Center for Endocrinology, Diabetes & Metabolism

When Anna M. Butturini, MD*, from our hospital's Division of Hematology/Oncology shared her findings with fellow researchers that children who are obese when diagnosed with high-risk leukemia have a greater chance of relapse, Steven D. Mittelman, MD, PhD could not stop wondering "Why?"

A physician-scientist in the Center for Endocrinology, Diabetes and Metabolism, Dr. MIttelman wondered whether the biological effects of obesity correlated with higher risk of relapse or whether it was related to another aspect of treatment.  To find answers, he teamed with Nora C. Heisterkamp, PhD, whose studies focus on the underlying biology of leukemia.  In 2007 the team found, through laboratory research efforts, that obesity increases leukemia relapse in mice after chemotherapy.

This raises the concern that the way some chemotherapy drugs are dosed to overweight children may lead to decreased efficacy. Next steps for the research team will include pharmacological studies to explore chemotherapy levels in fat and the idea that fat cells—once considered inactive—actually participate in disease processes. 

1. metformin alone versus metformin plus intensive lifestyle
2. metformin alone versus metformin plus rosiglitazone
3. metformin plus intensive lifestyle versus metformin plus rosiglitazone

The hypothesis is that metformin plus lifestyle will be the most efficacious approach.

Research is at the heart of the innovative treatments in the Comprehensive Childhood Diabetes Center. By conducting a wide range of investigations, we are better able to develop new strategies in the battle against diabetes. Our world-class physician-scientists are faculty members at the Keck School of Medicine of the University of Southern California, where they engage in collaborative research. In addition, we participate in basic science studies within The Saban Research Institute of Childrens Hospital Los Angeles.

Childrens Hospital Los Angeles is one of 18 medical centers in the United States participating in the Type I Diabetes TrialNet, which is dedicated to understanding the autoimmune process that leads to type 1 diabetes, preventing the disease and stopping its progression.

TrialNet is screening relatives of people with type 1 diabetes to find out if these family members are at risk for developing diabetes. First-degree blood relatives (siblings, children or parents) who are one to 45 years of age, as well as second-degree blood relatives (cousins, uncles, aunts, nieces, nephews, grandparents or half-siblings) who are one to 20 years of age may be screened to determine their risk of developing type 1 diabetes.

Screening involves a simple blood test for the presence of diabetes-related autoantibodies that may appear years before type 1 diabetes develops. Early detection of type 1 diabetes may improve your blood sugar control and reduce your chances of developing complications.

For TrialNet screening, please call 323-664-8568 or visit www.DiabetesTrialNet.org.

Researchers have learned a great deal about treating type 2 diabetes in adults, but much less is known about how best to treat this form of diabetes in youth. The TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) study is the first clinical trial sponsored by the National Institutes of Health to focus on type 2 diabetes in youth – and the first aimed at determining the effects of intensive lifestyle changes. Nationwide, about 750 children and teens ages 10 to 17 will be enrolled in the five-year trial.

Francine R. Kaufman, MD, director of the Comprehensive Childhood Diabetes Center, serves as national study chair of the TODAY trial. Mitchell E. Geffner, MD, director of fellowship training in the Childrens Hospital Center for Endocrinology, Diabetes and Metabolism. is principal investigator of the TODAY trial.

The TODAY study randomly assigns patients to three groups, with two groups receiving medication only, and the third receiving medication plus lifestyle intervention therapy, including physical activity and weekly meetings with a Physical Activity/Nutrition Leader.

The goal is to determine how well and for how long each treatment approach controls blood glucose levels.

For information about the TODAY trial, call 323-361-6052.

Childrens Hospital Los Angeles has joined the Keck School of Medicine of the University of Southern California in the Keck Diabetes Prevention Initiative. The goal: to address the interrelated factors that lead to obesity and diabetes in East and South Los Angeles. The initiative began in 2004 with a $2 million grant from the W. M. Keck Foundation, which will support two-year planning process to identify the factors that contribute to decisions about diet, physical activity and healthcare within the these communities, develop strategies to prevent diabetes and promote healthy lifestyle choices, as well as mobilize experts, government officials, community leaders, business and residents.

The planning process for the Keck Diabetes Prevention Initiative will advance an eight-year intervention in partnership with the Edward Roybal Comprehensive Health Center in East Los Angeles and the Hubert Humphrey Comprehensive Health Center in South Los Angeles.