Kelsey, Megan , M.D.
Health influences of puberty study
General Research Subject: Insulin Resistance Pre Diabetes
Focus: Integrated Physiology\Insulin Resistance, Obesity\Clinical Treatment, Pediatrics\Obesity
Type of Grant: Junior Faculty
Project Start Date: January 1, 2011
Project End Date: December 31, 2013
Diabetes Type: Type 2 diabetes
Type 2 diabetes mellitus (T2DM) is a common, potentially preventable, disorder that is costly to the health care system and to patients' quality of life, partly due to high prevalence of cardiovascular disease in patients with T2DM. As T2DM and cardiovascular disease are now affecting more children at younger ages, efforts at prevention aimed at this population are critical. During puberty, the body's insulin temporarily does not work as well as it does before and after puberty. Healthy adolescents are able to compensate for this by making more insulin. However, obese children may not be able to adequately compensate, putting them at risk for early development of T2DM.
This is evidenced by the fact that T2DM is rarely seen prior to onset puberty. This project is designed to clarify the important interaction between obesity and puberty and, therefore, help to better understand how children develop T2DM and cardiovascular disease. Furthermore, this project will assess whether treatment of obese adolescents with a medication to decrease the body's need for insulin will help these children better compensate for decreased insulin action in puberty. This will help to better target preventive efforts in the future.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
The HIP Study is designed to explore the relationships between puberty and the onset of type 2 diabetes in adolescents. The results of this study will help us better understand how to prevent type 2 diabetes in these youth. Children go through many changes during puberty, including important hormonal and behavioral alterations. Among these changes, it has long been known that, during puberty, insulin does not work as well as it does before and after puberty. This is called physiologic insulin resistance. In healthy children, this does not cause diabetes or affect blood sugar in any way because the body is able to compensate by making more insulin. Indeed, this is thought to be an important part of the adolescent growth spurt.
However, in some children with increased risk for developing type 2 diabetes due to obesity and genetics, the worsening insulin resistance of puberty cannot be compensated for and these youth get diabetes early. We believe this is because type 2 diabetes is rarely, if ever, seen before puberty begins, and the peak of diabetes onset in adolescents occurs at the time of the worst insulin resistance. This specific research project has two goals: 1. To examine effects of obesity on how well the body's insulin works during puberty, and 2. To see if treatment of obese children during this critical period of puberty with a medication that improves insulin resistance (metformin) will help prevent early onset type 2 diabetes.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
This project is not designed to help people who already have diabetes. However, people who have diabetes pass that genetic risk on to their children. Our goal is to help prevent their children from developing diabetes in the future.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
I became a physician in order to improve people's health and help prevent disease. However, as I went through my training, I recognized that it was not enough to help only the patients that I was directly treating. By doing research, I am making more of a contribution to understanding how disease develops and how to prevent it in larger numbers of individuals. I chose diabetes as an area of research because I had exposure to obesity and diabetes research as a research assistant prior to going to medical school. As I progressed through medical school and residency, I became increasingly aware of the problem of pediatric obesity and the potential effect that it will have on diabetes rates. Helping to prevent diabetes has the potential to benefit many more children than I can treat in my individual practice. In recent years, my interest in diabetes research has become much more personal because there is an extensive history of type 2 diabetes in my husband's family and I want to be able to prevent diabetes in my own children.
As a young investigator, this award is absolutely critical to development of my independent research career. With this American Diabetes Association award, I will have the resources and time to complete this study and have an important opportunity to identify a critical window for preventing diabetes.
In what direction do you see the future of diabetes research going?
We are only just beginning to appreciate the many genetic, physiologic and environmental factors contributing to the development of type 2 diabetes. Therefore, there is still extensive research required to better understand diabetes. Recent advances have already led to exciting new diabetes treatment options and there will be more to come as our knowledge improves. Despite these new medications, diabetes can still be a very difficult disease to treat. Therefore, research geared toward preventing childhood obesity and diabetes and improving the lifestyle habits of our young people should be an important emphasis of diabetes research now and in the future.
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