from the division director
Dr. Pinnaro, pediatric endocrine fellow, with supervision from pediatric endocrine faculty Dr. Curtis, have devised a simulator that models how pediatric patients develop ketones and how insulin dosing can be applied to prevent ketoacidosis. They have just published an overview of their work in the Journal of Diabetes Science and Technology.
Polycystic ovarian syndrome, often abbreviated as PCOS, affects 4-12% of American women. What is less commonly appreciated is that PCOS can start as early as puberty. Symptoms can include irregular periods, excess body/facial hair growth , and acne. Diagnosis of PCOS is less straightforward in adolescents compared to adults. Pediatric endocrinologist Dr. Lauren Kanner has assembled a multidisciplinary clinical team to help tackle PCOS in adolescents. The clinic offers a full PCOS diagnostic work-up and provides ongoing screening and treatment regarding any metabolic, weight, and hyperandrogen concerns. The clinic includes dietary and psychology services. Referral to other specialists needed for care, such as dermatology and gynecology, is also provided. Currently the clinic meets monthly. Browse to the “Clinical Website” on the Links page to find appointment contacts.
We have entered a new era whereby wearable continuous glucose monitors (CGMs) can provide a reasonable representation of a person’s blood glucose for days on end. These devices have been very useful for persons with diabetes. However, one difficulty has been understanding what glucose levels reported by these devices represent normal. To better addressed this knowledge gap, our own Dr. Tansey helped direct a study assessing CGM data collected from healthy persons without diabetes. The results are now published in the prestigious Journal of Clinical Endocrinology and Metabolism. The results from this study will be very useful, especially when assessing persons who might be in the process of developing diabetes to determine when their blood glucose levels deviate from normal patterns.
To help better distribute pediatric endocrine care across the state, Dr. Sandberg has started a new outreach pediatric endocrine clinic in Cedar Falls. She will be seeing pediatric endocrine patients there on Wednesdays. To find how to schedule an appointment, go to the links page and click on the “Clinical Website” link. (Note that at this time, the Cedar Falls clinic does not have the personnel or resources to see pediatric diabetes patients at that location.)
Dr. Larson Ode is the principal investigator and leader of an ongoing multicenter research study aimed at better understanding cystic fibrosis related diabetes. The study is funded by the Cystic Fibrosis Foundation (https://www.cff.org/). The name of the study is the “EnVision CF Multicenter Study of Glucose Tolerance in Cystic Fibrosis”, and will be funded at least through August 2021. As the leader of the study, Dr. Larson Ode coordinates studies at the University of Iowa, the University of Minnesota, University of Colorado, and Washington University in St Louis.
A recent study published Aug 2019 in the New England Journal of Medicine (abstract link here) has shown that a drug called teplizumab can delay the onset of type 1 diabetes by 2 years on average in persons at risk. Teplizumab is a monoclonal anti-CD3 antibody, and as such interferes with the activation of T cells involved in attacking beta-cells of the pancreas. This is a significant step towards meaningful strategies to prevent type 1 diabetes. Not only are we thrilled at this development, but we are also proud that one of the senior faculty in our Division, Dr. Eva Tsalikian, helped conduct the research and write the article. Other staff in Iowa involved with the study included division faculty Dr. Michael Tansey, and research coordinators Joanne Cabbage & Julie Coffey.
Metformin is a first-line medication used to treat type 2 diabetes, where its main action is to improve insulin sensitivity and ultimately to decrease complication rates. In persons with type 1 diabetes, metformin alone is not effective treatment, because it can not replace the profound lack of insulin that occurs in this disease. However, some patients with type 1 diabetes, especially those who are obese, develop insulin resistance. Dr. Tansey and Dr. Tsalikian helped direct a recent study which found that 3 months of metformin treatment (in addition to insulin treatment) in these patients led to improvements in insulin sensitivity. Differing from type 2 diabetes however, hepatic insulin sensitivity was not improved. The results from this study are now published in the prestigious Journal of Clinical Endocrinology and Metabolism.
Dr. Pesce has authored a powerful opinion piece entitled “Everything but Everydayness” about the joy of being a pediatric endocrinologist. In an almost poetic way, she describes the many scenarios in which a pediatric endocrinologist can make a significant difference in the health and well-being of a child. Find the piece here (link note this is not a permanent link) , on page 10 (12th page of PDF) of the Feb 2018 issue of Endocrine News .
We are pleased to announce that Dr. Beth Sandberg is starting as a new pediatric endocrinologist in our division. She received her MD from Northwestern University, completed a residency in pediatrics at Univ North Carolina, and then completed a fellowship in pediatric endocrinology there as well. She has published expertise in the areas of quality improvement for diabetes care and in the genetics of short stature. In clinic, her practice will include general pediatric endocrinology and diabetes, as well as gender-related endocrine care.
Dr. Curtis has authored an editorial weighing recent evidence suggesting that male puberty is occurring earlier than in the past. The editorial appears in JAMA Pediatrics, and has received national press. Many thanks to her for sharing her expertise.