Tag Archive for: Marks

girl monitoring blood sugar

Continuous glucose monitoring use patterns in young children after T1D diagnosis

girl monitoring blood sugar

Continuous glucose monitoring (CGM) is a blood glucose monitoring device worn on the body that is linked to positive glycemic outcomes in people with Type 1 diabetes

Continuous glucose monitoring (CGM) is a blood glucose monitoring device worn on the body that is linked to positive glycemic outcomes in people with Type 1 diabetes (T1D). However, very little research has examined CGM use and glycemic outcomes in young children, particularly those newly diagnosed with T1D.

A new Diabetes Technology and Therapeutics study led by Randi Streisand, Ph.D., C.D.C.E.S., Chief of Psychology and Behavioral Health at Children’s National Hospital, and others identified four meaningful trajectories of CGM use among young children across 18-months post-T1D diagnosis: those who “always” used CGM; those who got on CGM later but stayed on it (“late/stable”); those who used CGM inconsistently; and those who “never” used CGM. The investigators conducted a study of 157 parents of young children (1-6 years) newly diagnosed with T1D who enrolled in a behavioral intervention.

Importantly, the authors found that those with private insurance were more likely than those with only public insurance to be in the “always” and “late/stable” groups (as opposed to the “never” group). Those in the “always” and “late/stable” groups also had better glycemic outcomes than those in the “never group” at 18-months post-T1D diagnosis.

“This research highlights that insurance type can be a barrier to accessing CGM,” Dr. Streisand noted. “Further, this is one of the first studies, among newly diagnosed young children, to show that CGM initiation at diagnosis or near diagnosis followed by sustained use is associated with better glycemic outcomes compared to never initiating CGM, supporting findings from other studies conducted with older youth.”

The findings inform clinical care with patients as it suggests that, when clinically appropriate, CGM initiation near or at the time of diagnosis benefits glycemic outcomes in young children when followed by sustained use. This is the only study to examine patterns of CGM use among 1-6-year-old children newly diagnosed with T1D over the first 18-months post-diagnosis.

“It was exciting to find differences in glycemic outcomes based on CGM initiation and use in this unique population,” Dr. Streisand said. However, the authors concluded that, given the health benefits of CGM, further exploration of barriers to CGM access and use among some families is needed.

In addition to Dr. Streisand, other Children’s National co-authors include Carrie Tully, Ph.D.;  Maureen Monaghan, Ph.D., C.D.E., and Christine Wang, Ph.D.

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

Five Children’s National Hospital faculty named to Society for Pediatric Research

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital: Drs. Rana Hamdy, Panagiotis Kratimenos, Brynn Marks, Shayna Coburn and Katie Donnelly.

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital. Established in 1929, SPR’s mission is to create a multi-disciplinary network of diverse researchers to improve child health.

Membership in SPR is a recognized honor in academic pediatrics. It requires nomination by academic peers and leaders as well as recognition of one’s role as an independent, productive child health researcher.

“I am so proud of our faculty and all that they have accomplished. I am thrilled that they have been recognized for their achievements,” said Beth A. Tarini, M.D., M.S., SPR president and associate director for the Center for Translational Research at Children’s National Hospital.

SPR 2021 active new members from Children’s National are:

    • Katie Donnelly, M.D., M.P.H., attending physician in the Emergency Department at Children’s National Hospital. She is the medical director for Safe Kids DC, an organization dedicated to preventing accidental injuries in children in Washington DC. Her personal research interest is in preventing firearm injuries in children and she is a member of Safer through Advocacy, Firearm Education and Research (SAFER), a multidisciplinary team dedicated to firearm injury prevention at Children’s National. She is also the medical director of the newly founded hospital-based violence intervention program at Children’s National and an associate professor of pediatrics and emergency medicine at The George Washington University.“To be recognized by my peers as a researcher with a significant contribution to our field is very validating. It also opens a world of potential collaborations with excellent scientists, which is very exciting!” said Dr. Donnelly. “I am grateful for the immense support offered to me by the Division of Emergency Medicine to complete the research I am passionate about, especially my mentor Monika Goyal.”
    • Panagiotis Kratimenos, M.D., Ph.D., newborn intensivist and neuroscientist at Children’s National. He studies mechanisms of brain injury in the neonate, intending to prevent its sequelae later in life. Dr. Kratimenos’ interest lies in identifying therapies to prevent or improve neurodevelopmental disabilities of sick newborns caused by prematurity and perinatal insults.“Being a member of SPR is a deep honor for me. SPR has always been a ‘mentorship home’ for me since I was a trainee and a member of the SPR junior section,” said Dr. Kratimenos. “A membership in the SPR allows us to access a very diverse, outstanding team of pediatric academicians and researchers who support the development of physician-scientists, honors excellence through prestigious grants and awards, and advocates for children at any level either locally, nationally, or internationally.”
    • Rana Hamdy, M.D., M.P.H., M.S.C.E., pediatric infectious diseases physician at Children’s National and Director of the Antimicrobial Stewardship Program. She is an assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences. Her area of expertise focuses on the prevention and treatment of antimicrobial resistant infections and the promotion of good antimicrobial stewardship in inpatient and outpatient settings.“It’s an honor to be joining the Society for Pediatric Research and becoming part of this distinguished multidisciplinary network of pediatric researchers,” said Dr. Hamdy. “I look forward to the opportunity to meet and work with SPR members, make connections for future collaborations, as well as encourage trainees to pursue pediatric research through the opportunities that SPR offers.”
    • Shayna Coburn, Ph.D., director of Psychosocial Services in the Celiac Disease Program at Children’s National. She is a licensed psychologist specializing in coping and interpersonal relationships in chronic illness treatment, particularly for conditions involving specialized diets. She holds an appointment as assistant professor of psychiatry and behavioral sciences at The George Washington University School of Medicine and Health Sciences. Her work has focused on promoting effective doctor-patient communication, reducing healthcare disparities and supporting successful adherence across the developmental span of childhood and adolescence. She currently has a Career Development Award from National Institute of Diabetes and Digestive and Kidney Diseases to refine and test a group intervention designed to improve self-management and quality of life in teens with celiac disease.
      “I hope that my background as a psychologist researcher will help diversify SPR. As an SPR member, I hope to encourage more opportunities for training, awards, and other programs that would be inclusive of clinician researchers who may not hold a traditional medical degree,” said Dr. Coburn.
    • Brynn Marks, M.D., M.S.-H.P.Ed., endocrinologist at Children’s National. As a clinical and translational scientist her goal is to use unique personal experiences and training to optimize both patient and provider knowledge of and behaviors surrounding diabetes technologies thereby realizing the potential of diabetes technologies improve the lives and clinical outcomes of all people living with diabetes. Her experiences as a person living with Type 1 diabetes have undoubtedly shaped her clinical and research interests in diabetes management and medical education.
      “It is an honor to be accepted for membership in the Society for Pediatric Research,” said Dr. Marks.  “Being nominated and recognized by peers in this interprofessional pediatric research community will allow me networking and growth opportunities as I continue to advance my research career.”
insulin pump

Diabetes technology use in the cystic fibrosis community

insulin pump

Although diabetes technologies are associated with improvements in glycemic control and health-related quality of life among people with type 1 diabetes (T1D), the use and perceptions of continuous glucose monitors (CGM) and insulin pumps within the cystic fibrosis (CF) community have not been well documented.

In a recent study published in Diabetes Technology & Therapeutics, Brynn Marks, M.D., MS-HPEd, and co-authors, found that compared to T1D, rates of sustained diabetes technology use in the cystic fibrosis-related diabetes (CFRD) community are low, despite perceived benefits. The authors conclude that better insurance coverage to mitigate cost, better patient education and confirmation that these technologies improve health and patient-reported outcomes may increase uptake.

Read the full article in Diabetes Technology & Therapeutics.

doctor taking blood sample from child

Study shows increase in diabetes cases during COVID-19 pandemic

doctor taking blood sample from child

A retrospective study found pediatric Type 1 diabetes cases rose 15.2% and Type 2 diabetes cases increased by 182% during the first year of the COVID-19 pandemic compared to the prior two years— affecting non-Hispanic Black youth the most.

While the effects of COVID-19 on diabetes-related outcomes are extensively studied in adults, data about the incidence and severity of presentation of pediatric new-onset Type 1 diabetes (T1D) and Type 2 diabetes (T2D) is limited. A new retrospective study of 737 youth diagnosed with diabetes at Children’s National Hospital between March 11, 2018 and March 10, 2021 found pediatric T1D cases rose 15.2% and T2D cases increased by 182% during the first year of the COVID-19 pandemic compared to the prior two years — affecting non-Hispanic Black youth the most.

The study, published in Hormone Research in Paediatrics, compared T1D and T2D cases during the first 12 months of the pandemic, between March 11, 2020 and March 10, 2021, to the same time in the previous two years. This increase in cases was accompanied by a nearly six-fold rise in diabetic ketoacidosis (DKA) and a 9.2% incidence of hyperosmolar DKA during the pandemic as compared to no cases in the two years prior.

“A better understanding of the impact of the COVID-19 pandemic is crucial for raising public awareness, shaping policy and guiding appropriate health screenings,” said Brynn Marks, M.D., M.S.H.P.Ed., endocrinologist at Children’s National and lead author of the study.

Children’s National provides clinical care to approximately 1,800 youth with T1D and 600 youth with T2D annually. In the two years before the pandemic, cases of T2D accounted for 25.1% of all newly diagnosed diabetes at Children’s National compared to 43.7% during the pandemic. Before the pandemic, females accounted for 59.6% of youth with new-onset T2D but 58.9% of new-onset T2D cases were among males during the pandemic.

The researchers noted that the rise in cases of T2D and severity of presentation of both T1D and T2D during the pandemic disproportionately impacted non-Hispanic Black youth (NHB). NHB youth accounted for 58% of cases of T2D pre-pandemic, which further increased to 77% during the pandemic. The findings also showed that cases of DKA among NHB youth newly diagnosed with T1D increased during the pandemic compared to the two years before (62.7% vs. 45.8%, p=0.02).  Before the pandemic, there was no significant difference in A1c at T1D diagnosis between racial and ethnic groups. However, during the pandemic, hemoglobin A1c levels were higher among NHB youth.

“Future studies are needed to understand the root cause of the disproportionate impact of the COVID-19 pandemic on non-Hispanic Black youth with newly diagnosed diabetes,” said Dr. Marks. “These outcomes during the pandemic will likely worsen pre-existing health care disparities among youth with diabetes.  In understanding the indirect effects of our response to the pandemic, we can better inform future emergency responses and develop strategies to improve outcomes for all youth living with diabetes.”

blood glucose monitoring system

Patterns of continuous glucose monitoring use in young children after T1D diagnosis

blood glucose monitoring system

The findings suggest that, when clinically appropriate, continuous glucose monitoring initiation near or at the time of diagnosis benefits glycemic outcomes in young children when followed by sustained use.

Continuous glucose monitoring (CGM) is a blood glucose monitoring device worn on the body that is linked to positive glycemic outcomes in people with Type 1 diabetes (T1D). However, very little research has examined CGM use and glycemic outcomes in young children, particularly those newly diagnosed with T1D.

A new Diabetes Technology and Therapeutics study led by Randi Streisand, Ph.D., C.D.C.E.S., Chief of Psychology and Behavioral Health at Children’s National Hospital, and others identified four meaningful trajectories of CGM use among young children across 18-months post-T1D diagnosis: those who “always” used CGM; those who got on CGM later but stayed on it (“late/stable”); those who used CGM inconsistently; and those who “never” used CGM. The investigators conducted a study of 157 parents of young children (1-6 years) newly diagnosed with T1D who enrolled in a behavioral intervention.

Importantly, the authors found that those with private insurance were more likely than those with only public insurance to be in the “always” and “late/stable” groups (as opposed to the “never” group). Those in the “always” and “late/stable” groups also had better glycemic outcomes than those in the “never group” at 18-months post-T1D diagnosis.

“This research highlights that insurance type can be a barrier to accessing CGM,” Dr. Streisand noted. “Further, this is one of the first studies, among newly diagnosed young children, to show that CGM initiation at diagnosis or near diagnosis followed by sustained use is associated with better glycemic outcomes compared to never initiating CGM, supporting findings from other studies conducted with older youth.”

The findings inform clinical care with patients as it suggests that, when clinically appropriate, CGM initiation near or at the time of diagnosis benefits glycemic outcomes in young children when followed by sustained use. This is the only study to examine patterns of CGM use among 1-6-year-old children newly diagnosed with T1D over the first 18-months post-diagnosis.

“It was exciting to find differences in glycemic outcomes based on CGM initiation and use in this unique population,” Dr. Streisand said. However, the authors concluded that, given the health benefits of CGM, further exploration of barriers to CGM access and use among some families is needed.

In addition to Dr. Streisand, other Children’s National co-authors include Brynn Marks, M.D., M.S. HPEd.; Carrie Tully, Ph.D.;  Maureen Monaghan, Ph.D., C.D.E. , and Christine Wang, Ph.D.

vials and needles

Study examines severity of COVID-19 on kids with Type 1 diabetes

vials and needles

A new study published in the Journal of Diabetes, found that although nearly 80% of youth with Type 1 diabetes and COVID-19 infection are managed at home, youth from racial and ethnic minority groups – those with higher hemoglobin A1c values – and those with public insurance are at increased risk for hospitalization.

In a new study published in the Journal of Diabetes, researchers found that although nearly 80% of youth with Type 1 diabetes (T1D) and COVID-19 infection are managed at home, youth from racial and ethnic minority groups – those with higher hemoglobin A1c values – and those with public insurance are at increased risk for hospitalization. Most hospitalizations among these youth were related to diabetic ketoacidosis (DKA) (72%) and 86% of youth hospitalized had an A1c value over 9%. The increased risk for DKA among racial and ethnic minority groups and publicly insured youth in this study is indicative of disparities in T1D outcomes and aligns with other research findings both before and during the pandemic.

Adults with certain underlying medical conditions, like diabetes, are at an increased risk for severe illness from COVID-19. Though there are limited data on youth with T1D who have been infected with COVID-19, viral infections can make it harder to control blood glucose levels. If not properly managed, infections may lead to DKA, a serious life-threatening condition where the body converts fat instead of sugar into energy, causing ketones to build up in the blood and acid levels to rise.

“There is still more to learn about COVID-19 and how it affects children with diabetes and other underlying medical conditions,” said Brynn Marks, M.D., MS-HPEd, pediatric endocrinologist at Children’s National Hospital and one of the study’s co-authors. “We are hopeful that this latest data will emphasize the importance of optimizing glycemic control and give physicians and families more information about the virus and T1D so that severe illness and hospitalizations can possibly be prevented.”

In April 2020, the T1D Exchange Quality Improvement Collaborative, along with endocrinology clinics across the U.S., formed a COVID-19 clinical registry to better understand symptoms and outcomes of patients with T1D who also tested positive for SARS-CoV-2 infection. More than 46 centers nationwide, including Children’s National Hospital, submitted data to this novel registry of 266 youth under the age of 19 with previously established T1D and laboratory confirmed COVID-19.

The study found that nearly 80% of youth with T1D and known COVID-19 infection were cared for at home without any adverse outcomes. It is also important to note that COVID-19 was incidentally discovered in 16% of hospitalized youth admitted for reasons unrelated to COVID-19 or T1D (e.g. urological procedures, psychiatric admissions). However, the data revealed a disproportionate rate of hospitalizations and DKA among racial and ethnic minority groups, children who were publicly insured and those with higher A1c. Out of the 266 patients, 72% of the 61 patients were hospitalized due to DKA. An overwhelming majority (82%) of hospitalized patients had an A1c value greater than 9%. More than 40% of non-Hispanic Black youth in the study were hospitalized as compared to 14% of non-Hispanic white youth. Researchers also noted that those patients with public insurance were less likely to use insulin pumps and continuous glucose monitors, emphasizing the continued need to improve more access to diabetes technologies.

“Diabetes technology has advanced rapidly in the last decade and access to insulin pumps and continuous glucose monitors is improving, however these technological advances are perpetuating pre-existing disparities in T1D care and outcomes,” Dr. Marks said. “The data is clear and there is a pressing need to act to promote optimal care for all people with T1D.”

Recently, Dr. Marks and the Children’s National Diabetes team became official members of the Type 1 Diabetes Exchange Collaborative. The team looks forward to using the opportunity to improve diabetes care both here at Children’s National and across the country.

 

boy checking his blood glucose

There’s still more to learn about COVID-19 and diabetes

boy checking his blood glucose

Researchers have learned a lot about COVID-19 over the past year and are continuing to learn and study more about this infection caused by the SARS-CoV-2 virus. There have been many questions about whether COVID-19 affects people with diabetes differently than those without and why this might occur.

Diabetes experts, like Brynn Marks, M.D., M.S.H.P.Ed., endocrinologist at Children’s National Hospital, have been studying the relationship between COVID-19 and diabetes, especially in the pediatric population. Dr. Marks tells us more about what we know so far and further research that needs to be done when it comes to COVID-19 and diabetes.

1.      What do we know about COVID-19 and its effect on people with known diabetes?

The Centers for Disease Control and Prevention (CDC) currently lists type 2 diabetes (T2D) as a high risk condition for severe illness related to COVID-19 infection, while stating that adults with type 1 diabetes (T1D) might be at increased risk. A recent study from Vanderbilt University found that people with T1D and T2D were at approximately equal risk for complications of COVID-19 infection. As compared to adults without diabetes, adults with T1D and T2D were 3-4 times more likely to be hospitalized and to have greater illness severity. Given these comparable risks, both the American Diabetes Association and the Juvenile Diabetes Research Foundation are lobbying for adults with T1D to be given the same level or priority for COVID-19 vaccines as adults with T2D.

However, as pediatricians, we all know to be wary of extrapolating adult data to pediatrics. Children are less likely to be infected with COVID-19 and if they are, the clinical course is typically mild. To date, there have not been any studies of the impact of COVID-19 on youth with known T2D. Our clinical experience at Children’s National Hospital and reports from international multicenter studies indicate that youth with T1D are not at increased risk for hospitalization from COVID-19 infection. However, paralleling ongoing disparities in T1D care, African Americans with known T1D and COVID-19 infection were more likely to be develop diabetic ketoacidosis (DKA) than their White counterparts.

With the increased use of diabetes technologies, including continuous glucose monitors, insulin pumps and automated insulin delivery systems, diabetes care lends itself well to telemedicine. Studies from Italy during the period of lockdown showed better glycemic control among youth with T1D. Further studies are needed to better understand the implications of telehealth on diabetes care, particularly among those in rural areas with limited access to care.

Brynn Marks

Diabetes experts, like Brynn Marks, M.D., M.S.H.P.Ed., endocrinologist at Children’s National Hospital, have been studying the relationship between COVID-19 and diabetes, especially in the pediatric population.

2.      What do we know about the impact of the COVID-19 pandemic on children with newly diagnosed diabetes?

Nationwide studies from Italy and Germany over the first few months of the pandemic found no increase in the incidence of pediatric T1D during the COVID-19 pandemic as compared to the year before; in fact, the Italian study found that fewer children were diagnosed with T1D during the pandemic. However, many centers are seeing higher rates of DKA and more severe DKA at diagnosis during the pandemic, possibly due to decreased primary care visits and/or fears of contracting COVID-19 while seeking care.

To date, no studies have been published exploring the incidence of T2D in youth. A group from Children’s National, including myself, Myrto Flokas, M.D., Abby Meyers, M.D., and Elizabeth Estrada, M.D., from the Division of Endocrinology and Randi Streisand, Ph.D., C.D.C.E.S. and Maureen Monaghan, Ph.D., C.D.C.E.S., from the Department of Psychology and Behavioral Health, are gathering data to compare the incidence of T1D and T2D during the pandemic as compared to the year before.

3.      Can COVID-19 cause diabetes to develop?

This has been area of great interest, but the jury is still out. The SARS-CoV-2 virus, which causes COVID-19 infection, binds the angiotensin-converting enzyme 2 (ACE2) receptor which is located in many tissues throughout the body, including the pancreas. SARS-CoV-2 has been shown to infect pancreatic tissue leading to impaired glucose stimulated insulin secretion. Although the SARS-CoV-2 virus could plausibly cause diabetes, assessment has been complicated by many confounders that could be contributing to hyperglycemia in addition to or rather than the virus itself. Stress-induced hyperglycemia from acute illness, the use of high dose steroids to treat COVID-19 infection, and the disproportionate rates of infection among those already at high risk for T2D, as well as weight gain due to changes in day-to-day life as a result of social distancing precautions are all likely contributing factors.

woman writing data to medical form and glucometer for checking sugar level

New grant to assess screening tools for cystic fibrosis-related diabetes

woman writing data to medical form and glucometer for checking sugar level

A grant from the Cystic Fibrosis Foundation will help Children’s National researchers assess the feasibility and accuracy of two new cystic fibrosis-related diabetes screening tools.

Cystic fibrosis-related diabetes (CFRD) is the most common non-pulmonary manifestation of cystic fibrosis (CF), affecting up to 30% of adolescents and 50% of adults living with CF, according to the Cystic Fibrosis Foundation (CFF). CFRD is often asymptomatic and so the CFF recommends that people living with CF be screened for CFRD annually starting at 10 years of age using an oral glucose tolerance test.

Although early detection and treatment of CFRD can lead to significant clinical improvements and prolong life, rates of screening are poor, likely due to the burdensome nature of oral glucose tolerance testing (OGTT). Rates of OGTT screening in patients 10-17 years of age vary widely among CF care centers, ranging 5.9% to 100% with a median of 61.3% of patients at a given center completing screening. At Children’s National, only 46.4% of pediatric CF patients without CFRD completed the OGTT in 2019.  The most commonly cited reason for failure to complete recommended OGTT screening is the additional burden that this time-consuming fasting test, requiring three blood draws, places upon patients who already contend with multiple medical interventions.

“People living with CF face tremendous medical burdens.,” says Brynn Marks, M.D., MSHPEd, pediatric endocrinologist at Children’s National Hospital. “Novel, more convenient approaches to CFRD screening that can provide both diagnostic and therapeutic information are urgently needed.”

Dr. Marks and Carol Chace, MSW, a social worker at Children’s National, have collaborated to receive a $160,000 Pilot and Feasibility Award from the CFF that will allow researchers to assess the feasibility and accuracy of two new CFRD screening tools, the Dexcom G6 Pro, a continuous glucose monitoring (CGM), and the Digostics GTT@home, a home-based OGTT kit. The Dexcom G6 Pro is the first unblinded professional CGM that enables patients to see their glucose values and trends in real-time. The GTT@home uses a built-in timer and audio-visual cues to guide users to collect capillary blood samples through finger sticks.

“While the idea of home-based testing is exciting in general, it is particularly important in the midst of the COVID-19 pandemic, as many are limiting preventative health care visits,” says Dr. Marks. “This research will hopefully inform future larger studies that could one day allow for this screening to be done at home.”

Brynn Marks

Bringing diabetes technology to patients and providers

Brynn Marks

Brynn Marks, M.D., endocrinologist at Children’s National Hospital, was diagnosed with Type 1 diabetes at the age of five years old and knows too well the struggles that may come with managing this chronic condition. After finding the right, knowledgeable provider as a teen, Dr. Marks realized that she wanted to become an endocrinologist and be that resource and support for others with Type 1.

Developments in diabetes technologies, including continuous glucose monitors (CGM) and insulin pumps, hold great promise for improving diabetes control while also improving quality of life for those living with Type 1. However, the pace of development also presents challenges for busy clinicians who must keep up with rapid developments in the field. Dr. Marks is focused on making sure patients and providers have the latest information and training on diabetes technologies with the goal that they can be more effectively used by more people in the real world.

“These diabetes technologies are very important for kids and teens with diabetes because they can help them to live life as normally as possible while affording the freedom they need to just be kids,” says Dr. Marks.

Dr. Marks’ recent research includes a study where she used an app to deliver medical education about diabetes technology. Participants received authentic, case-based scenarios focused on the technologies to help them apply knowledge of these technologies to real-world clinical scenarios involving insulin pumps and CGMs. All of the education was delivered through questions and explanations in an effort to keep the learners engaged with the curriculum. The questions were repeated over 3-4 months to improve learning and long-term knowledge retention. The study showed that knowledge and confidence about these technologies improved and ultimately led to better patient care.

Dr. Marks presented two posters at a recent International Society for Pediatric and Adolescent Diabetes (ISPAD) meeting related to her efforts to make these technologies more accessible:

Experiential Learning in T1D Technology Education: Knowledge of Parents and Clinicians: Dr. Marks enrolled different groups of learners in the diabetes technology curriculum mentioned above, including parents of children with Type 1 diabetes, attending physicians, pediatric endocrine fellows and certified diabetes educators. Results showed minimal difference among those groups in terms of knowledge about the pumps and CGMs. Interestingly, clinicians who had the opportunity to wear the technologies for educational purposes had greater knowledge than clinicians who did not have the same opportunity. Based on these results, Dr. Marks advocated that opportunities to wear pumps and CGMs should be a routine part of education for clinicians working with these technologies.

A Qualitative Analysis of Clinicians’ Experiences Wearing CGM: Dr. Marks explored the reactions of clinicians without diabetes who were given the opportunity to wear continuous glucose monitors for 1 week. Participants reported that the opportunity to wear these technologies improved their knowledge and gave them greater empathy for patients using CGM.

Dr. Marks’ work to date has identified strategies to improve knowledge about insulin pumps and CGM. Moving forward, she will continue to study the best ways to educate parents and clinicians about these diabetes technologies in hopes of improving the day to day lives of the children they care for.

regional pediatric endocrinology meeting

Regional pediatric endocrinologists gather at Children’s National

regional pediatric endocrinology meeting

On Nov. 10, 2019, more than 30 pediatric endocrine physicians and nurse practitioners from Washington, D.C., Maryland and Northern Virginia gathered at Children’s National Hospital to discuss the latest in pediatric endocrinology research.

Organized by Paul Kaplowitz, M.D., Professor Emeritus of Pediatrics, this was the third regional pediatric endocrinology meeting since 2012 and the second held at the hospital. “The meetings are a great opportunity for providers to meet regional colleagues who they may communicate with about patients but rarely see face to face,” explains Dr. Kaplowitz.

The providers spent half a day at Children’s National viewing presentations and connecting with their colleagues. Among the presentations was a talk by new Children’s National faculty member Brynn Marks, M.D., MSHPEd, titled, “Medical Education in Diabetes Technologies.”

The presentation highlighted Dr. Marks’ research on how to best teach providers to make optimal use of the information provided by continuous blood glucose monitoring, as well as how to adjust insulin pump settings based on frequent blood glucose testing.

Another notable presentation was by Richard Kahn, Ph.D., recently retired former chief scientific and medical officer at the American Diabetes Association. Dr. Kahn’s talk was titled “Prediabetes: Is it a meaningful diagnosis?”

“This was an excellent talk whose message was that making a diagnosis of ‘prediabetes’ may not be nearly as helpful as we thought, since most patients tests either revert to normal or remain borderline, and there is no treatment or lifestyle change which greatly reduces progression to type 2 diabetes,” says Dr. Kaplowitz.

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Children’s National regional pediatric endocrinology meeting presentations

Welcome from Paul Kaplowitz, M.D., and Children’s National Endocrinology Division Chief Andrew Dauber, M.D.

“Prediabetes: Is it a meaningful diagnosis?”
Richard Kahn, Ph.D., University of North Carolina at Chapel Hill

“Overlapping genetic architecture of Type 2 diabetes and Cystic fibrosis-related diabetes”
Scott Blackman, M.D., Ph.D., Johns Hopkins Medicine

“Pediatric Pituitary Tumors: What we have learned from the NIH cohort”
Christina Tatsi, M.D., Ph.D., National Institutes of Health

“Medical Education in Diabetes Technologies”
Brynn Marks, M.D., MSHPEd, Children’s National Hospital

“A phenotypic female infant with bilateral palpable gonads”
Cortney Bleach, M.D., Walter Reed National Military Medical Center

“Estimating plasma glucose with the FreeStyle Libre Pro CGM in youth: An accuracy analysis”
Miranda Broadney, M.D., MPH, University of Maryland School of Medicine

“Recruiting for research project on “Arginine-Stimulated Copeptin in the diagnosis of central diabetes insipidus”
Chelsi Flippo, M.D., Fellow, National Institutes of Health