Countless people in the United States suffer from a condition called “leaky gut,’’ where the lining of the intestines becomes porous enough to allow toxins to seep through it and into the bloodstream.

Many are unaware of their condition, or that it can lead to serious health problems, such as chronic inflammation, type 2 diabetes, heart disease, dementia and even some types of cancer. The condition also can cause a variety of unpleasant gastrointestinal syndromes, such as indigestion, gas, bloating, abdominal pain and diarrhea.

In a new paper published in Gut, a leading high-impact international journal in gastroenterology and hepatology, USF Health researchers describe how the right balance of bacteria can deter leaky gut – and how the wrong mix can threaten a person’s health.

The study addresses how leaky gut can accelerate the progression of diabetes in overweight people, and how selective probiotics work to reduce that risk.

People with meat-rich diets are especially vulnerable, said Hariom Yadav, Ph.D., senior author of the study and director of the USF Center for Microbiome Research, Microbiomes Institute, and associate professor of Neurosurgery and Brain Repair.

Hariom Yadav, PhD

“We describe the unique role of the microbiome as a garbage cleaner of our body and our diet’s byproducts, such as how a meat-enriched diet increases the garbage in our gut that changes the microbiome,’’ he said. “This creates leaky gut and inflammation that ultimately induces diabetes.’’

The microbiome is the collection of microbes − bacteria, fungi, and viruses − that naturally live on our bodies. The balance of these tiny organisms can enhance or impair the body’s metabolic and immune functions.

Because everyone’s gastrointestinal tract is selectively porous, many of these organisms – along with nutrients − travel into the bloodstream. However, a person with increased intestinal permeability has too much “leakage,” allowing larger molecules into the bloodstream, creating inflammation. This inflammation impacts many organs in the body, potentially changing their normal functions if exposed for long periods of time and increasing the risk for developing such diseases as diabetes.

“These toxins keep circulating back and forth in our bodies and cause serious health problems,’’ Dr. Yadav added. “We wanted to know how these microbes work in the cleaning process, how they serve as garbage cleaners to remove toxins.’’

The new study discovered that leaky gut in both overweight people and mice diminished the microbiome’s capacity to metabolize a chemical called ethanolamine, a chemical found in beef and other animal food products. High levels of ethanolamine lead to increased permeability of the gut wall, and as a result, more proinflammatory molecules are released into the bloodstream.

Because ethanolamine is found in bovine muscle, people with diets heavy in beef ingest higher-than-normal levels of the chemical than people who eat meat less frequently.

“It’s an intrinsic part of animal meat,’’ Dr. Yadav said of ethanolamine. “So, eating a heavy meat diet contributes more of this chemical, and if the (probiotic) bacteria that metabolizes ethanolamine isn’t there to fight it, those people will be more likely to have leaky gut.’’

If ethanolamine-metabolizing bacteria are low or absent, then the accumulated ethanolamine acts on epithelial cells to cause leakiness. To counter this, the researchers suggest a novel probiotic therapy that would reverse elevated gut permeability, inflammation and dysfunction of glucose metabolism.

“What’s important is to know what kind of bacteria is in our gut and whether it can clear ethanolamine,’’ Dr. Yadav said. “Normally, people talk about what the microbiome produces, but in this study, we talk about what the microbiome utilizes or eats, and how it clears up all these toxins which either comes from our body or from diet. The therapy is where we put back these helpful bacteria in gut, and we can do this with oral probiotics therapy.’’

Dr. Yadav hopes this original research will benefit medical practitioners and policy makers in making better decisions on dietary guidelines.

Dr. Yadav has several ongoing research projects focused on the microbiome. Last year, he received a grant from the National Institute on Aging to help determine if a common medication can restore microbiome diversity in older patients who have a form of heart failure. Results of his three-year study could help prevent the subsequent problems that tend keep these patients inactive and cause their conditions to worsen. He also is working on another study funded by Florida Department of Health, called the Microbiome in Aging Gut and Brain (MiaGB) study, which focuses on how the microbiome impacts brain health, and teaches what to eat and avoid to keep the brain healthy during aging.

Armed with more knowledge about how the microbiome affects inflammation, type 2 diabetes, cardiovascular complications, dementia and even cancer, USF Health researchers hope to identify high-risk patient populations that could benefit from next-generation therapies. Rather than a general treatment, these people might receive more personalized care based on their microbiome and a leaky gut.

— Story by Kurt Loft for USF Health News; photo by Allison Long | USF Health  

In the ongoing research and treatment of diabetes, the focus is typically on the two forms of the disease that dominate public awareness. Type 1 is caused by the immune system attacking the cells that produce insulin, so that the person requires insulin therapy for life; type 2 is frequently associated with obesity and lack of exercise, resulting in insulin resistance.

But researchers are learning more about patients whose symptoms are classified as “atypical,” thanks to the Rare and Atypical Diabetes Network (RADIANT), led by teams at USF Health, Baylor College of Medicine, the University of Chicago, and Massachusetts General Hospital. The USF Health research team is led by Jeffrey Krischer, Ph.D., director of the USF Diabetes and Endocrinology Center and the USF Health Informatics Institute, and includes Hemang Parikh, Ph.D., an associate professor in bioinformatics and biostatistics in the Health Informatics Institute.

Their paper, “Data Mining Framework for Discovering and Clustering Phenotypes of Atypical Diabetes,” was recently published in the Journal of Clinical Endocrinology & Metabolism in collaboration with Ashok Balasubramanyam, M.D., and Maria Redondo, M.D., Ph.D., from Baylor College of Medicine, and Christiane Hampe, Ph.D., from the University of Washington.

Hemang Parikh, PhD, of the USF Health Informatics Institute

“In addition to type 1 and type 2 diabetes, there is a range of atypical forms of diabetes that affect people who cannot be categorized in the same way,” said Dr. Parikh. “Sometimes, these people – children and adults – are misdiagnosed and receive different treatment than they should get.”

One form of atypical diabetes – monogenic– is due to the dysfunction of a single gene. Another type results from a cluster of genetic disorders and relates to abnormal mitochondrial function. Another is characterized by patients who appear to have type 2 diabetes, yet present with diabetic ketoacidosis, a complication thought to occur only in patients with type 1 diabetes. Yet another affects the manner in which fat is stored.

The new paper furthers the study of these rarer forms of the disease, for which patients’ symptoms and health challenges differ from those with type 1 and type 2. The analysis was conducted through the sophisticated process of data mining – digging through data to discover hidden patterns and is sometimes referred to as “knowledge discovery in databases.”

Dr. Parikh and his team developed a data mining system as part of a program called DiscoverAD (short for Discover Atypical Diabetes). In essence, DiscoverAD relies on a two-step filtering process – first to exclude participants who meet definitions of the typical type 1 diabetes or type 2 diabetes, then to include participants with certain pre-specified atypical diabetes characteristics.

“This is followed by robust analysis to discover novel phenotypes of atypical diabetes (AD) within the filtered group,” Cassandra Remedios, M.S., an assistant in research in bioinformatics in the Health Informatics Institute said. “We purposefully developed DiscoverAD to permit flexibility and efficiency so it can be applicable to various clinical settings with different types of large cohort datasets.”

In the study, two distinct and very different cohorts of patients with diabetes were investigated. The first cohort comprised Hispanic participants with diabetes from the Cameron County Hispanic Cohort led by Joseph McCormick, M.D., and Susan Fisher-Hoch, M.B.B.S., M.Sc., F.R.C. Path., M.D., of the University of Texas Health Sciences Center. The second cohort comprised 758 multiethnic children within the Texas Children’s Hospital Registry for New-Onset Type 1 Diabetes study. The investigation allowed them to identify and cluster phenotypes of atypical diabetes. “Due to the large cohort datasets, a manual review would have been extremely time-consuming,” Parikh explained.

The study was conducted as part of RADIANT, which is dedicated to discovering and defining rare and atypical forms of diabetes. RADIANT is comprised of universities, hospitals, and clinics around the United States working to gain a deeper understanding of atypical diabetes. Baylor College of Medicine and the University of Chicago are the national centers of the consortium, and USF serves as the data coordinating center for the entire network.

“This work demonstrates the high prevalence of atypical forms of diabetes in varied populations. The DiscoverAD tool is an innovative and practical tool to identify such patients in different datasets. I believe this could be a foundation for developing criteria that clinicians can use to diagnose their patients with diabetes more accurately and treat them more precisely,” Dr. Balasubramanyam said.

The idea of RADIANT’s study, which is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, is to identify people who have atypical diabetes – which is a cluster of traits, “ Dr. Parikh explained. “It can’t be characterized in just one way. There is heterogeneity in atypical cases.”

The significance of the research lies in the fact that some patients with rare forms of diabetes remain undiagnosed or could possibly receive incorrect treatment. Proper diagnosis, according to RADIANT, “enables targeted therapy, leads to improved quality of life, and aids in the diagnosis of diabetes in other family members.”

Patients with atypical diabetes are treated throughout the country, but frequently as isolated, individual cases, and that has made it difficult to amass a base of knowledge that benefits providers and patients. RADIANT addresses that challenge by creating a centralized database, information, and resources – with the goal of leading to more effective diagnoses and better treatment plans.

“We found in our studies that atypical cases are quite high – comprising about five to eleven percent of diabetes diagnoses,” Dr. Parikh said. “And we also found that many people have been misdiagnosed as either type 1 or type 2 diabetes.”

A key indicator of atypical diabetes is a treatment that does not seem to be working. For instance, some diabetes patients might start losing weight quickly and inexplicably. Others may see glucose levels remain high despite receiving insulin.

“If a person is not responding in a way they should be, that could be a sign,” Dr. Parikh said.

As one of the nation’s leading diabetes researchers, Dr. Krischer has been studying data related to atypical diabetes for several years. Several hundred subjects have been involved in the RADIANT study to gain a greater understanding of atypical diabetes through data mining.

Jeffery Krischer, PhD, at the USF Health Informatics Institute on USF’s campus in Tampa.

 “These new analytic techniques make it easier to recognize atypical forms of diabetes that can lead to better management tailored to individual case’s characteristics,” said Dr. Krischer, who also holds the USF Health Endowed Chair in Diabetes Research. “Not only does this demonstrate the potential of personalized medicine, but the analytics also define computable phenotypes that can be generalized to many data mining situations.”

Dr. Parikh, whose expertise lies in biomedical data analysis, has a personal connection to the study of diabetes. Both of his late grandfathers developed type 2 diabetes and his mother has it as well. That led him to want to learn more about the disease.

He finds his work with RADIANT particularly rewarding, with a collaborative approach to researching and treating atypical diabetes.

“It’s a huge consortium, and we’re the main data coordinating center, which means we focus on the aggregation and management of data from multiple sites,” he said. “Then we work with these different network partners for processing of the biospecimens for high-throughput technologies such as whole-genome sequencing, RNA-sequencing, or metabolomics and deep phenotyping of individuals and/or families.”

The study is ongoing, Dr. Parikh stresses. If somebody suspects they may have atypical diabetes or know someone who might, they can visit the RADIANT website (www.atypicaldiabetesnetwork.org). Visitors are asked to complete a questionnaire and then, based on the responses, could be enrolled in the study.

“There is a considerable number of atypical cases out there that people may not realize,” Dr. Parikh said. “And we want those people to receive the proper diagnosis, to avoid causing diabetes complications over time.”

— Story by Dave Scheiber for USF Health Communications 

Cardiologists could and should take more action in guiding their patients to interventions aimed at delaying, and even preventing, diabetes, USF Health faculty proposed last month in a review published  in the American Journal of Cardiology.

“We propose cardiologists can play a key role in preventing diabetes and aligning practice patterns with guideline recommendations among endocrinology, cardiology, and primary care stakeholders,” wrote Nicholas W. Carris, PharmD, assistant professor in the USF Health College of Pharmacy.

The review article, which summarizes previously published studies on the topic, presents cohesively for the first time the specific factors contributing to an apparent lack of action by clinicians, and suggests an approach that might better encourage cardiologists to proactively engage their patients who have prediabetes.

“The prediabetes timeframe is an opportunity to act and significantly reduce the likelihood of someone progressing to diabetes,” Dr. Carris said. “It’s an opportune time to help patients at considerable cardiometabolic risk and to have a significant impact on the current diabetes epidemic.”

“Eighty-four million patients in the United States have prediabetes and at least 70 percent will develop diabetes unless they receive an intervention,” he said. “Most of these patients have or are at risk for cardiovascular disease, with recent reports describing significantly increased microvascular and macrovascular risks among patients with prediabetes.”

Central to what Dr. Carris and authors suggest is for cardiologists to actively engage their patients with prediabetes and implement evidence-based methods of diabetes prevention.

“For several key reasons, we believe cardiologists have a responsibility and opportunity to improve the health of their patients with prediabetes by making it a very high priority to prevent progression to diabetes,” Dr. Carris said. “First, we must recognize that multiple cardiovascular medications may increase risk for new-onset diabetes. Second, avoiding or delaying diabetes’ onset can improve quality of life and decrease health-system cost. And third, because heart disease and stroke are the most common causes of death in people with diabetes, we expect that preventing diabetes will improve long term health.”

The authors go on to note how strong an influence cardiologists could have on shifting the diabetes epidemic.

“Cardiologists are increasingly being asked to weigh in on diabetes management as select agents demonstrate cardiovascular benefit… as the mortality risk of patients with a history of myocardial infarction and diabetes is almost double that of patients with a history of myocardial infarction who are free of diabetes, there is even more potential benefit in delaying/avoiding diabetes in patients with cardiovascular disease.”

Current methods of intervention show an impact in reversing prediabetes or slowing progression to diabetes, Dr. Carris said.

“Cardiologists are centrally positioned to help patients adopt a healthier lifestyle and prescribe therapeutic and preventive medications when appropriate,” he said. “Studies have shown that intensive lifestyle intervention, metformin, and other medications reduce the progression to diabetes.

“The bottom line is, it cannot be ignored that avoiding diabetes is an important outcome – at the very least from a humanistic perspective – and cardiologists are pivotal to helping patients avoid diabetes.”

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Friends and supporters gathered  Nov. 14 to celebrate the fifth anniversary of the opening of a new facility for the USF Diabetes Center on the fifth floor of the USF Health Morsani Center for Advanced Healthcare, and to recognize the impact the Center has had since then on patients and families coping with diabetes.

The USF Diabetes Center Fifth Anniversary Celebration, held on World Diabetes Day, was attended by the center’s friends and supporters.

Surrounding the demonstration kitchen in the USF Diabetes Center, founding benefactors, current patients and their families, and supportive USF Health faculty and staff mingled and shared memories that spanned the five years. Guests then moved to the on-site classroom to hear updates on the Center’s progress. Remembering when the original space was only a shelled out, incomplete floor, Henry Rodriguez, MD, medical director and pediatric endocrinologist, recalled the excitement for designing a space with patients in mind.

“Back when this floor and the floor above us was all shelled space, when you could see from one end of the building to the other, we walked through a taped off area of the Diabetes Center,” Dr. Rodriguez said. “Since that time, we have done some pretty remarkable things. We have grown over the years and continue to expand our providers, our research team and our patient population.”

 Dr. Henry Rodriguez talks about what’s on the horizon in the next 5 years.

Dr. Rodriguez also presented statistics that mark the reality of diabetes for more than 30 million Americans, offering greater insight into the disease’s prevalence, impact, and projected increase in the number of diagnoses.

 Dr. Rodriguez comments on the USF Diabetes Center’s TrialNet Clinical Center.

Henry Rodriguez, MD, medical director of USF Diabetes Center

“I don’t need to convince anyone here of the urgency of looking at prevention to improve the lives of those affected by diabetes,” Dr. Rodriguez said. “Diabetes is expensive, because medical expenses for people with diabetes are double that of people who do not have diabetes. It’s also demanding, because it requires constant vigilance. And it’s a pain, because individuals with diabetes report a lower quality of life compared to the general population.”

 Dr. Rodriguez shares some advances in diabetes research.

The conversation turned to Jeffrey Krischer, PhD,  Distinguished University Health Professor and director of the USF Health Informatics Institute, which has an internationally renowned team of experts in Type 1 diabetes and related autoimmune disorders.  He offered details about new research that may impact current knowledge on how diabetes works and how it can be treated.

“Research is my passion and, as evidenced by the growth of our program over the last five years, my passion extends to helping children and adults who are affected by Type 1 diabetes,” Dr. Krischer said. “In the last five years, the amount of research here has grown and continues to grow. We have more to offer and more ways we can benefit our patients who come to us for care. We are a blend of both clinical care in a warm and supportive, multidisciplinary setting, and access to the latest, state-of-the-art therapies and research advancements that you can only find in this kind of setting.”

Jeffrey Krischer, PhD, Distinguished University Health Professor and director of the USF Health Informatics Institute

 Dr. Jeffrey Krischer explains the role of the USF Health Informatics Institute.

In answering a guest’s question about coordinating information among the multiple clinical centers, Dr. Krischer said, “Some 200 (clinical centers) participate with my office directly and we coordinate all of that research worldwide. So it’s done right here, on this campus, less than a tenth of a mile away from where we’re sitting right now. All of those programs look to us for these results. Research is complex these days and requires coordination, and I’m really proud of the fact that this is where it’s happening.”

 Dr. Krischer on the questions scientists seek to answer about diabetes and related autoimmune disorders.

The USF Diabetes Center opened in 2011, coinciding with World Diabetes Day, a day that marks the birthday of Frederick Banting, who co-discovered insulin in 1922. Today, the Center sees primarily patients with Type 1 diabetes, with about half adults and half children and adolescents.  Most patients live in the region served by USF Health, but many are from across the state.

Key milestones for the USF Diabetes Center include:

• 2011: Ribbon Cutting that opened the USF Diabetes Center’s new facility on the fifth floor of the USF Health Morsani Center for Advanced Healthcare.
• 2012: The inaugural meeting of the Tampa Bay Diabetes Society, offering patients and families a resource for support and services.
• 2013: The USF Diabetes Center begins an Insulin Pump Program that provides new technology to patients and enhances patient care.
• 2014: USF named one of 19 TrialNet Clinical Centers in North America.
• 2015: USF Health consolidates the diabetes and endocrinology services to offer more streamlined care and expanded service locations.
• 2016: Sam Fuld’s Sports Camp, partnered with the USF Diabetes Center, is recognized by the Florida Sports Hall of Fame.

Photos by Eric Younghans, USF Health Office of Communications. 

Henry Rodriguez, MD, clinical director of the USF Diabetes Center, joined U.S. Rep. Kathy Castor at USF recently to host a roundtable discussion by community experts and advocates taking action to treat and prevent diabetes.

The Oct. 12 event in the USF Student Marshall Center was conducted in collaboration with the Arthur Green Jr. Memorial Foundation, LIFT Health, Inc., and the American Diabetes Association (ADA).   It drew representatives from across the Tampa Bay area, including the USF College of Public Health, Tampa General Hospital, JDRF, the YMCA, Tampa Family Health Centers, and the Pinellas County Urban League

In a discussion moderated by Rep. Castor, the participants talked about the need to raise awareness about the growing epidemic and how they might work together more effectively to maximize resources for people with diabetes and prediabetes. In Florida, diabetes affects more than 2.3 million people in Florida, or 13 percent of the state’s population. The ADA estimates that people with diabetes have medical expenses 2.3 times higher than those without diabetes. The metabolic disease a leading cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

Dr. Henry Rodriguez, clinical director of the USF Diabetes Center, joined U.S. Rep. Kathy Castor in a recent diabetes roundtable discussion that brought together community providers and advocates.

“Diabetes is very expensive,” said Rep. Castor, adding that the cost of diabetes care can cause financial havoc to the health care system and personal lives. “We need to fight for research so that USF and other places around the country have the funds they need to tackle this disease.”

Rep. Castor introduced Dr. Rodriguez as a member of the team headed by Dr. Jeffrey Krischer, the world’s top-funded National Institutes of Health principal investigator with a longstanding commitment to diabetes research. Dr. Krischer and his team are making powerful strides in organizing, coordinating and analyzing clinical trial data in type 1 diabetes and related autoimmune disorders, which can lead to advances in treatment and prevention.

“Diabetes is a club you don’t want to belong to,” said Dr. Rodriguez, who focuses on prevention and clinical management of type 1 diabetes through partnerships with primary care providers and research collaborators. “It’s critically important that we coordinate and collaborate across the spectrum in fighting this disease.”

Also at the discussion was Lena Young Green, whose husband Arthur died in police custody in 2014 after suffering an acute hypoglycemic episode. Green’s death led to a Florida law providing more training for law enforcement officers regarding how to recognize and respond to diabetic emergencies, in which a person’s symptoms can resemble those of someone who is intoxicated or impaired.  Also present was State Rep. Ed Narain of Tampa, who helped sponsor the legislation.

Roundtable participants spoke about the need to marshal and coordinate resources to help prevent Type 2 diabetes in children identified as prediabetic and to motivate patients and their families to use the tools they need to manage diabetes on a daily basis.

Janice Zgibor, PhD, an associate professor in the USF College of Public Health, who recently published a book on integrated diabetes care, challenged providers to “think outside the traditional medical model” in breaking down the barriers to effective diabetes treatment and prevention.

For example, it may work better to bring diabetes education to the patient at their primary care providers’ offices rather than refer patients out to other locations, Zgibor said. “People trust their primary care doctors and like that they don’t have to make extra appointments.”

The roundtable drew representatives from across the Tampa Bay area, including the American Diabetes Association, JDRF, the YMCA, Tampa General Hospital, Tampa Family Health Centers, and the Pinellas County Urban League

Dan Vukmer, JD, senior associate vice president of network integration for USF Health, suggested the group may want to include representatives from managed care and health insurance plans, who have an vested interest in keeping a community healthy, in future discussions.

Pattye Sawyer-Hampton, MA, director of health initiatives for the Pinellas County Urban League, emphasized the importance of family support in helping people manage diabetes.

“When someone lives with diabetes, it affects everyone in their family,” she said. “The patient needs continual family support to eat right and exercise, monitor their blood sugar and keep doctor appointments.”

Rep. Castor concluded the gathering by outlining some action steps, including her intent to share with the diabetes roundtable participants information about federal grant funding available and how to apply and to reach out to primary care providers and health plans.

Photos by Ryan Noone, USF Communications & Marketing

When patients take active roles in their own health care, outcomes improve. That’s the premise for a pilot program taking place in the USF Health’s Division of General Internal Medicine through a grant provided by the Centers for Disease Control and Prevention.

The six-month $12,000 study is a pilot project aiming to measure the efficacy of providing patient education group sessions to help patients control their diabetes, said Crystal Jacovino, DO, assistant professor of medicine and co-principal investigator for the study.

Diabetes patients watch a cooking demonstration as part of the nutrition section of the group education program.

“Each month, the group meets to discuss key topics that can help patients better manage their diabetes, from having a better understanding of the disease and its effect on their bodies to managing their medications to nutrition and physical activity,” Dr. Jacovino said.

“Measured against a control group, vitals and blood work will reveal whether the focused group education approach gives patients the information they need to take more active roles in successfully managing their diabetes. When we take a multi-disciplinary approach to patient care we are all working together to help educate our patients and improve their condition.”

Jerry Brown offers cooking tips for eating better carbs, as Dr. Jacovino reads a product label showing nutrition content.

As part of the study, the 12 patients in the education group were chosen randomly among consenting patients meeting the study criteria (Type 2 diabetes, ages 18 to 85 and A1C > 9%). The group of 12 is meeting once a month for six months; the program started in June and is set to wrap up in November. Members of the group also discuss their own concerns with other group members and health care experts and share tips each has learned for improving their own diabetes management. The results will help USFPG providers determine future programs for providing a group medical care model, Dr. Jacovino said.

The project also provides a critical learning opportunity for the resident physicians in training in the Division of General Internal Medicine, said Lucy Guerra, MD MPH FACP FHM, associate professor of medicine, associate director of the internal medicine residency program for USF Health, and director of the Division of General Internal Medicine.

“A major aim of the project and a core component of national resident educational goals is to offer innovative ways of delivering medical care,” Dr. Guerra said. “In this project has involved residents in every diabetic group visit, giving them that opportunity to see firsthand another option that could help their future patients succeed with managing their diabetes.”

Prior to the cooking demonstration, patients are taught best approaches to meal planning.

The education program is also part of a broader effort across the USF Physicians Group to create a patient-centered medical home for patients that coordinates care and reinforces a stronger patient-doctor relationship. In addition, the patient education program in the Division of General Internal Medicine dovetails with USF Health’s overall diabetes efforts that encompass not only patient care but also research and outreach.

Photos by Eric Younghans, USF Health Office of Communications.

A dog can be much more than simply the family pet.  For many people, their dog is a necessity for daily living – from navigating to retrieving items to sensing that blood sugar levels are dropping.

Michele Laine, nurse practitioner director for the USF Health Diabetes Home, with Hershey, a Labrador/Husky mix specially trained to detect fluctuations in blood sugar levels in patients with diabetes. Photo by Eric Younghans.

Called service dogs and canine companions, these unique animals take roles as people’s eyes, hands, legs and more.

To help raise funds and awareness for these dogs, USF Health is hosting the Tampa DogFest 2015 Walk ‘n Roll Nov. 8 to benefit the Canine Companions for Independence program (more details below).

Photo courtesy of CCI.org

The USF Health event will include a walk, silent auction, bake sale, dog photography, a kids’ activity table and, of course, visiting service dogs.

There are several ways to help. Donations can be made directly to the Tampa effort by visiting the Canine Companions website. You can also narrow your donation on that page to a USF Health team that will be walking Nov. 8 at the USF Health event, or start your own team and begin collecting sponsorships and donations. You can also provide items and services that can be included in the gift baskets that will be auctioned off for funds.

Gracie provides some de-stressing pet therapy for USF Health students at the Shimberg Health Sciences Library. Photo courtesy of the Shimberg Library.

You can also donate at the event, which is where you can meet some of the many folks benefiting from these service dogs, as well as those who help raise and train canine companions.

There are challenges people with disabilities face every day and canine companion assistance dogs are highly trained to help children, adults and veterans live more independently, said Karen Burdash, associate executive director of the USF Physicians Group and associate dean of the USF Health Morsani College of Medicine.

“Vets have served us, so it’s the least we can do for them,” Burdash said. “Wounded vets who might not have the ability to lead a full life can turn to a canine companion for help.”

Photo courtesy of CCI.org

Canine Companions for Independence provides highly trained assistance dogs to children and adults with disabilities, including veterans with physical disabilities. There is no charge to the recipient for the dog but training and on-going follow-up services ends up costing at least $50,000 per dog. Training a dog to be a service dog takes months. Following the intensive training, dogs are matched with a recipient, who has also undergone evaluation. Then, when a match is made, both dog and recipient undergo six weeks of training together.

The USF Health DogFest Walk ‘n Roll is aiming to raise at least that $50,000 to help a local veteran get matched to a dog, Burdash said.

“One of our main goals for this DogFest walk is to be able to say that USF Health was able to help raise enough to sponsor a dog to help someone,” she said.

As a longtime proponent for rescuing and training therapy dogs, Burdash said she can tell pretty quickly whether a dog has the temperament to be a therapy or service dog.

Karen Burdash with pet therapy dog Eric. Photo courtesy of Karen Burdash.

“Some dogs just show an affinity for helping,” she said. “It’s truly rewarding to me. The look on people’s faces when there is a good match is wonderful. And when a dog is really enhancing the quality of life for someone, that’s magical. That’s making someone’s life better.”

Details:

Tampa DogFest 2015 Walk ‘n Roll

Sunday, Nov. 8, 11 a.m. to 3 p.m.

At USF Health, east side of CMS building on the corner of Bruce B. Downs and USF Holly

The free event is open to the community. Donate or register a team at cci.org/dogfesttampa

Photo courtesy of CCI.org

Staff dog Snitch (note his ID card) also offers pet therapy to USF Health students at the Shimberg Library. Photo by Eric Younghans.

The USF-led study may lead to drug therapies to replenish cells destroyed or damaged by diabetes

Tampa, FL (Sept. 23, 2015) — Cells that express neurogenin 3 (NGN3) may one day be harnessed to create a plentiful supply of insulin-producing beta cells for the treatment of diabetes, a study led by researchers at the University of South Florida suggests.

NGN3 is the master gene driving development of the human endocrine pancreas, including the beta cells that make and secrete the hormone insulin, which helps control blood sugar levels. In type 1, or juvenile, diabetes, insulin-producing beta cells are destroyed by the person’s immune system, and patients need insulin injections to survive. Patients with the more common type 2 diabetes, referred to as adult-onset diabetes, produce insulin but their bodies cannot use it properly, and they often require extra insulin.

In a study recently published in the journal PLOS ONE, researchers from the Children’s Research Institute, USF Health Morsani College of Medicine; Johns Hopkins University School of Medicine; and the University of Illinois at Chicago, detected the NGN3 protein in histologically normal pancreatic biopsies from two sources — cadavers and patients requiring biopsy for diagnostic purposes.

Michael Shamblott, PhD

“NGN3 expression in the adult pancreas was unexpected, because it cannot be detected in the adult rodent pancreas – only during fetal development,” said the study’s principal investigator Michael Shamblott, PhD, an endowed chair of pediatrics at the Children’s Research Institute, USF Health Morsani College of Medicine, whose research focuses on regenerative cell therapies to replenish the insulin-producing cells destroyed or damaged by diabetes.

The researchers found NGN3-expressing cells in the exocrine pancreas, the part of the pancreas that produces digestive enzymes.  NGN3-expressing cells closely match the characteristics of both mouse and human endocrine “progenitor” cells that give rise to all and only cells in pancreatic tissue known as islets.  These cells can be collected from cadaveric pancreas tissue or from the patient’s own pancreas and coaxed to resemble beta cells that produce and secrete insulin.

Islet transplantation as a means of reversing diabetes has been hampered by the limited durability of grafts and scarcity of pancreas donors. It can take multiple donors to yield enough islet cells for one recipient and donor tissue is not matched to the recipient so strong immunosuppressive drugs are required to avoid rejection.

“Now that we know these NGN3 cells are a normal part of adult human pancreas biology, we can learn to increase them and to coax them towards becoming differentiated pancreatic endocrine cells by using specific drugs,” Dr. Shamblott said.  “Our goal is to regenerate functional beta cells that can cure diabetes.”

The researchers have also discovered several pathways regulating NGN3 in the adult pancreas, which may be targets of future drug treatments of diabetes, Dr. Shamblott said.

Article citation:
Danielle L. Gomez, Marci O’Driscoll, Timothy P. Sheets, Ralph H. Hruban, Jose Oberholzer, James J. McGarrigle, Michael J. Shamblott, “Neurogenin 3 Expressing Cells in the Human Exocrine Pancreas Have the Capacity for Endocrine Cell Fate,” PLOS ONE, Aug. 19, 2015, DOI: 10.1371/journal.pone.0133862.

About USF Health

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation.  For more information, visit www.health.usf.edu

Media contact:
Anne DeLotto Baier, USF Health Communications and Marketing
abaier@health.usf.edu or (813) 974-3303

Dr. Troy Quast suggests opportunities exist for improving quality of care with minimal effects on cost

Tampa, FL (June 30, 2015) – Are higher costs in health care for diabetes patients always associated with higher quality goods and services?  Not necessarily, writes Troy Quast, PhD, in the June issue of  The American Journal of Managed Care.

The publication, “Quality of Care and Relative Resource Use for Patients With Diabetes,” investigates the relationship between the quality of care and relative resource use of health plans in treating enrollees with diabetes, one of the most prevalent conditions in the United States.

“I find that better outcomes are, in fact, not always associated with higher costs, but that this association varies by the type of health insurance plan and geographic region,” said Quast, who this July will  join the University of South Florida College of Public Health in the Department of Health Policy and Management.

Troy Quast, PhD

Quast’s study consisted of 813 observations from a sample of 407 commercial health plans submitted to The National Committee for Quality Assurance from 2009 to 2011.

The study estimated correlations between quality of care and various relative resource use measures, as well as year-to-year changes in quality and relative resource use.

The findings suggest that quality and relative resource use are not necessarily positively related and that some resources might not be used efficiently. Furthermore, the study’s findings provide insight into the geographic variation in health care utilization.

An associate professor with research interests in health economics, Quast said that he’s very interested in looking into ways to obtain better outcomes for patients without incurring higher costs.

“My hope is that my study provides insight into contexts where this may be possible,” he said.

-USF College of Public Health-

Established in 1984 as the first college of public health in the State of Florida, the USF College of Public Health is a recognized leader in community health, online education, maternal and child health, social marketing, and global infectious disease research. The college offers multiple online and on-campus concentrations that lead to MHA, MPH, MSPH, DrPH, and PhD degrees, as well several dual degrees, graduate certificates, and special programs.  To learn more about the college and its 1600 students who commit to passionately solve problems and create conditions that allow every person the universal right to health and well-being, visit www.publichealth.usf.edu.

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 50^th in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu.

Media contact:
Natalie D. Preston, USF College of Public Health, npreston@health.usf.edu

Written by Annamarie Koehler-Shepley, USF College of Public Health

Even the routine tasks for people with diabetes can be a challenge – as medical students in the SELECT program at the USF Health Morsani College of Medicine are now learning.

SELECT students agreed Thursday to take the “Bringing Science Home Diabetes Challenge.” They’ll carry a blood sugar monitor with them for the next 24 hours, check their blood sugar every few hours, respond to text messages about their diabetes and keep a journal on their experience.

SELECT student Emma Qureshey gets some help testing her blood sugar.

Students soon realized that even the basic step of sticking a finger and collecting enough blood to test their glucose level is harder than it looks. Several students needed help to set up the monitors and advice on how to squeeze out more blood.

“We all thought it would be kind of easy,” said Jennifer Chevinsky. “And now we’ve already spent 10 minutes trying to figure out how to check our blood. So I think we’ll gain a good amount of perspective by the end.”

The challenge is sponsored by Bringing Science Home, the USF Health program established to help people with chronic diseases live more optimistic lives. SELECT (Scholarly Excellence, Leadership Experiences, Collaborative Training) is a two-year old partnership with the Lehigh Valley Health Network that emphasizes developing emotional intelligence skills and leadership abilities for tomorrow’s physician leaders.

Nicole Johnson, executive director of Bringing Science Home, and high school student Emma Donahue talk with SELECT students.

SELECT program students sat down Thursday to hear from Nicole Johnson, executive director of Bringing Science Home, and several students and family members associated with the program.

“My mom said right from the get-go I have to check my blood sugar before I get in the car,” high school student Emma Donahue, who has diabetes, told the group. She knows that if her blood sugar drops, it may impair her driving ability.

Donahue always keeps her car stocked with snacks and extra testing supplies, just in case.  She also told the group about the challenges of controlling her blood sugar and participating on her high school swim team – an issue that struck close to home for some of the SELECT students.

“I was a swimmer in high school, and swimmers get light-headed,” said SELECT student Emma Qureshey. “We used to eat Jell-O packs between races – and that’s with normal blood sugar.”

That kind of understanding is exactly what Johnson is aiming for. USF graduate psychology students are also participating, and Johnson plans to sign up other student groups for the “Diabetes Challenge” as well.

Emma Donahue talks about living with diabetes.

Johnson told the SELECT students Thursday that she knows three separate instances of high school teachers mistaking an insulin pump for a cell phone and trying to confiscate it – pulling the pump right out of the student’s body.

There are scarier possibilities as well. People with diabetes – and their family members – worry especially night time lows, which can be deadly if they don’t wake up. They are especially dangerous for young adults, who may not live with someone who can check on them.

“You’ll be getting one day in our shoes,” she told the group.

Learn more about Bringing Science Home at www.bringingsciencehome.com

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