The second and third years of our fellowship program are devoted to research with one of the faculty in Pediatric Endocrinology or with one of the faculty in other departments who are affiliated with the NIH-supported training program shared with the Adult Endocrinology division. Fellows participate in the research meetings, journal clubs and other activities of the preceptor's laboratory, where they may work with pre- and postdoctoral Ph.D. students, as well as physicians.

Third Year Fellows

Soumya Adhikari, M.D.

Y. Annie Wang, M.D.

Second Year Fellows

Jill Ann Goldfarb, M.D.

Shuchi Shah, M.D.

Soumya Adhikari, M.D.
Research Type:  Clinical
Mentor:  Perrin C. White, M.D.

Preservation of Beta Cell Function in Type 1 Diabetes

Type 1 Diabetes is caused by the gradual immune-mediated destruction of the beta cells of the pancreas. Diabetes management has long focused on optimizing metabolic control with little attention to the underlying immune processes. Recent studies have suggested a role for immunomodulatory therapies in the maintenance of beta cell function and possibly in the prevention of diabetes altogether. Dr Adhikari, through his involvement in TrialNet and independent studies is studying the various factors which contribute to the preservation of beta cell function in children with newly diagnosed diabetes.

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Y. Annie Wang, M.D.
Research Type:  Clinical
Mentor:  Sunita Stewart, Ph.D.

The Use of Motivational Interviewing in Adolescents with Type 1 Diabetes

Motivational interviewing (MI) is a brief intervention that has become popular in many aspects of clinical care.  The effectiveness of MI has not been established in adolescents with diabetes.  Currently, the most common use of MI has been in the addiction field.  In that setting, MI sessions typically last 30 minutes with a low frequency of visits.  We have found from previous studies that it is extremely difficult to engage the groups of patients who need the most help with their diabetes care.  The advantage of MI is to provide an intervention that is realistic for the patient with respect to the frequency and duration of the intervention.

We currently have a randomized controlled trial using MI in adolescents with type 1 diabetes in poor metabolic control.  We aim to enroll 60 patients.  Half will be randomly assigned to the MI intervention, the other half to traditional diabetes education (DE).  Our hypothesis is that motivational interviewing will be more effective at improving glycemic control compared to traditional diabetes education.  Our primary objective to find an improvement in HgbA1C in the MI group compared to control.  Our secondary objectives are to see improvements in psychological measures.  By following HgbA1C and psychosocial measures for 12 months, we will also be able to determine how long the effects of this relatively short intervention will last.

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Jill Ann Goldfarb, M.D.
Research Type:  Clinical
Mentor:  Jon D. Oden, M.D.

Role of Growth Hormone in the Development of Abnormal Glucose Tolerance in Obese Youth

Recently, we have witnessed a dramatic increase in prevalence of type 2 diabetes (T2DM) in youth which has paralleled the current childhood obesity trend.  Currently, >15% of U.S. children are overweight and ~45% of newly diagnosed diabetics have T2DM.   Obese children are not only at risk for developing T2DM, but they are also at higher risk for early onset cardiovascular disease, dyslipidemia, steatohepatitis, and psychosocial problems.   Insulin resistance (IR) is commonly associated with obesity and may lead to hyperglycemia and eventually T2DM. Although obesity is the most important risk factor for T2DM and is associated with IR, not all obese IR children develop T2DM.   As the peak incidence of diabetes occurs during puberty when endogenous growth hormone levels are highest, much research has involved the GH axis and its effect on insulin sensitivity.   In fact, studies in patients with acromegaly have concluded that prolonged exposure to elevated serum GH concentrations does lead to IR.  A number of studies have also explored the relationship between GH levels and obesity.  Interestingly, these studies show that obese patients have reduced serum GH.  However, these studies did not distinguish which patients had insulin resistance, and to what degree.  Therefore, we propose a study which compares stimulated growth hormone values in children who are obese and mildly IR to those who are obese and severely IR.   We expect that severely IR children will have significantly higher GH values.  If successful, our future investigation would be to follow our patient population to determine if these children will go on to develop T2DM.  T2DM is a complex and potentially debilitating disease with multiple known and well studied risk factors and several which have yet to be identified.   Excess endogenous GH could be one of those risk factors thus; a better understanding of the GH axis could ultimately lead to the prevention of T2DM.

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Shuchi Shah, M.D.
Research Type:  Clinical
Mentor:  Bassil M. Kublaoui, M.D., Ph.D.

Glycomark as a Screening Tool for Impaired Glucose Tolerance in Pediatric Obese Patients

Glycomark is a colorimetric assay of 1,5-anhydroglucitol, which declines as serum glucose rises above the renal glucose threshold. Recent studies have shown Glycomark to correlate better with postprandial blood sugar values than hemoglobin A1c (HbA1c). Because patients with impending pancreatic beta cell failure tend to lose their ability to respond to the rapid influx of glucose directly after a meal, hyperglycemia typically follows a glucose challenge. Such impaired glucose tolerance signifies a much higher risk of progressing to type 2 diabetes. Currently, the oral glucose tolerance test is the gold standard for identifying patients with impaired glucose tolerance. However, this test has practical limitations including inconvenience and lack of reproducibility. Due to its mechanism and its correlation with postprandial glycemic excursions, Glycomark may be an ideal test in identifying children with glucose intolerance. Our study will enroll patients seen at their initial visit in the pediatric endocrinology Insulin Resistance Clinic. In addition to the standard new patient evaluation including a formal oral glucose tolerance test, we will obtain a fasting Glycomark level. Glycomark values will be compared with oral glucose tolerance test results to determine if Glycomark is able to discriminate between those who are insulin resistant and those who have impaired glucose tolerance. The Glycomark assay will also be correlated with current monitoring tools for type 2 diabetes, including HbA1c and a measure of insulin resistance.

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