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Potential Exocrine-Endocrine Pancreas Crosstalk

Pancreatic islets are the cells that produce insulin and glucagon, and are otherwise known as the endocrine pancreas. The islets are surrounded by the exocrine pancreas. The exocrine pancreas is a gland that creates digestive juices for the intestine. It has long been postulated that the exocrine pancreas cells help support the function and existence of the islets. The corollary is that a diseased exocrine pancreas might have negative influence on islet function. This postulated biology may be at play in cystic fibrosis related diabetes (CFRD), a unique form of diabetes that afflicts many persons who have cystic fibrosis. To test this possibility, researchers at the University of Iowa have studied exocrine pancreas cells grown in cell culture from ferrets with and without cystic fibrosis. The researchers found that the exocrine cells affected by cystic fibrosis secrete different proteins than the healthy cells. Furthermore, some of the differences are expected to impact islet function. The results were published in the Journal of Cystic Fibrosis. Dr. Norris from our division was one of the study authors, along with other scientists.

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Modeling Pancreatitis-induced Islet Dysfunction.

Pancreatitis often leads to hyperglycemia. However, there have been major limitations in understanding the involved pathophysiology. Several collaborators at the University of Iowa have now created a model to help understand the process. The research team found that cerulein injections led to pancretitis with elevated amylase and lipase. Acute accompanied the acute pancreatitis, with both impaired insulin levels and evidence of insulin resistance. Glucose tolerance normalized by 3 months. The research team included our Dr. Andrew Norris, but also pediatric gastroenterologist Aliye Uc and researchers and faculty from the Department of Anatomy and Cell Biology.

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Children with Type 1 Diabetes Can Require Hospitalization with COVID, Largely Due to Diabetic Ketoacidosis.

Dr. Catherina Pinnaro

An important question during the COVID-19 pandemic has been whether children and adolescents with type 1 diabetes have increased risk of severe COVID-19. Dr. Pinnaro from our Division was one of a group of pediatric endocrinologist across the country who sought to help answer this important question. Their findings have now been published in the Journal of Diabetes (link to article). Briefly, they found that children and adolescents with type 1 diabetes who developed COVID-19 were at roughly 20% risk of being hospitalized while infected. Importantly, however, the cause of hospitalization was typically related to diabetes, less so than due to severe manifestations of COVID-19 such as lung dysfunction. Diabetes ketoacidosis was the most frequent cause of hospitalization. This is not uncharted territory, because a variety of viral infections can also precipitate a variety of diabetes emergencies, including ketoacidosis , leading to hospitalization. Also importantly, it appears that type 1 diabetes does not strongly increase the risk of severe COVID. For youth with type 1 diabetes who developed COVID-19, the basics of sick day management become important, including glucose and ketone checking, supplemental insulin when needed, and copious fluids, just as with any infection. Please know that our group of diabetes nurses and doctors remain available 24/7 to assist with sick days. Join us in thanking Dr. Pinnaro for her hard work and research.

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Type 1 Diabetes, Hyperglycemia, and Structural Brain Changes in Children.

  • Dr. Tansey
  • Dr. Tsalikian

It has previously been observed that young children with type 1 diabetes have changes in brain structure, when compared to children without diabetes. However, it has not been known how these differences in brain structure might change over time. To help address this knowledge gap, Drs. Tsalikian and Tansey have helped conduct a multicenter longitudinal trial following over 100 children with type 1 diabetes. The children underwent repeated brain imaging with MRI over an average span of 6 years time. The results from this study have now been published in the prestigious journal Diabetes Care (link). The study found that the brains of children with type 1 diabetes exhibited smaller volume, and that this difference became greater over time. Importantly, higher blood sugar levels were correlated with greater loss of brain volume. These results lend further credence to the notion that loss of brain tissue is a complication of childhood diabetic hyperglycemia. Furthermore, the results suggest that meticulous glycemic control might prevent these structural brain changes. Since the study was correlative, these conclusions are not fully definitive and further study is needed. It remains crucial that children with diabetes be followed by an expert pediatric endocrinology team, such as at the University of Iowa. Several other of our division members contributed to this work, including study coordinators Julie Coffey MSN and Rachel Bisbee. We also thank the families and children who volunteered as participants in this study.

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Diabetes Research Center Highlighted

The University of Iowa Fraternal Order of Eagle Diabetes Research Center

The University of Iowa Fraternal Order of Eagles Diabetes Research Center (FOEDRC) is being highlight this month in Iowa Magazine (link). You can read about work from the FOEDRC aimed at better treating and preventing diabetes. Our faculty members Drs. Norris, Tansey, and Tsalikian are mentioned.

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A Novel Approach that Might Prevent “Belly Fat”

Dr. Akhila Ramakrishna

Perhaps the worst place to gain fat is inside your abdomen. This type of fat is called visceral fat, and contribute to risk of cardiovascular disease, type 2 diabetes, and a host of related complications. Unfortunately, it is also a common place to gain fat. Dr. Ramakrishna has just published new research that has identified a potential new strategy to prevent visceral fat. She used two approaches in mice to reduce the amounts of a protein called PAPP-A. This was accomplished using a genetic and a neutralizing antibody approach respectively. These treatments reduced the amounts of visceral fat that the mice developed while on a high fa diet. Not only was the amount of visceral fat reduced, but the treatments helped prevent fatty liver. She published the work in the journal Endocrinology (link to paper). We look forward to further development of this approach.

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Treatment-Induced Neuropathy of Diabetes in Pediatric Aged Patients

Dr. Eirene Alexandrou

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.

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Glucose Control and COVID Hospitalization Risk in Persons with Type 1 Diabetes

  • Dr. Pinnaro
  • Dr. Tansey

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.

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Electromagnetic Fields Can Treat Type 2 Diabetes

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).

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A Tale of Two Pancreases

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)