- Clinical Investigator, NIDDK, NIH, 2000-present
- Senior Fellow, NIDDK, NIH, 1998-2000
- Visiting Associate Pediatric Endocrinology, NICHD, NIH, 1995-1998
- Visiting Scientist Institute of Molecular Biology II, University of Zurich, Switzerland, 1994-1995
- Fellowship in Pediatric Endocrinology, Massachusetts General Hospital and Mayo Clinic, 1991-1994
- Residency in Pediatrics (years 2 and 3), Mayo Clinic, 1989-1991
- Internship in Pediatric Endocrinology, Children's Hospital Zurich, 1988-1989
- Residency in Pediatrics (year 1), Mayo Clinic, 1987-1988
- M.H.Sc., NIH and Duke University, 2008
- M.D. & Doctoral Thesis, Albert Ludwigs University Freiburg, 1986
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 identify contributing factors and to improve treatment for each one of these conditions.
Obesity: My team is especially interested in clarifying the role of artificial sweeteners, which have been associated with obesity in epidemiologic studies. These food supplements are being used with increasing frequency (e.g., 200% increase in children over the last 2 decades). They affect hormonal responses and are not metabolically inert as previously assumed. Since artificial sweetener exposure begins early in life (intra-utero and postnatally), we are investigating the consequences of this exposure. We are also studying whether artificial sweeteners change the absorption and metabolism of medications.
Type 2 diabetes: We developed clinical protocols to test beta cell rest in adolescents with type 2 diabetes and 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. We are also interested in identifying mechanisms by which novel diabetes drugs may impact long-term health (e.g. increase fracture risk), which is of particular importance for youths with type 2 diabetes due to the expected long duration of treatment.
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).
Genetic conditions associated with endocrine phenotypes: 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 affect the gut microbiome. In our ongoing projects, we focus on artificial sweetener exposure early in life, study their effects on adipogenesis, and try to find out whether they interact - directly or indirectly - with the absorption and metabolism of medications.
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.
Need for Further Study
Examples of areas which need to be explored are:
- long-term effects of artificial sweetener ingestion on the human metabolism, body weight regulation, neurocognition, behavior and on food preferences
- long-term effects of diabetes drugs, especially when given in combination and to vulnerable individuals (children, persons with certain comorbidities).
- How Non-nutritive Sweeteners Influence Hormones and Health.
- Rother KI, Conway EM, Sylvetsky AC.
- Trends Endocrinol Metab (2018 Jul) 29:455-467. Abstract/Full Text
- Factitious hypoglycemia in children and adolescents with diabetes.
- Bauman V, Sturkey AC, Sherafat-Kazemzadeh R, McEwan J, Jones PM, Keating A, Isganaitis E, Ricker A, Rother KI.
- Pediatr Diabetes (2018 Jun) 19:823-831. Abstract/Full Text
Research in Plain Language
My research focuses on artificial sweeteners and their effects on our metabolism. To learn more about these food additives is especially important for persons who are overweight/obese and for individuals with type 2 diabetes, a condition that until recently was typical for older adults who are obese. Nowadays it is also seen in children and adolescents. My team is also interested in finding out more about long-term side effects of diabetes drugs, and hormonal abnormalities in children who have diseases in which the body develops immune responses against itself. Two of these conditions are called CANDLE syndrome and dermatomyositis.
- Artificial Sweeteners and Obesity - More than an Association
- Outsmart Diabetes: A Framework for Prevention and Management
- Challenges of the Rising Incidence of Childhood Diabetes