2017 Year in Review: UF Diabetes Institute

UF Diabetes Institute

Director: Mark Atkinson, Ph.D.

The UF Diabetes Institute completed its third year in 2017, pushing forward toward its overarching mission to improve the lives of those living with diabetes so that we may one day see a diabetes-free world.

With one new person diagnosed with diabetes every 23 seconds and approximately one quarter of patients admitted to a UF Health Shands hospital having diabetes as part of their medical diagnosis, our mission is not only obvious … but increasingly urgent.

In picking one word to describe the Diabetes Institute for 2017, it would be that of growth. Indeed, this past year not only saw continued growth for some of UF’s hallmark diabetes programs but also marked expansion in many new areas not previously associated with our institute. While many notions could be highlighted, below are a represented selection from a program dedicated to research, improved patient care, training and public outreach — all efforts for which we at UF are proud to be a part.

Research

Most people are aware of the importance of the heart, brain and lungs to healthy living, but the pancreas is one of the human body’s most often forgotten organs. That is, unless it isn’t working. The Diabetes Institute is helping to grow a strategic and highly collaborative effort focused on pancreas research at UF. So much so, we now think of ourselves as “Pancreas U.” Indeed, we have been the coordinating center for the JDRF’s Network for Pancreatic Organ donors with Diabetes (nPOD) program for a full decade ($26 million in funding to date); multiple Diabetes Institute investigators lead pancreas/pancreatic islet research programs funded by the National Institutes of Health, including those within the Human Islet Research Network, or HIRN; and the Leona M. and Harry B. Helmsley Charitable Trust is supporting a pioneering effort to create a Human Atlas of Neonatal Development & Early Life Pancreas, or HANDEL-P, to describe in detail how the pancreas develops from birth through 10 years of age, among other efforts. The Diabetes Institute is also overseeing a program that screens organ donors across the United States for blood-based biomarkers reflective of diabetes, among the largest non-transplant-related research efforts within the organ procurement organizations in the country.

Beyond increasing efforts in pancreas research, in both 2016 and 2017, we placed an emphasis on obtaining NIH grants dedicated to research training, and the results have been remarkably rewarding. These efforts are highlighted, below.

Additional examples of research and training notables in 2017 include:

• In December 2017, the Juvenile Diabetes Cure Alliance noted UF as the No. 3 entity in the United States receiving NIH funding for Type 1 diabetes.
• Drs. Asbhy Walker and Michael Haller received a $1.6 million grant from the Leona M. and Harry B. Helmsley Charitable Trust to pilot a program that will improve access to care for underserved adults and children living with diabetes. This grant is a collaborative effort with Stanford University; participating primary care providers in Florida and California will address urgent racial, socioeconomic and geographic disparities for people living with diabetes.
• Desmond Schatz, M.D., received a major grant from the Patient Centered Outcomes Research Institute to support the formation of pragmatic trials targeting obesity in the southeastern United States.
• Dr. Mark Atkinson received a new NIH award ($3.4 million) that, together with investigators at the University of Pennsylvania and Vanderbilt University, will identify organ donors suitable for research investigations by the HIRN network.
• The University of Florida remained the world’s top recipient of research funding from JDRF, which is the largest nongovernmental entity providing funds dedicated to Type 1 diabetes. Indeed, our university receives nearly 10 percent of the annual research funding from this international organization.
• Drs. Michael Haller and Todd Brusko are collaborating with Cord Blood Registry® (CBR®) on a potential clinical trial exploring the use of cord blood expanded autologous regulatory T cells as an immunotherapy in children with Type 1 diabetes.
• In late 2017, it was announced that the JDRF and Leona M. and Harry B. Helmsley Charitable Trust would renew funding for the aforementioned nPOD program for an additional five years ($16.4 million).

Clinical Care

Starting with adult diabetes, Dr. Kenneth Cusi, chief of the division of endocrinology, diabetes and metabolism in the UF College of Medicine Department of Medicine, has led the charge to continue to improve comprehensive diabetes care at UF Health. Dr. Cusi created (and since 2013, chaired) the Diabetes Care Task Force to coordinate efforts and educate housestaff, faculty and other health care providers about inpatient diabetes care. With more than 14,000 outpatient visits in 2017 (~65 percent with diabetes), the UF adult endocrinology and diabetes division continues to relentlessly grow and serves as a referral center to the community and region (e.g., a 4-fold growth in outpatient visits in the past five years). Moreover, the division provided 5,120 inpatient consults and follow-up visits at UF Health Shands Hospital in 2017, and was recognized as offering the best inpatient consult service in 2015-2016, second best in 2017, by physicians within the UF Department of Medicine.

• With 21 endocrinologists and advanced registered nurse practitioners, the UFDI hosts the second-largest regional endocrine, diabetes and metabolism program (after the University of Miami).
• In the 2016-17 U.S. News & World Report rankings, UF ranked 31st among national adult endocrine programs (second in the state of Florida).
• The UF adult endocrinology & diabetes division ranked second across the department of medicine, after nephrology.
• More than 10 randomized control trials and research studies are ongoing in Type 2 diabetes, obesity and nonalcoholic fatty liver disease. Having developed state-of-the-art stable isotope and liver imaging techniques, UF hosts one of the leading clinical translational research programs in the United States in Type 2 diabetes and nonalcoholic fatty liver disease.
• Recently reported in the Annals of Internal Medicine (the official Journal of the American College of Physicians), findings from a three-year clinical trial led by Dr. Kenneth Cusi revealed that the drug pioglitazone is the first safe and effective intervention for patients with prediabetes or Type 2 diabetes who have nonalcoholic steatohepatitis, a chronic liver disease caused by fat buildup in the liver that is the second cause of cirrhosis in the United States. Indeed, fatty liver disease is a risk factor for Type 2 diabetes, even in non-obese patients.

The pediatric endocrinology and diabetes program, led by Michael Haller, M.D., was ranked 23rd in pediatric endocrinology by U.S. News & World Report, and our pediatric endocrinology division received the Most Outstanding Division Award for the department of pediatrics for the fourth consecutive year. The pediatric diabetes faculty sees over 1,000 unique diabetes patients per year and continues to offer leading-edge care to children and families affected by diabetes. The Florida Diabetes camps, directed by UF pediatric diabetes faculty, also served over 500 children with diabetes in 2017.

• The pediatric endocrinology group now boasts eight M.D. faculty, two ARNPs, four certified diabetes educators, two registered dietitians and psychology support embedded in our clinics. We offer diabetes education five days per week as well as evening classes in advanced diabetes pumping and continuous glucose monitoring.
• The UF pediatric diabetes program was chosen as one of only four sites internationally to test the Medtronic 690G artificial pancreas system.
• The UF Pediatric Diabetes Program played an integral role in the studies that led to the recent acquisition of intranasal glucagon by Eli Lilly and Company.
• Our Pediatric Fun and Fit program, led by Dr. Angelina Bernier, has demonstrated reductions in BMI percentile in our overweight youth.
• Drs. Martha Campbell-Thompson and Michael Haller completed their NIH-funded DP3 demonstrating reduced pancreas volume in children at risk for developing Type 1 diabetes.
• Dr. Michael Haller led the NIH TrialNet consortium in reaching the primary outcome in a randomized clinical trial of ATG and GCSF in new-onset Type 1 diabetes patients (manuscript under review at The New England Journal of Medicine).
• Dr. Arlan Rosenbloom received the Judson VanWyk Award, the highest award bestowed by the Pediatric Endocrine Society.

Training

As mentioned previously, with an interest in increasing training opportunities through obtaining funding, we note a newly funded interdisciplinary T32 Training Grant bridging the studies of diabetes and biomedical engineering (led by Drs. Mark Atkinson and Dr. Ben Keselowsky) along with other Diabetes Institute members (Drs. Todd Brusko, Michael Clare-Salzler, Patrick Concannon, John Driver, Clayton Mathews, Michael Haller, Gregory Hudalla, Lyle Moldawer, Laurence Morel, Desmond Schatz, Janet Silverstein, Cherie Stabler, Mark Wallet, Shannon Wallet and Lin Yang). Diabetes Institute-supported trainees also saw an remarkable of accomplishment, examples including two pre-doctoral students (Ms. Olivia Bailey and Ms. Melanie Shapiro) receiving NIH F31 (diversity) awards and third-year pediatric endocrine fellows (Dr. Kristen Dayton and Dr. Laura Jacobson) receiving highly competitive extramural grants from the Pediatric Endocrine Society and the JDRF, respectively.

With six physicians-in-training in the Adult Endocrinology Fellowship program, UF is the second-largest adult endocrine training program in the state of Florida. The program, which provides leading-edge diabetes care training to fellows with the latest on insulin pump + continuous glucose monitoring outpatient care technology, receives more than 160 applications for endocrinology fellowship training each year. Moreover, UF has regional leadership in subspecialty and multidisciplinary endocrine care clinics for patients with thyroid cancer, pituitary disease, lipid management, cystic fibrosis, obesity medicine program, nonalcoholic fatty liver disease, osteoporosis and more. UF endocrinology division faculty members hold leadership roles in national medical societies in education and research, including the ADA, the Obesity Society and the Endocrine Society. Over 30 peer-reviewed manuscripts were published by adult endocrinology trainees in 2017 alone (over 100 manuscripts published in the past five years).

UF’s pediatric diabetes and endocrinology division has three fellows, two of which are graduating in 2018 and will, as a sign of growth, remain as new faculty. These fellowships are quite competitive, with over 30 applicants turned down each year. In 2017, UF clinical fellows published over 20 manuscripts and, to varying degrees, participated in more than 50 ongoing clinical trials occurring within the division.

Outreach and Community Involvement

Here, the Diabetes Institute seeks to extend the mission to the community at large. For example, Dr. Anastasia Albanese-O’Neill in the UF Division of Pediatric Endocrinology serves as the co-chair of the American Diabetes Association’s Safe at School Working Group. The group works to make sure the diabetes management needs of students across the United States are met so these children are healthy and safe when they are at school and school-sponsored activities.

The Diabetes Institute now provides a variety of educational offerings in the use of diabetes technology, including an introductory class on diabetes technology, insulin pump training (start and advanced), continuous glucose monitoring training, and training on data transfer and interpretation. Patients and their family members have the option to participate in diabetes technology education in person, in a group setting, or via telehealth using Vidyo software. This latter program was made possible through a grant from the UF Children’s Miracle Network.

• The NIH-supported T1D DATA (Type 1 Diabetes Data Acquisition and Transfer Adherence) Study was undertaken at UF to improve glycemic control by facilitating data sharing of blood glucose, continuous glucose monitoring and pump data by patients between clinic visits.
• UF is one of 14 sites that participate in the SENCE (Strategies to Enhance New CGM use in Early Childhood) Study, examining the benefits of continuous glucose monitoring and continuous glucose monitoring + behavioral training in children ages 2-7 years with Type 1 diabetes. An added benefit of this study is that it has provided continuous glucose monitoring technology to many families who may not have otherwise been able to afford the device.
• In August, the Diabetes Institute hosted the Basketball Training Camp for former UF basketball player Corey Brewer. Corey, currently the NBA’s “Iron Man” for the longest number of consecutive games played, donates the proceeds from the camp to support diabetes care and education for underserved populations.

• Using continuous glucose monitoring, blood glucose and insulin pump data, this study pits the DreaMed Advice4U pro algorithm against medically guided recommendations by physicians to determine insulin dosing for suboptimally controlled patients with Type 1 diabetes, somewhat akin to “IBM’s Deep Blue versus the world chess champion Garry Kasparov.”
• Our Telehealth Transition Study provided group diabetes education via videoconference (Vidyo) for young adults (ages 18-25 years) with Type 1 diabetes who were transitioning to living away from home. The study had a companion website, where additional information on a variety of topics could be found. Links were pushed to participants immediately after each videoconference, with pronounced improvements in care observed.
• The Diabetes Institute was selected as one of six sites participating in the national Young Adult Racial Disparities in Diabetes, or YARDD study. Dr. Ashby Walker, our site PI, is collaborating with Dr. Shivani Agarwal at the University of Pennsylvania. The study seeks to better explicate the role of adverse childhood events in racial disparities for Type 1 diabetes.
• The Diabetes Institute spearheaded a number of exciting new initiatives for our college students with Type 1 Diabetes. Drs. Ashby Walker and Desmond Schatz successfully piloted the All for ONE mentoring program with grant funding from the Type 1 Exchange. This program paired college students living with Type 1 diabetes as mentors with publicly insured teens who also have Type 1 diabetes in the clinics at UF and is gaining national recognition for its innovation. As part of this program, 22 college students with Type 1 diabetes were able to participate in a directed research experience exposing them to the major research labs at the institute and related career trajectories. We also are providing support for the College Diabetes Network chapter on campus — a vibrant student group hosting monthly gatherings and many social network opportunities for college students with Type 1 diabetes.
• Dr. Lisa Scarton, of the UF College of Nursing, hosted a significant three-day conference in Gainesville, bringing in investigators (epidemiologists, health care providers, public health department heads) and tribal leaders from Native American Indian Tribes throughout the United States, for the purpose of identifying pragmatic ways of averting obesity in Native American families.
• On Nov. 14, 2017 the Diabetes Institute hosted an event for World Diabetes Day about “Women, Diabetes, and Health Equity.” This multi-college and multidisciplinary event showcased research about Type 1 diabetes and Type 2 diabetes in women’s health and was a tremendous success, including an opening proclamation of World Diabetes Day by Gainesville Mayor Lauren Poe.