Passion for pediatric diabetes: A conversation with Kristen Nadeau, MD, MS
Pediatric diabetes research is an area that hits close to home for Kristen Nadeau, MD, MS, professor of pediatric endocrinology at the University of Colorado Anschutz Medical Campus.
A member of the Prairie Band of Potawatomi, Nadeau worked on two Native American reservations in medical school and observed a rising medical problem within the population.
“I saw the growing rates of type 2 diabetes in the Native American population, and the first youth that were being diagnosed with type 2 diabetes was happening during that time,” Nadeau told Healio. “That's when I realized that I wanted to go into endocrinology, specifically in pediatrics, because it was now clear that childhood obesity and resulting type 2 diabetes was a new, growing problem that really needed attention.”
Nadeau, who also serves as research director of pediatric endocrinology and bariatric surgery at University of Colorado, co-chair of the University of Colorado NIH Diabetes Research Center Complications Core, director of the University of Colorado Medical School Longitudinal Mentored Scholarly Activity Program, and pediatric chair of the CU CCTSI Scientific Advisory and Review Committee, is being honored for her work in elucidating the mechanisms behind insulin resistance in youths with diabetes. Nadeau is the recipient of the 2021 Outstanding Scientific Achievement Award at the American Diabetes Association Scientific Sessions. The award is given annually for research in diabetes that demonstrates independence of thought and originality.
Nadeau recently spoke with Healio about some of the most interesting studies she has participated in, the two people she admires the most, and some of her hobbies and interests outside of medicine.
Healio: Have you ever been fortunate enough to witness or to have been part of medical history in the making?
Nadeau: Right as I was beginning my pediatric endocrinology fellowship, I became a part of the TODAY study, which is a national study of youth with type 2 diabetes. Being a part of that study for the past 17 or so years, I’ve learned what a critical issue youth-onset type 2 diabetes is, how difficult it is to treat and how it also appears to be different from type 2 diabetes in adults. The RISE study — a study comparing youth directly to adults — is revealing how much work there is to be done and what a significant problem this is. We need to know more about what happens with the endocrine system during puberty and how that makes the development and progression of type 2 different for youth.
Healio: What advice would you offer a student in medical school today?
Nadeau: Try to pick an area that you really love and that gets you out of bed in the morning. Some people try to focus on work-life balance so they feel they can be happy overall. Not to minimize that, but if you find something that you're passionate about and love, then work doesn't have to be a chore; you don't feel like you have to have something else to balance it out if you really like what you're doing.
One way to try to do that is to find activities and things you can get involved with that are what we call a “three-way win” — something that helps to advance your science career, but also is something that your family could be involved with and benefit from, and something that you get personal satisfaction out of, like advocacy. We don't have enough time in the day to do everything, and so finding things you can be passionate about helps to advance all the parts of what makes you a whole person.
The other thing I would say to medical students is to make sure you are starting your research question with a hypothesis, but to have an open mind. You never know what you're going to find. If you go into it trying to prove your hypothesis and prove what you think is the correct answer, you may actually find information that’s just not correct. Try to have an open mind to what you might find, and that may actually lead you in different, but exciting directions.
That’s what we found regarding insulin resistance in type 1 diabetes. We initially had a study design where we were trying to compare people with type 1 diabetes, who we thought did not have insulin resistance, to those with type 2 diabetes with similar glycemic control, but with insulin resistance. We found we were totally wrong, as those with type 1 diabetes turned out to have insulin resistance, but discovering insulin resistance in type 1 diabetes opened up a whole new opportunity.
Healio: Whom do you most admire and what would you ask that person if you had 5 minutes him/her?
Nadeau: Drawing on my Native American roots, I would pick a pair of two people, because they accomplished something similar simultaneously. In 2018, US Rep. Sharice Davids of Kansas and Rep. Deb Haaland of New Mexico were simultaneously elected as the first Native American women in Congress, so they were the two firsts at the same time. Sharice Davids, in addition to being a Native American woman, is also in the LGBTQ community. These women really are trailblazers in their area and are amazing examples of advocacy for the underserved. Deb Haaland is now the US Secretary of the Interior, so for the first time ever we have a Native American overseeing the Bureau of Indian Affairs. What I'd like to ask them about is how they keep going as the first Native women, and how they find the courage to lead in an area where they may have different opinions from people around them.
Healio: What are your hobbies and interests outside of practicing medicine?
Nadeau: I have always had a passion for trying to encourage kids— and especially girls because they seem to be more affected by type 2 diabetes — to be physically active. I've done that over the years by activities like coaching soccer and basketball. As my kids were getting a little bit older, I hated to see that the girls especially started t to drop out of sport or kids not participating when the intensity of time commitment got higher, costs rose and travel became necessary.
Most recently I have been trying to work with the martial arts. The neat thing about the martial arts that I've participated in is that it's multi-generational, so young kids, middle-aged, older people, all doing it together and having a focus on meeting wherever people are at and advancing their individual goals rather than having to make a team. And I love how often the kids can teach the adults, more than the other way around, giving leadership and confidence building opportunities to kids. Through COVID-19, being able to continue martial arts online kept me going. I got my black belt during COVID-19, which I'm most proud of, and I'm working on getting instructor status to keep me motivated, but also to help work with kids. We also recently started a scholarship to help provide funding for underserved kids to access martial arts and leadership training.
Healio : Are you currently working on any interesting research and, if so, what is it?
Nadeau: Three main areas of focus right now. One is trying to see if we can use adjunctive therapies in type 1 diabetes to address insulin resistance, cardiovascular disease and obesity in type 1 diabetes. Glucose control is important, but we're also thinking about the whole picture of other ways that we can reduce cardiovascular risk and other complications in type 1 diabetes, especially when obesity is also present. We have another study right now that examines bromocriptine, another type 2 diabetes medicine, in type 1 diabetes and are thinking about next steps of other similar approaches to try to improve insulin resistance in type 1 diabetes.
We also learned how severe type 2 diabetes can be in youth. In the area of prevention, we are studying whether improving sleep in youth, or improving depression in youth can help to prevent diabetes, especially in youth who have difficulties with diet and exercise, to find other ways we can help to support them.
The last is on the other end of the spectrum of youth who already have complications of diabetes. We're looking at the role of bariatric surgery in treating youth with type 2 diabetes and, in particular, trying to understand why it seems to be working well. We’re trying to learn why bariatric surgery seems like it may be working because if there are other ways we could mimic the results of surgery, we could avoid having to do something so invasive as surgery.