Obesity and diabetes (type 1 and type 2 diabetes) are enormous health burdens both on an individual and on a societal level. We conduct clinical research with the goal to shed light on the underlying pathophysiologic mechanisms, contributing factors and to improve treatment for each one of these conditions.
Type 1 diabetes: We tested immunomodulation with oral, low dose interferon-alpha in children with new onset type 1 diabetes, and replacement of pancreatic beta cells (islet transplantation) and beta cell regeneration with a GLP-1 analogue in adults with long-standing type 1 diabetes. Despite not having been able to reconstitute sufficient beta cells to achieve insulin independence, our results with GLP-1 analogue treatment in addition to insulin administration have been promising (improved insulin sensitivity, reduced insulin requirements and lower body weight).
Type 2 diabetes: We developed clinical protocols to test beta cell rest in adolescents with type 2 diabetes and initiated a study to evaluate a peer support intervention in this cohort. Our experience with difficult recruitment and retention was a valuable lesson which we explored in depth. Future studies will address potential side effects of novel diabetes drugs, which is of particular importance for youths with type 2 diabetes due to the expected duration of treatment.
Obesity: My team is especially interested in clarifying the role of artificial sweeteners, which have been associated with obesity in epidemiologic studies. In contrast, results of interventional studies are much less clear.
Additional topics of interest include the endocrine features of rare diseases associated with lipodystrophy, e.g., PIK3CA-related overgrowth disorders, dermatomyositis and CANDLE syndrome.
A main focus is the elucidation of health effects of artificial sweeteners, which have been shown to alter hormonal regulation (e.g., GLP-1, insulin) and which may affect the gut microbiome. Additional questions addressed in our ongoing projects are whether 1) certain artificial sweeteners interact - directly or indirectly - with medications and 2) newborns are exposed to sweeteners via breast milk.
This research is especially relevant for 1) individuals who are recommended to replace sugar with artificial sweeteners: overweight and obese individuals and persons with diabetes, and 2) children, since their artificial sweetener use is rising rapidly, which is partially driven by the awareness of negative health effects of refined carbohydrates.
We are also conducting a clinical trial to investigate side effects of novel diabetes drugs, and we collaborate with our colleagues on characterization of endocrine features in autoinflammatory & autoimmune diseases associated with lipodystrophy, e.g., CANDLE syndrome and dermatomyositis.