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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.

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The Effectiveness of 3-Years Growth Hormone Treatment for Aggrecan Deficiency

Dr. Eirene Alexandrou

Growth failure resulting in short stature has a variety of causes. One uncommon cause of short stature relates to mutations in the aggrecan gene. This conditions runs in families in an autosomal dominant pattern and causes severe loss of height growth. Osteoarthritis often occurs in adulthood. Dr. Alexandrou is part of a team that now reports 3-year outcomes resulting from growth hormone treatment in children with this condition. She helped co-author the scientific report, which is being published in the Journal of the Endocrine Society (PubMed link to their publication). Briefly their results indicate that roughly 2.5 inches of additional growth were achieved without adverse effects. Studies to determine long-term outcomes are still needed. The publication highlights the importance of bringing children who are growing poorly to be evaluated by a pediatric endocrinologist to help determine the potential causes and to consider possible treatments.

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Dr. Pinnaro Elected to the Society for Pediatric Research

Dr. Catherina Pinnaro

The Society for Pediatric Research (SPR) was founded in 1929 and serves “to cultivate a diverse network of child health researchers through collaboration, community, mentorship, and advocacy“. Election to the SPR is selective, recognizing productive, independent, active researchers who are conducting hypothesis-driven research in a field related to pediatrics. We are thus proud to announce that our faculty Dr. Cat Pinnaro has been elected to the SPR, effective January 1st, 2024. Dr. Pinnaro received her medical training at New York Medical College. She then completed a pediatric residency followed by a pediatric endocrinology fellowship, both at the University of Iowa. During this time she was a trainee in both the Physician Scientist Training Program and the T32 diabetes research program and earned a Masters in Translational Biomedicine. She has developed an independent research program focused on identifying genetic modifiers that influence the manifestations of karyotypic disorders. She has contributed to the understanding of diabetes as a complication of Turner syndrome and has established expertise in researching the impact of insulin delivery technology. Dr. Pinnaro already has published 19 articles appearing in the PubMed database, despite being an early stage investigator. She successfully competed for an NIH K23 career development award. Additionally, she is an active clinical member of our pediatric endocrinology and diabetes program. Finally, she 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. Pinnaro for this well earned honor of being elected to the SPR.

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Dr. Baum, Endocrinology Fellow, Receives National Rising Star Award

Dr. Kyle Baum

The Pediatric Endocrine Society is dedicated to advancing the treatment of children and adolescents with endocrine disorders. Part of its mission is to identify and support talented young physicians who show acumen for biomedical research. For this purpose, the Pediatric Endocrine Society has created a competitive “Rising Star Award”, which provides funds to support research being conducted by pediatric endocrine fellows. We are pleased to announce that our own 2nd year pediatric endocrine fellow, Dr. Kyle Baum, has been announced as the recipient of one of these competitive awards. The funded project is entitled “Role of FoxOs in muscle strength and mitochondrial function in response to GLP-1RA weight loss“. Congratulations Dr. Baum on this recognition and support.