{"id":1219,"date":"2021-11-18T12:13:37","date_gmt":"2021-11-18T17:13:37","guid":{"rendered":"https:\/\/med.virginia.edu\/exercise-physiology-core-laboratory\/?p=1219"},"modified":"2022-10-28T09:31:56","modified_gmt":"2022-10-28T13:31:56","slug":"adolescence-is-a-time-of-rapid-change","status":"publish","type":"post","link":"https:\/\/med.virginia.edu\/exercise-physiology-core-laboratory\/2021\/11\/18\/adolescence-is-a-time-of-rapid-change\/","title":{"rendered":"Adolescence is a Time of Rapid Change"},"content":{"rendered":"

\"University<\/p>\n

By Lisa Farr, M.Ed.\u00a0 \u00a0Director, Exercise Physiology Core Lab<\/em><\/strong><\/h5>\n

Interview with Mark De Boer, MD, MSc, MCR, Department of Endocrinology<\/h4>\n

Parents of pre-teens know that, overnight, it seems like their child is no longer a little kid. Instead, they are a small-sized semi adult with moods, preferences, and a strong desire to exert their independence.<\/p>\n

For parents of pre-teens with type1 diabetes, this can be a particularly challenging time.\u00a0 Parents begin to have less control of the child\u2019s schedule, eating habits, and daily behaviors.\u00a0 Of note, the ages of 11- 15 correspond with an incredible rise in hemoglobin A1-C. Hemoglobin A1-C is a blood test that provides a picture about average blood glucose over the preceding 3 months. We know from previous studies that there is an ideal range for HbA1c; while this range will vary a little based on the age and health of the patient, values that are consistently elevated indicate that the diabetes is not under good control.\u00a0 The following graph provides a visual as to what typically happens during adolescence:<\/p>\n

\"Graph<\/p>\n

Graph Description<\/h5>\n

Note the large spike in HbA1c during adolescence. Why is this concerning?High HbA1c indicates poor glucose control\u2014i.e, higher blood sugars. Higher blood sugars are associated with many of the complications diabetics face as they get older, such as eye damage, poor circulation and healing, and kidney disease.<\/p>\n

 <\/p>\n

For years it was assumed that the large spike in blood sugar seen during the adolescent years was just due to behavioral changes, such as the adolescent assuming a role in diabetes management previously played by parents. But endocrinologists began to suspect there was more to it—might there be physiological reasons as well? It was discovered that the timing of the spike in HbA1c coincided with a spike in levels of hormones that are associated with insulin resistance. Insulin resistance can occur at many different tissues throughout the body, including the liver and muscles.\u00a0 When the cells of the body are more resistant (\u201cless sensitive\u201d) to insulin, blood glucose levels rise.<\/p>\n

Dr. Mark De Boer and his colleagues in Endocrinology are studying this issue.<\/p>\n

Questions and Answers with Mark De Boer, MD<\/h4>\n

Question
\n<\/strong>Why did you want to study diabetes control during adolescence?<\/p>\n

Answer
\n<\/strong>This project addresses what is perhaps the biggest challenge in the clinical care of type 1 diabetics.\u201d\u00a0\u00a0 \u201cWe are examining physiological and psychosocial factors that influence the spike in HbA1c commonly seen in adolescence. We hypothesize that using an artificial pancreas system—an \u201call in one\u201d diabetes management system that more tightly regulates blood glucose by automatically increasing insulin dose as needed\u2014will in part blunt the rise in HbA1c.<\/p>\n

We know that diabetes control—as measured by HbA1c\u2014gets a lot worse during this time frame.\u00a0 We also know that insulin resistance gets worse too. So the thought was—maybe it\u2019s not JUST that these kids are becoming more independent in taking care of their diabetes. Maybe the hormonal changes of adolescence are part of the issue. And if that\u2019s the case—if these normal hormonal changes are partially the culprit\u2014then maybe we, their Physicians, need to be more responsive. Maybe we need to change their care more often during this time. Or maybe an artificial pancreas system, which is a closed loop system that regulates insulin dosing based on current blood glucose level as well as glucose trends, would be the way to go.<\/p>\n

\n

Question
\n<\/strong>So the real life application here is–?<\/p>\n

Answer
\n<\/strong>That we provide better diabetes management during a time when it typically isn\u2019t as good.\u00a0 We know that diabetes management is very important to prevent diabetic complications.<\/p>\n

\n

Question
\n<\/strong>Your study will measure insulin resistance using something called \u201ctriple label glucose assessment\u201d and will also measure body composition. Can you tell us a little about each test?<\/p>\n

Answer
\n<\/strong>We\u2019ll bring the kids into the clinical research unit and feed them a meal.\u00a0 We will use a stable isotope tracer (no radiation) to look at insulin and glucose responses at various body tissues in response to the meal.\u00a0 We will also do a yearly Bod Pod body composition test\u2026this allows us to dose the tracer based on how much of their body weight is lean tissue versus fat tissue.\u00a0 It also gives us insight about important shifts in fat and muscle occurring during this period. \u00a0(the Bod Pod is pictured above)<\/p>\n

\n

Study Specifics<\/h4>\n

Dr. De Boer\u2019s subjects will also be given activity trackers. Exercise and activity are important ways to improve insulin sensitivity and prevent insulin resistance.<\/p>\n

Dr. De Boer\u2019s study will enroll type 1 diabetic children who are 11 or 12 years old and follow them for 2 years.\u00a0 The kids in the study will be randomly assigned to either the artificial pancreas system described above, or usual care + CGM. (continuous glucose monitor)<\/p>\n

In addition to monitoring HbA1c they will perform a variety of measures at baseline, 12, and 24 months to look specifically at insulin resistance.\u00a0 They will also use surveys and questionnaires to assess for peer relationships, family dynamics, diabetes distress, and other psychosocial markers.<\/p>\n

In summary, at the end of this study, Dr. De Boer and his colleagues hope to have better understanding of both the physiological and psychosocial causes for poor diabetes control during adolescence, and whether an artificial pancreas makes a difference.<\/p>\n

Their study, funded by the National Institutes of Health, is \u201cArtificial Pancreas-Adolescent Physiology and Psychology Longitudinal Evaluation\u201d (A.P.Apple), HSR 190088.<\/p>\n

\n
\"Mark

Mark De Boer and his daughter Arianna.<\/p><\/div>\n

While catching up with Dr. De Boer about his important new study, we also took a moment to get a little personal too.<\/h4>\n

Question<\/strong>
\nWhat kind of exercise do you do, Dr. De Boer? You look very fit.<\/p>\n

Answer<\/strong>
\nI\u2019ve enjoyed running with my kids\u2026my daughter is now running cross country at William and Mary!… and I also participate in a group called F3, which stands for fitness, fellowship, and faith. We meet a few times each week and do a boot-camp style class that of running, body weight exercises, and all kinds of stuff.\u00a0 Sometimes I even lead the group. It meets bright and early, which is helpful for my schedule.<\/p>\n

Question<\/strong>
\nIf you could give health or fitness advice to your younger self what would it be?<\/p>\n

Answer
\n<\/strong>To make time for exercise. Those years of medical school and residency that were so busy—I must have gone years without exercising on a regular basis. You have to carve out time.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Lisa Farr, M.Ed.\u00a0 \u00a0Director, Exercise Physiology Core Lab Interview with Mark De Boer, MD, MSc, MCR, Department of Endocrinology Parents of pre-teens know that, overnight, it seems like their child is no longer a little kid. Instead, they are a small-sized semi adult with moods, preferences, and a strong desire to exert their independence. 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