 Hypoglycemia in children with type 1 diabetes is the focus of a myriad of studies under way through the Diabetes Research in Children Network (DirecNet), a coalition of leading pediatric diabetes centers with active clinical and research programs. Under the direction of Washington University physician Neil White, MD, CDE, recognized for his long-standing contributions to the science of pediatric endocrinology and diabetes at St. Louis Children’s Hospital, this collaboration will examine the risks associated with hypoglycemia and seek to improve glucose control in children and young adults with type 1 diabetes.
By understanding how a child’s body compensates for hypoglycemia, DirecNet physician scientists from across the country have come together in hopes of improving the management of diabetes, the second most common chronic childhood disease. The first of numerous studies currently underway are exploring the potential use of glucose monitoring technology and its impact on the management of type 1 diabetes in children, as well as a study of glucagon, the hormone that raises sugar in children with diabetes.
“Over a span of five years, DirecNet research teams will focus on glucose monitoring technology, hypoglycemia physiology, the relationship of exercise and hormones on hypoglycemia and the long-term effects of hypoglycemia on children,” says Neil White, MD, CDE, a pediatric endocrinologist at St. Louis
Children’s Hospital and professor of pediatrics in the Division of Endocrinology and Diabetes at Washington University School of Medicine (WUSM). Other School of Medicine investigators participating in these projects include Philip Cryer, MD, Department of Internal Medicine, Tamara Hershey, PhD, Department of Psychiatry, and Ana Maria Arbeláez, MD. “Hypoglycemia is the limiting factor to achieving good control in patients with type 1 diabetes,” says Dr. Arbeláez, pediatric endocrinologist at St. Louis Children’s Hospital and WUSM assistant professor of pediatrics in the Division of Endocrinology and Diabetes. “In an effort to decrease the rates of hypoglycemia and improve diabetes control, we will study different outcome measures and examine the most reliable continuous glucose monitoring technology. This work also will include assessment of this technology in very young children.”
Sponsored by the National Institute of Child Health and Human Development, participating centers include Washington University School of Medicine, Stanford University, Yale University School of Medicine, University of Iowa Carver College of Medicine and the Nemours Children’s Clinic. The Jaeb Center for Health Research in Tampa serves as the data coordinating center.
"Hypoglycemia is one of the major morbidities of diabetes in young children and why parents are afraid of their children having low sugar,” explains Dr. White, who also serves as the director of the Pediatric Research Unit at the School of Medicine. “Fear of hypoglycemia is a major issue for the parents of young children and very key to DirecNet’s mission to reduce the low sugars so that patients can get good control without as much of the risk and the fear of hypoglycemia.”
According to Dr. White, the defense against the onset of hypoglycemia is the recognition that sugar is low. “A patient’s ability to recognize low sugar is diminished by at least three things — exercise, sleep and having had a previous episode. Hypoglycemia unawareness is a major problem,” he adds.
The DirecNet collaboration is moving in the direction of investigating a closed-loop system, an automated system in which sugar is measured and insulin delivered to a child. “Our research must first perfect the technology and the information that feeds the technology as well as, understand how exercise and hormones affect blood sugar. Then, we can combine our findings to build a closed-loop system that will keep blood sugar normal,” concludes Dr. White.
Today, with more than 1,200 active parents in its diabetes program, St. Louis Children’s Hospital, in conjunction with Washington University, was the first pediatric institution in the United States to utilize insulin to treat children with diabetes mellitus in 1922. Beginning in the late 1960s, St. Louis Children’s was one of the first pediatric programs in the country to combine patient care, research and training efforts across endocrinology, diabetes and metabolism. This approach has now become a standard format at other pediatric academic medical centers. |