Posted on

Screening for Diabetes in Persons with Cystic Fibrosis: Current Situation on the Ground

Dr. Larson Ode

Many persons who have cystic fibrosis develop diabetes at some point. In its early mild stages, diabetes can have few symptoms. Despite the lack of symptoms, mild diabetes still can damage the eyes, kidneys, and nerves. Furthermore, in those with cystic fibrosis, diabetes can worsen lung disease and increase the risk of mortality. For these reasons, it is important to screen for diabetes in persons who have cystic fibrosis. To accomplish this, the recommendations are to perform an oral glucose tolerance test yearly in those over age 10 with cystic fibrosis. To assess how well this recommendation Is being carried out, a group of physicians, including Dr. Larson Ode from our division, surveyed medical centers. Unfortunately, less than half of centers were screening at least half of persons with cystic fibrosis. These results indicate that further progress is needed in screening persons with cystic fibrosis for diabetes. These results are published in the journal Frontiers in Endocrinology and can be found at the following links (pubmed & doi).

Posted on

Using a Scribe to Improve Outpatient Physician Care.

  • Dr. Kanner
  • Dr. Pesce

Endocrine conditions are generally treated at home. Treatment can be complicated. A major purpose of appointments with the endocrinologist is to learn more about treatment. Often, a personalized plan is needed, depending on one’s daily schedules and activities. As a result, visits to the endocrinologist often involve numerous suggestions and details. Recording all of these details into the medical record can be difficult and time consuming. Two physicians in our Division participated in a pilot project whereby a scribe accompanied the physician during outpatient visits with the purpose of documenting the discussions and details. The results from this pilot project have now been published. The findings indicate that scribes have variable impact on visit times and physician charting burden, with improvements seen in one sub-specialty (developmental-behavioral pediatrics) but not another (pediatric endocrinology) . Patient satisfaction was equally high (>95%) with or without scribes. Two physicians from our Division, Dr. Kanner and Dr. Pesce contributed to the project and published manuscript. The paper is entitled “The Value of Adding Scribe Services to Two Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record” and is being published in the journal Clinical Pediatrics. The manuscript’s abstract can be found at Pubmed (link).

Posted on

Iowa Well Represented at National Pediatric Endocrine Society Meeting

The Pediatric Endocrine Society (PES) is a professional organization of over 1,600 endocrinologists with the purpose of advancing treatment of youth with endocrine disorders. The PES held its annual meeting May 5-8 in San Diego. Several of our division faculty attended the meeting. Dr. Pesce presented at one of the symposium session on Endocrinology in the Neonatal Intensive Care Unit. Dr. Parra Villasmil presenter her research, conducted under the mentorship of Dr. Pinnaro, on Screening for Turner Syndrome-associated Hyperglycemia. Dr. Parra Villasmil’s work was selected as one of the top-ranking abstracts, receiving a PES Presidential Poster award. In addition, our future fellow, Dr. Kyle Baum, currently a pediatric resident at Sanford School of Medicine, also had an abstract selected for a PES Presidential Poster award.

Dr. Pesce presenting at PES 2023
Dr. Parra Villasmil at PES 2023

Posted on

Off To College Class to be Held July 24, 2023, 5-6 pm

Dr. Kanner

Save The Date! Dr. Kanner has announced that she will host our annual Off To College Class on July 24, 2021 at 5-7 pm, via Zoom. Students, parents, future roommates, and any others interested are welcomed to attend. If you are interested, contact us, either through the email link at Dr. Kanner’s webpage (link) or by contacting our diabetes nursing team. The event’s flyer is immediately below.

Posted on

Setting Research Priorities to Better Understand, Treat, and Prevent Cystic Fibrosis Related Diabetes

  • Dr. Norris
  • Dr. Larson Ode

Potent medications have recently been developed to treat cystic fibrosis. These new therapies dramatically improve lung disease for those with cystic fibrosis. Persons with cystic fibrosis often develop a unique form of diabetes termed cystic fibrosis related diabetes (CFRD). It is not yet clear how the new therapies will impact the propensity of persons with cystic fibrosis to develop CFRD. A group of researchers, clinical experts, and patients/families were assembled by the NIH and the Cystic Fibrosis Foundation to discuss research priorities to better understand treat and prevent CFRD. This group convened in June of 2021 at a workshop open to the public. This group has now written and published a summary describing their collective thoughts on research priorities priorities CFRD, Their writings appear this month in the two journals Diabetes and Diabetes Care. Contributing to the article were two physicians from our division: Dr. Norris and Dr. Larson Ode, with Dr. Norris serving as one of the lead authors of the work. The publication can be found at the following Pubmed link.

Posted on

Dr. Pesce Recognized for her Outstanding Clinical Teaching

Dr. Pesce

Dr. Liuska Pesce is being recognized by the Carver College of Medicine for outstanding teaching. Today she is receiving the Collegiate Teaching Award. This award is given to recognize teaching that demonstrates unusually significant and meritorious achievement. The Award includes a plaque and monetary bonus. Those who have trained under her have many laudatory statements, including the following anonymous comment: “Dr. Pesce is the Mary-Poppins of physicians, ‘practically perfect in every way.’ She is an excellent teacher with clear explanations behind her thought processes which are always guided by best practices. She is very professional and thorough in all of her patient interactions and examinations. She provides excellent and timely feedback on presentations, physical exam findings, and clinical notes. She goes out of her way to ensure learners get the feedback they need.” Dr. Pesce is also involved in educational efforts at the national level, for example having just contributed as an author to this educational material “Pediatric ESAP 2023-2024: Pediatric Endocrine Self-Assessment Program. Washington, DC: Endocrine Society; 2023.”

Posted on

Pediatric Research Day

Pediatric Research Day 2023 at the University of Iowa was held on the afternoon of April 7th, highlighting six speakers and multiple posters. The Division of Endocrinology and Diabetes was well represented. Faculty Dr. Cat Pinnaro gave a research talk entitled “Explaining phenotypic variability in Turner syndrome: Does X Mark the Spot”. Third year endocrinology fellow Dr. Alexander Tuttle gave an award-winning talk entitled “An Interactive E-Book Resource About Inpatient Pediatrics Diabetes Management for Medical Learners: Preliminary Results of a Pilot Study”. Dr. Graciela Parra Villasmil presented a research “data blitz” and poster entitled “Variability in glycemia measured by CGM in children and young adults with acute recurrent or chronic pancreatitis”. Importantly, these highlight our division’s ongoing efforts to improve the care of children with endocrine conditions.

Dr. Pinnaro presenting her research, April 2023.
Dr. Tuttle presenting his research, April 2023.
Dr. Parra Villasmil presenting her research talk, April 2023.
Dr. Parra Villasmil (middle) at her poster with Dr. Larson Ode (R) and Dr. Tansey (L), April 2023.
Posted on

Expert Advice on Providing Estrogen Replacement Therapy for those with Turner Syndrome

Dr. Eirene Alexandrou

The majority of women with Turner syndrome experience primary ovarian failure, meaning that their ovaries never produce estrogen in normal quantities. For this reason, normal puberty does not occur. Estrogen production is not only important for a feminizing puberty to occur but also is important for overall health and wellness. Dr. Eirene Alexandrou heads the Turner syndrome clinic (clinic homepage link) at the University of Iowa Stead Family Children’s Hospital. She is a published expert in Turner syndrome care. Recently, on April 4, Dr. Alexandrou gave an invited webinar entitled “Estrogen Replacement Therapy in Turner Syndrome” (announcement link) for the Turner Syndrome Foundation. She reviewed the prevalence of primary ovarian failure in Turner syndrome, the benefits of estrogen replacement therapy, and the timing of such replacement including initiation.

Posted on

Advancing Reproductive Health of Youth

The North American Society for Pediatric and Adolescent Gynecology (NASPAG) is a non-profit association dedicated to advancing gynecologic care for youth. NASPAG held its 37th annual clinical & research meeting March 24-26 this year in Nashville. Dr. Kanner from our division was one of the Planning Committee members directing the meeting. Fellow Dr. Parra Villasmil from our division also attending the meeting and presented a Roundtable lecture. We thank them for their efforts to improve health.

Dr. Parra Villasmil leading a Roundtable at NASPAG 2023.
Dr. Kanner speaking at NASPAG 2023.
Posted on

Impact of Highly Effective Modulator Therapy for Cystic Fibrosis on Body Composition

Dr. Larson Ode

The triple combination therapy consisting of elexacaftor/tezacaftor/ivacaftor (ETI) has made a tremendous impact for the health of persons with one of the most serious and most common genetic forms of cystic fibrosis. This medication dramatically improves lung health and helps persons with CF live a longer and healthier life. These medications also help persons with CF regain weight, which is important for health because being underweight in those with CF is associated with a higher risk of worsening lung disease and mortality. However, what is not yet known is whether the weight gain with ETI therapy is healthy weight gain such as muscle mass or less health gain such as excess adipose tissue. To address this knowledge gap, Dr. Katie Larson Ode from our division teamed with a group of investigators at several other hospitals across the country to study this in persons on ETI therapy. They found, perhaps concerningly, that the weight gain occurred mainly as increased fat mass and that the changes were associated with reduced insulin sensitivity. These results indicate a need to closely monitor and further study the metabolic impact of ETI therapy. Their study has been published in the journal Pediatric Pulmonology and is titled “The Impact of elexacaftor/tezacaftor/ivacaftor on Body Composition in a Small Cohort of Youth with Cystic Fibrosis”. It can be found at this pubmed link.