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National Institute of Diabetes
and Digestive and Kidney Diseases

Wednesday, January 29, 2003
Joan Chamberlain
or Jane DeMouy
(301) 496-3583

Help Wanted: Pediatric Endocrinologists
Funding Will Help Train Researchers in Childhood Diabetes

To enlarge the pool of pediatric endocrinologists conducting diabetes research, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recently awarded research training and career development grants to seven medical centers with strong research programs in childhood diabetes.

"With this funding, we hope to create a pipeline of new and talented investigators whose focus is pediatric diabetes research," said Dr. Judith Fradkin, director of NIDDK's Division of Diabetes, Endocrinology, and Metabolic Diseases. "These awards support not only research fellowships but also a longer period of research career development until a junior researcher is ready to begin an independent career."

The NIDDK awards went to Baylor College of Medicine in Houston, TX; University of Colorado Health Sciences Center in Denver, CO; Washington University School of Medicine in St. Louis, MO; Joslin Diabetes Center in Boston, MA; Children's Hospital of Pittsburgh, PA; The Children's Hospital of Philadelphia, PA; and Yale University in New Haven, CN.

"Now is a wonderful time to consider a research career in childhood diabetes," said Dr. Georgeanna Klingensmith, who heads the Division of Pediatrics at the Barbara Davis Center, University of Colorado Health Sciences Center. "Diabetes research has progressed dramatically in the last 5 years, and many developments on the horizon can make a big difference. We need young people with energy and enthusiasm to take these new findings in molecular biology, genetics, and immunology and put them together to move the field ahead."

The scarcity of pediatric endocrinologists, reflected in the many unfilled vacancies for these specialists in medical centers around the country, has impeded clinical research in pediatric diabetes. Specifically, a shortage of clinical investigators has hindered research at a time when the momentum of basic research discoveries has rapidly accelerated. Physician scientists are needed to speed the flow of new information from the bench to bedside.

"We have a number of open faculty positions. We could hire two or three today, but we can't find individuals with in-depth training to fill them," noted Dr. Morey Haymond, chief of Pediatric Endocrinology and Metabolism at Baylor College of Medicine, one of the centers receiving the NIDDK awards. "I get letters almost weekly from institutions looking for pediatric endocrinologists at any level — assistant, associate, or full professor — to get their programs going. However, very few physicians are entering our training programs. And in the last decade, many of our colleagues have left — gone to industry or retired early."

Pediatric endocrinologists begin their careers as pediatricians. To be eligible for pediatric endocrinology training, a medical school graduate must first complete a 3-year pediatric residency. A fellowship in pediatric endocrinology normally takes 3 years. The burden of debt and the length of training discourage many potential candidates from pursuing subspecialty and clinical research careers.

The awards, through the T32 (institutional research training) and K12 (clinical scientists career development program) grant mechanisms of the National Institutes of Health (NIH), provide for 2 - 3 years of fellowship training as well 2 - 3 additional years of support for a junior clinical investigator in diabetes, for a total of 5 years. The funding supports up to five positions at each medical center. The center is free to decide how many of the five slots will be reserved for pediatric endocrinology fellows or investigators who are transitioning from fellowship to independent scientists.

The NIDDK, with support from the American Diabetes Association and the Juvenile Diabetes Research Foundation International, has been working to expand the cadre of pediatric endocrinologists pursuing careers in diabetes research. Support for the new training programs, which totals $17 million over 5 years, comes from special statutory funding for type 1 diabetes research, which was recently extended by $150 million annually for the next 5 years.

To attract physicians to clinical and pediatric research, the NIH, a component of the U.S. Department of Health and Human Services, has introduced a loan repayment program that offsets some of the educational debt incurred by many graduates in the health professions. Qualified candidates who agree to conduct pediatric research 50 percent of time, or not less than 20 hours per week, for a 2-year consecutive period may apply for the program. Program participants may receive up to $35,000 annually in educational loan repayment, depending on total educational loan debt. For more information, see http://www.lrp.nih.gov/.

Diabetes afflicts about 17 million people in the United States and is the sixth leading cause of death. About 1 million Americans have type 1 diabetes, formerly known as juvenile onset or insulin-dependent diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood glucose. This form of diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive. Insulin treatment, however, is not a cure, nor can it reliably prevent the long-term complications of the disease.

Type 2 diabetes, which accounts for up to 95 percent of diabetes cases in the U.S., is most common in adults over age 40. Affecting about 8 percent of the U.S. population aged 18 and older, it is strongly associated with obesity (more than 80 percent of people with type 2 diabetes are overweight), inactivity, family history of diabetes, a history of gestational diabetes, and racial or ethnic background.

Once seen only in adults, type 2 diabetes has been rising steadily in children, especially minority adolescents — African Americans, Hispanic Americans, and Native Americans, according to reports from clinics around the country. Although there are no population-based national data, studies in Cincinnati, Charleston, Los Angeles, San Antonio, and other cities indicate that the percentage of children with newly diagnosed diabetes who are classified as having type 2 diabetes has risen from less than 5 percent before 1994 to up to 30 - 50 percent since 1994.

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