(From left) Mark DeBoer, MD, Principal Investigator; Dillon Flanagan, Data Operations Specialist; David Fulkerson, Data Analyst; and Lianna Smith, Clinical Research Coordinator. Not pictured: Marc Breton, PhD, Co-Principal Investigator
Mark DeBoer, MD, is a pediatric endocrinologist and professor in the Department of Pediatrics at the UVA School of Medicine. He is passionate about improving the health of children and adolescents with Type 1 diabetes, with a particular interest in the development and testing of new diabetes technology. As a physician-scientist, Dr. DeBoer has collaborated with the UVA Center for Diabetes Technology for over 12 years conducting assessments of artificial pancreas systems in challenging pediatric situations such as during exercise, when not given insulin for food, and long-term home use.
In this second installment of our series “A Healthier Future — One Clinical Trial at a Time,” Dr. DeBoer discusses his study titled, “Artificial Pancreas – Adolescent Physiology and Psychology Longitudinal Evaluation.” His goal for the study is to better understand the origins of difficult adolescent diabetes management, which may lead to future new treatments for Type 1 diabetes during puberty.
Q. What do you hope to learn in your study “Artificial Pancreas — Adolescent Physiology and Psychology Longitudinal Evaluation?” Will the results potentially change the standard of care for future patients?
DeBoer: It has been well documented that among patients with Type 1 diabetes, adolescents have the most difficult management of their blood sugars, with hemoglobin A1C values that spike in the early teen years to levels far above any other time in life. The reasons for this are likely diverse but may include changes in insulin resistance during puberty and changes parent-child dynamics and a shift in priorities, including an elevation in the importance of peer perceptions and relationships over other factors.
In this study, we are following adolescents over a two-year period when HbA1c values have been known to spike, assessing insulin and glucose flux using state-of-the-art tracer techniques and assessing shifts in multiple aspects of psychology. Our findings may help Type 1 diabetes providers better understand the origins of difficult adolescent diabetes management that could help address and prevent these problems.
Q. Does your trial give novel treatment or other opportunities to your/our patients?
DeBoer: For this study, we assess insulin resistance and glucose flux during yearly sessions in the Clinical Research Unit, where the adolescent receives three different glucose molecules labeled with stable (non-radioactive) isotopes, so that we can track these molecules and calculate multiple aspects of glucose dynamics that will help us follow for potential increases in insulin resistance during puberty and whether this resistance is more at the level of the liver or the periphery. This may guide future treatment approaches for Type 1 diabetes during puberty.
Q. What is novel about your study design, treatment, or intervention?
DeBoer: We are one of the only centers in the world able to perform these triple-labeled glucose flux studies, with detailed analysis of how insulin resistance might change over the course of puberty. Our assessments of psychological changes over the course of puberty will also provide novel insights on how these changes are related to potential worsening diabetes management during these transitional years.
Q. How do you ensure inclusion of a diverse subject population?
DeBoer: We have been able to recruit under-represented minorities to this study by making this a priority in contacting families about potential participation. This is especially important in a study in Type 1 diabetes, which is a disease that has racial/ethnic differences in its prevalence, with a much higher proportion of non-Hispanic white individuals among those who are affected.
