There remains much to learn about endocrinology, and most of the conditions we treat do not have definitive cures. To help advance the field, the faculty in our Division direct endocrinology-focused research ranging from laboratory biomedical science to clinical studies. Here we report some of our noteworthy progress.
Treatment-Induced Neuropathy of Diabetes (TIND) is a insufficiently recognized complication, usually temporary, that can occur after rapid correction of severe hyperglycemia. Its occurrence in the pediatric-aged population has not been well studied. Dr. Eirene Alexandrou has just published a paper describing 7 cases of TIND among children and young adults. She published the work in the Journal of the Endocrine Society (link to paper). The cases occurred in both type 1 and type 2 diabetes, and in each case followed a rapid improvement from severe hyperglycemia. All but 1 of the cases were transient. Symptoms included pain, often burning in nature, numbness, and autonomic disturbance. Management included stabilization of glycemia and medical therapy.
Yesterday, data were published indicating that among persons with type 1 diabetes, higher average glucose levels are associated with increased risk of requiring hospitalization for COVID infection. The peer reviewed data was published in the Journal of Clinical Endocrinology and Metabolism ( doi permanent link ; pubmed link ). The data were collected via the national T1D Exchange study consortium. Drs. Pinnaro and Tansey from our division are part of this consortium and helped author the article. The data indicate that if you have type 1 diabetes, you should keep your blood sugars in range as much as possible to help prevent severe COVID. We remain happy to help you achieve this goal; our contact information can be found by clicking on the “clinical website” at the top of our links page.
Graphical summary of findings showing that electromagnetic fields can treat type 2 diabetes.
Our division director has contributed to new scientific work that has been published in Cell Metabolism showing that exposure to generated electromagnetic fields lowers blood sugar in rodents with type 2 diabetes. Dr. Norris helped design and interpret the glycemic clamp studies that were used to better understand the physiological mechanisms involved in the phenomenon. (Pubmed link; DOI link).
A graphical summary of exocrine-endocrine interactions in the pancreas
Fascinatingly, the pancreas is really two organs mixed together. The exocrine part of the pancreas produces digestive enzymes that are secreted into the small intestine. The endocrine part of the pancreas makes insulin and glucose, which are secreted into the blood stream. The endocrine parts of the pancreas are scattered like islands within the exocrine part. Although the function of endocrine part of the pancreas has long been considered to be fairly independent of the exocrine, it is increasingly being recognized that the health of the exocrine pancreas influences the endocrine portion. Our division director, Dr. Norris, just helped author a review article on this topic. The work was just published in the journal Diabetologia, which is the leading diabetes research journal published in Europe. The article reviews how diseases of the exocrine pancreas can lead to defects in insulin production and diabetes. (Pubmed link, DOI link)
“With the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions.” –Andrew Norris
Dr. Tansey
Dr. Tansey and collaborators across the country have been studying brain function in children with and without type 1 diabetes. In a study published today (link) in the prestigious journal Diabetes, they report important differences between these two groups. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given memory tasks. Compared to children without diabetes, those with type 1 diabetes exhibited decreased memory performance relative to children without diabetes. Interestingly the children with type 1 diabetes showed greater increases in brain activation with harder tasks than those without diabetes, suggesting that their brains were working harder to compensate. More research is needed to understand how these effects of diabetes occur and how they might be modulated. With the recent advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions. Also involved in the study from our Division were Dr. Tsalikian, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.
There appears to be an increased risk of developing diabetes for persons with Turner syndrome. The exact reasons for this are enigmatic, as there have been very few studies. This lack of knowledge makes it difficult to know how best to screen for and help prevent diabetes in this population. To help address this, pediatric endocrine fellow Dr. Pinnaro has initiated a study of blood levels levels in persons with Turner syndrome who do not have diabetes. The initial results from this study suggest a greater degree of atypical glucose levels in those with Turner syndrome as compared to controls. This past weekend, Dr. Pinnaro would have presented these initial results at the national Pediatric Endocrine Society meeting in Texas (cancelled due to COVID-19). Her faculty mentors for this study were Drs. Katie Larson Ode and Andrew Norris.
Dr. Katie Larson Ode has been named director of the Clinical Core component of the University of Iowa’s Center for Gene Therapy of Cystic Fibrosis. The NIH grant funding for this project was just renewed. Her core will support maintenance and growth of a Cystic Fibrosis biobank which will obtain/provide clinical samples from/to researchers in cystic fibrosis for translational projects. Congratulations to Dr. Larson Ode on your excellent work.
“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.
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.
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!
