not determine how such changes might evolve over time. Now, the research team—including Drs. Tsalikian and Tansey from our division—has completed a long-term follow-up of the original study participants. The results, recently published in the journal Diabetes, are available via PubMed (link here) in abstract form. The follow-up spanned 6 to 8 years and revealed that the previously observed brain differences largely persisted. Although the magnitude of some differences diminished slightly, higher average blood glucose levels continued to correlate with more pronounced structural changes. These findings reinforce the importance of maintaining tight glycemic control to potentially mitigate long-term neurological impacts. As the cohort transitions into adulthood, continued monitoring will be essential to fully understand the long-term implications of these early brain changes.

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The Mouth Tells the Story: Metabolic Syndrome Impacts the Oral Milieu Even Before Dental Disease Occurs

Dr. Curtis
Dr. Kanner

Obesity and metabolic syndrome are known to negatively affect oral health, but the underlying mechanisms and early indicators remain unclear. To help bridge this knowledge gap, Dr. Curtis and Dr. Kanner from our division collaborated with scientists from the School of Dentistry led by Dr. Sukirth Ganesan. Together they conducted a study involving children and adolescents with healthy teeth and gums. Participants were grouped into three categories: normal-weight healthy, healthy obese, and obese with metabolic syndrome.

Saliva samples were collected from each participant and analyzed their bacterial, metabolic, and hormonal content. All three components showed distinct differences between the obese and normal-weight healthy groups. Notably, by integrating data from all three saliva components, researchers were able to identify individuals with metabolic syndrome.

These findings suggest the potential for developing non-invasive saliva-based tests to assess metabolic health—potentially even eliminating the need for some blood draws. Additionally, the results offer new insights into how obesity and metabolic syndrome may contribute to oral health issues. The study was published in the Journal of Dental Research, and the abstract is available on PubMed at this link.

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Benefits of Blood-sugar Self-Review in Adolescents with Type 1 Diabetes

Dr. Catherina Pinnaro

Dr. Catherina Pinnaro and her research team have now published a second report indicating benefits to reviewing diabetes device blood sugar data. The article is entitled “Adolescent-Initiated Retrospective Glucose Data Review is Associated With Improved Glycemia in Type 1 Diabetes Mellitus”, and was just published as a peer reviewed research article in Pediatric Diabetes (pubmed Link; free fulltext Link). This paper expands upon her group’s prior related paper (previously reviewed in this blog here). Whereas the prior paper studied whether blood sugar levels improved when family-members reviewed their child’s blood sugar data, the current paper examines the impact when the child/adolescent reviews their own data. Importantly, blood sugar levels were significantly improved in those adolescents who reviewed their own blood glucose data. Co-authors on the work from our division included Drs. Palmer, Norris, and Tansey.

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Pediatric Research Day 2025

The 2025 Pediatric Research Day was held on the afternoon of April 11th, highlighting eight speakers, a “data blitz”, and a poster session. Our Division of Endocrinology and Diabetes was well represented. Two of our fellows had their abstracts selected for one of four speaker slots. Additionally, our faculty contributed to several poster abstracts. The fellow talks were as follows: Dr. Kyle Baum: “Impact of the incretin, retatrutide, on weight loss, lean body mass, and muscle physiology in mice”. Dr. Benjamin Palmer: “Assessing Sports Participation and Associated Barriers in Youth with Type 1 Diabetes Mellitus”

Senior Fellow Dr. Palmer speaking at Research Day.
Fellow Dr. Baum speaking at Research Day.
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Altered Fat-Burning in Infants with Congenital Disorders

Dr. Catherina Pinnaro

Almost immediately after birth, we begin burning fat for energy and warmth. Recently, members of our division studied whether this process is altered in infants with congenital disorders. The study focused on two specific disorders: congenital hypothyroidism and cystic fibrosis. The peer-reviewed study is now available online (PubMed link). The results indicate that infants with these disorders burn less fat than normal. Surprisingly, however, these infants burned relatively more of a specific fatty acid—linoleic acid. One possible explanation for this finding relates to higher levels of inflammation in these infants. This finding is particularly important for cystic fibrosis, as it may help explain why this condition often causes lifelong linoleic acid deficiency. The manuscript’s lead author is Dr. Pinnaro from our division, with Dr. Norris serving as the senior author.

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Loss of CFTR from Pancreatic Ductal Cells Unlocks the Potential to Form New Endocrine Cells

Dr. Norris

Several years ago, researchers at the University of Iowa discovered that the balance between endocrine and exocrine cells in the pancreas is impacted by cystic fibrosis. The distribution of cell types in pancreases affected by cystic fibrosis suggested the emergence of a dynamic regenerative process. To better understand this possibility, the researchers teamed up with experts at the University of Colorado. The results of this collaborative work are now published in the journal iScience (PubMed link).

Cystic fibrosis is caused by the loss of CFTR function. The published work shows that when all CFTR function is lost from certain pancreatic ductal cells, these cells begin to express a protein named PDX1. This is important because PDX1 drives the development of several different components of the pancreas during organ formation. Indeed, the pancreatic ductal cells that expressed PDX1 exhibited the potential to produce several cell types, including pancreatic endocrine cells. Consistent with this, the researchers identified the presence of insulin-expressing cells within the ductal epithelium of pancreases affected by cystic fibrosis.

These findings enhance our understanding of the cellular formation of ductal versus endocrine cells in the injured pancreas and could be beneficial for future attempts at pancreatic endocrine and/or exocrine regeneration. Dr. Norris from our division was involved in the research.

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The Influence of X Depends on Which Parent It Comes From

Dr. Catherina Pinnaro

Nope, the newest research results from Dr. Pinnaro are not related to a social media platform formerly represented by a blue bird. Rather, her latest research publication deals with the X-chromosome and how it modifies the risk a person has to develop diabetes. Specifically, the new results show that persons with Turner syndrome who inherited just a single X-chromosome have a higher risk of elevated blood sugar levels if that X-chromosome came from their mother compared to if it came from their father. The manuscript describing the results has been accepted for publication in the journal Hormone Research in Paediatrics (link to article on PubMed). The results may have implications for diabetes in the general population, as males necessarily inherit their X from their mother and for females the impact of risk differences between their two X chromosomes could be influenced by which parent each came from. Dr. Norris from our division also contributed to the manuscript.