Laura Whittington, DO - Sanford Health News

Researchers targeting autoimmune diseases

Courtney Collen (Host):

Hello, welcome to Her Kind of Healthy, a health podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. This series is starting brand new, honest conversations about self-care, healthy living and so much more today. We’re talking about the new PLEDGE study through Sanford Research, which is a really unique opportunity to identify and predict which children may be at risk of developing autoimmune diseases, like type 1 diabetes and celiac disease. Dr. Kurt Griffin, a pediatric endocrinologist, is leading the PLEDGE study. We also have Dr. Laura Whittington, a pediatrician with Sanford Children’s.

Let’s talk about these two diseases and children. Talk about maybe some of the challenges that families who have children diagnosed with celiac or type 1 diabetes might face.

Dr. Laura Whittington:

Children are at about – we see about half of a percent of the population who will develop type 1 diabetes. Kids with type 1 diabetes, they go through a lot. It’s a lot to have to monitor blood sugars. It’s a lot to have to memorize, to know how much I need to bolus. If I eat a certain food, it’s a lot of education. And so that’s a lot to deal with for all of these families, as far as celiac disease. I mean also huge for education on that. Being on a gluten-free diet for the general population, they can certainly go on a gluten-free diet, but it’s not going to help them necessarily for kids who have celiac, they have to have a gluten-free diet. If they don’t, oftentimes we will see issues with how they’re growing. They’re going to have issues with abdominal pain, maybe diarrhea, vomiting.

Courtney Collen (Host):

Dr. Griffin, I want to bring you back in what does it cost to participate?

Dr. Kurt Griffin:

So because it is research, there is no cost. This is something that Sanford is contributing to significantly and providing a lot of services in kind. We’re also very fortunate that the Helmsley Charitable Trust has also been supporting this and is helping support some of the financial side of that.

Courtney Collen (Host):

So a child under six comes in with their parent or guardian, gets a finger prick. When did the results come back and how are those presented?

Dr. Kurt Griffin:

So the results come back kind of like any other result. So they need to be signed up for the, my chart, which is how they can also communicate with the clinic. And once the family has that any lab results that they get and, you know, they come in and if they’re getting a lead level at the same time, for example, that’ll show up on their chart and this shows up just the same way. And the nice thing is almost everybody we test is going to be negative. And we’re looking for those rare people that then we will follow up. And when that comes back, there’s a message at the bottom of the page that says, if there is a positive antibody, we will contact you in the, my coordinators on the research side, we’ll reach out to them in short order. And then we’ll set up, how do we follow with this?

You know, because seeing that positive antibody, you know, probably means you’re at least at some higher risk of getting that child is at higher risk of getting type 1 diabetes. We don’t want to just say, okay, go home and worry about this. We want to say, all right, let’s first of all, let’s double check this, be sure it’s real. And then that’ll help us decide how often do we want to monitor? And we really that’s going to be the one thing we can promise comes to this is if we monitor closely enough, we can prevent them from getting really sick when they come in. And really at this point, particularly on kids, the majority of them, when they’re diagnosed, they come in sick enough during intensive care for awhile. That’s one thing I know we can prevent almost completely. There may be some that sneak through, but we can do well with that. Beyond that, that’s where again, moves back more on the research side. I put my research side up and, you know, that’s where there’s some things we’re trying that are starting to show some promise. We can slow it down. Eventually, yes, our goal is to prevent it. You know, pediatrics is preventative medicine specialty, and you know, that’s, that’s the attitude we want to take with type 1 diabetes.

Courtney Collen (Host):

So having this information when kids are young is so valuable, isn’t it?

Dr. Kurt Griffin:

I think so. The reality is even if we can’t change what happens, we can at least catch it before he gets really severely sick. And yet there will be more things that we can do.

Dr. Laura Whittington:

I agree. It’s invaluable to know who is at higher risk. That way we can kind of help them monitor closely and they don’t end up in the hospital, hopefully.

Courtney Collen (Host):

Yeah. You know, expecting moms or moms of young children are so busy planning all the time, planning ahead, or if they’re pregnant planning for baby, why would this be an important screening to add to their list when it comes to the health care for their children?

Dr. Laura Whittington:

I think all families are going to want to know if their child is going to be at risk for really any disease. And so knowing if they’re at a high risk for type 1 diabetes, I think should be also on everyone’s list. It’s very easy. We make the process very easy when they come into clinic. If the family is interested in the study and they are signed up for My Chart, we can get everything done that day. And that way busy families don’t have to come back to clinic. We have them sign up through My Chart. So they do have to pull up My Chart or we can pull it up on our computer and have them sign into their account. And it’s a very quick process to go through the consent. As soon as we have the consent process done, the labs are ordered and they can stop at lab on their way out of clinic.

Courtney Collen (Host):

Dr. Griffin, why did you decide to lead this study?

Dr. Kurt Griffin:

So I’m a pediatric endocrinologist. So I wound up spending a lot of time with the families and the children that have type 1 diabetes and working with them, you know, to manage that disease. You know, it’s a disease that you can’t take a break from. If you take, for example, somebody with high blood pressure, if they stop taking their medicine for a week, probably not the smart thing to do, but it also probably isn’t actually going to kill them that week. Whereas if one of my kids stops taking insulin, that is going to be a big problem. And being off on how many carbs you’re counting for that meal means your blood sugar is going to be off because your insulin dose is off. And it’s something that you can never kind of take a break from. And as you know, we’re treating with insulin.

We’re replacing what the body can’t make, which I think is already in some ways a very elegant approach, but it doesn’t take care of the underlying autoimmunity. And that’s what really drives me. I’ve been working on clinical trials for immune modulation. How do we take people that have just been diagnosed? And there’s some drugs that have been used, particularly rheumatoid arthritis that tend to work pretty well there that we’ve been trying to use in diabetes without a lot of great success. The idea of moving this earlier and catching kids before their immune system is that aggressively attacking while they still have more of their beta cells making insulin. That’s something that we’ve for years been saying is what we need to do because it’s going to be easier. And it’s just about a year ago that a trial nets trial of a drug for kids that didn’t have full-on diabetes yet actually showed us, yes, that’s right. So how do we move this earlier and earlier where we can also probably use it more gentle, safer, more targeted approaches? That’s what really drives me because, you know, taking care of the families and the children with type 1 diabetes, you know, we can do that. I would be much happier if I could stop kids from getting to where they need that.

Courtney Collen (Host):

How proud are you to see Sanford providing this opportunity to families?

Dr. Kurt Griffin:

I have to say, it does make me proud of the organization that it’s willing to commit so many resources and so much effort to this. And there’s a lot of effort on the back end that’s hidden from view. We’ve talked about how easy we’re trying to make it from everybody from, you know, the kids giving the sample, to the family signing up, to the providers and the clinic staff, all that has taken tremendous lifting from the it side of things on the, how do we make it so that we can make this streamlined. And we’re actually using Epic and the, My Chart and messaging in a way that nobody has done before. So there’s been a lot of invention and a lot of engineering to make it happen. That is really impressive. Further, Sanford has made a commitment to type 1 diabetes. This I think is where we’re going to get the biggest payoff. And certainly if we can actually show that, not only can we do this, but we can do it in a cost-effective way so that eventually it does become standard of care. This will be an impact potentially for every child, not just here, not just in our system, eventually every child. That’s humbling.

Courtney Collen (Host):

Yeah. I can imagine. Is there anything else Dr. Whittington or Dr. Griffin that you want families to know who at home might be listening in to learn more about this PLEDGE study? What do you want them to know about enrolling their children and getting involved in advancing this research?

Dr. Laura Whittington:

I would recommend any family or any parent who has questions or concerns. They can certainly reach out to our clinic. They can talk to their primary pediatrician and get more information. If they’re interested, we can certainly send them a My Chart message or have the research team, send them a My Chart message. So they get more information.

Dr. Kurt Griffin:

Part of any research project is we have to ensure that people understand what they’re signing up for and that, you know, it always, you know, one of those things from the review board is we always have to make sure that all their questions are answered. So if they have questions, we really do want to talk to them ahead of time, get those squared away, and then help them to make an informed decision about this.

Courtney Collen (Host):

Well, thank you both so much for being here. I look forward to learning more about how the PLEDGE study will advance research in auto-immune diseases, especially as it relates to our children. We appreciate your time.

Dr. Kurt Griffin:

Thank you.

Dr. Laura Whittington:

Thank you.

Courtney Collen (Host):

Stay well. Have a great day.

Learn more about this topic

• Minnesota boy one of first to receive new diabetes treatment
• Ep. 8: Research screenings give rare disease families hope
• Sanford Health receives grant to enhance PLEDGE Study

Get more episodes in this series

How to enroll in type 1 diabetes prediction study

Courtney Collen (Host): Hello, welcome to Her Kind of Healthy, our health podcast series brought to you by Sanford Health. I’m your host Courtney Collen with Sanford Health News. This series is starting brand new, honest conversations about self-care, healthy living and so much more today.

We’re talking about the new PLEDGE study through Sanford Research, which is a really unique opportunity to identify and predict which children may be at risk of developing autoimmune diseases, like type 1 diabetes and celiac disease. I have the pleasure of sitting down with two Sanford Health providers to tell us more about PLEDGE and advancing science through autoimmune diseases. Dr. Kurt Griffin, a pediatric endocrinologist, is leading the PLEDGE study. We also have Dr. Laura Whittington, a pediatrician with Sanford Children’s, here to explain why this opportunity is so important and answer some of those more commonly asked questions. Thank you both so much for being here.

Dr. Kurt Griffin: Thank you for having us.

Courtney Collen (Host): Dr. Griffin, we’ll begin with you. Tell us what this PLEDGE research study is.

Dr. Kurt Griffin: My area that I focus on for research is type 1 diabetes. And at its heart, this is an autoimmune disease where the immune system that’s supposed to keep us healthy is instead attacking those cells that make insulin. This is something that usually by the time we know somebody has it it’s full-blown and we can treat it with insulin, but we’re not actually taking care of anything with the underlying process, at least to it. One of the things that we’re really working on is how do we figure out who’s on that path to getting type 1 diabetes? And how do we intervene earlier? And there’s an international group called diabetes. Trialnet who has been looking at this and screening family members of people with type 1 diabetes. And that’s where we’ve started to see some progress on, you know, there’s actually one study where we can actually show, we can slow it down a little bit, you know, by an average of two years of somebody getting it.

So that’s the first time that we’re actually starting to get some traction on this. The problem is if we’re looking just at family members of people who already have it, we’re missing more than 90% of the people that are going to get it eventually. So the problem is how do we spread it so that we can start looking more broadly? And this is something where it’s a great fit with Sanford Sanford as this large multi-state nonprofit organization that provides a lot of health care and also has an interest in fighting type 1 diabetes. This is a great match. And the goal here is how do we start to look at some of this screening and bake it into routine care and not just show that we can do it, but also measure outcomes from that that are financial, how much does it cost, but also how much is it saving down the road? And, you know, that’s something where we also have a population health research group. That’s very, has some very sophisticated modeling to help with that, with the goal of eventually showing this will actually pay for itself. And it’s worth implementing, not just here, but eventually this should be standard of care.

Courtney Collen (Host): Why these two diseases, type 1 diabetes and celiac together?

Dr. Kurt Griffin: Great way to put it because they, sometimes they oftentimes come together. And if you look at the kids who have type 1 diabetes, so they have an increased risk of having autoimmune thyroid disease, which, you know, we screen for as well, but also celiac disease. And some of that has to do with some of the genetics that kind of follow between the two of them. Celiac disease is also one of those where, you know, there’s a lot of awareness of that in the community. And a lot of questions about who may or may not actually have gluten sensitivity. And this is a question a lot of families kind of have anyway. So that’s kind of value added as long as we’re taking a sample. It turns out that the way we’re doing it, it’s just not costing us any more to provide this information. And it’s something that families and other places have found valuable.

Courtney Collen (Host): What exactly is this study collecting?

Dr. Kurt Griffin: So we’re collecting little bit of information, including, you know, who else in the family may already have diabetes in terms of physically collecting, we’re taking just a little bit of blood and at entry into the study, we take just literally a blood spot, which could even be incorporate into the newborn screen that every new baby gets, and then kind of around the two year well-child visit or around the pre-kindergarten visit. We’re trying to bake into that, collecting another sample for what we call auto antibodies. So markers at the body starting to attack the pancreas. So the sample for the auto antibodies, one of the things that has opened the doors to us, being able to do this now is not only have we a partner where we can get this done for, you know, very inexpensive cost to, to run the sample, but we can do on a very small volume. So rather than taking a whole big tube of blood, that may be a couple of tablespoons. We can do this on a finger stick and take a couple of drops, or we can take, you know, if you prefer a little bit of blood from a vein and particularly if a child’s already getting blood drawn is just one more small, very small tube that gets added onto that without even an additional poke.

Courtney Collen (Host): So it’s a very easy process.

Dr. Kurt Griffin: We’re actually trying to make it as easy as possible. And as I said, if we can piggyback on labs that are already being drawn so much the better we’re trying to make it as easy as possible for families to enroll in this. This is one things that, again, Sanford is really pushing the envelope on how this is being done by baking into routine care. Traditionally, there have been a few other places that have tried to do broader screening of the general population. And the way that usually works is you have a clinical research coordinator who’s specifically just for the study and he park him or her in a clinic or an emergency department. And every kid that comes in you offer. And then we go through the whole consent process and it’s fairly labor-intensive per specimen that he gets her per person, that he would enroll here.

Dr. Kurt Griffin: We’re actually leveraging the whole Epic, my chart that a lot of families are already using to communicate with the electronically and securely. So that that consent process actually gets presented to them there. And they can go through that. And as long as they don’t have questions that they need answered, they can actually do the consent themselves right there. That’s being again automated in a way where if we know someone’s coming in for well-child visit at the right window coming up in the next couple of weeks, we can send a message automatically to them. So they have time to look at it. They have time even to call us and we can answer any questions they have. And then the orders are already in the system so that when they’re here, they have their visit, they go to the lab and whatever labs they need for the study or outside the study get taken care of. And they go home easy. We try to make it as easy as possible for everybody. Yeah.

Courtney Collen (Host): And if a parent wants to enroll their child, how do they do that?

Dr. Kurt Griffin: There are really kind of two answers to that right now. We’re still in the process of ramping this up and the parents are coming to the clinics that are already open. We’ll be getting a message automatically. If it’s a scheduled visit, if it’s something that’s more of a sick visit, we can still do it then. And a lot of the providers are able to explain a little bit about what the study is. And if parents are interested in the clinic, there’s actually a way where they can sign up, right. Then they still have to go through the electronic consent process and be sure that all that’s taken care of before we collect a research sample, but that can all be done right on the spot. As we get to the point where we have enough clinics open, where we were essentially doing it across our whole footprint, which that’s our goal, that’s the point where we’ll actually have a lot more information up on a website that’s open to the general public and people would be able just to click there and it would take them right to where we do the automatic consent.

Shouldn’t, it’ll take them right to where they do the consent online and it’s filed away. And then the next time they come in, we just get the sample. And off we go.

Courtney Collen (Host): I want to bring in Dr. Laura Whittington, who is a pediatrician here at Sanford Children’s at the clinic at 69th and Louise. And thank you again for being with us. Why are you recommending this study to your patients and how do you do that? Like, what does the conversation look like?

Dr. Laura Whittington: Being a general pediatrician, a lot of our job is preventive care. We want to try to prevent these diseases in children before we have an issue. And the same goes for type 1 diabetes. If there is a way to know who is at risk, these children, we can monitor them more closely and try to one, prevent them from developing it, or maybe catch it earlier so that we don’t end up with them having to stay in the hospital while we try to get them under control so they can go back home.

So as far as general pediatrics, it’s very easy to have that conversation with parents. It goes right along with all of their other anticipatory guidance that we normally do at a well visit. We talk about how children and adults are at a risk for developing diabetes. And if we just screened those families, where there was a family history of diabetes, we would miss a lot of patients and most families when they hear this, they are ready to enroll in this study.

Courtney Collen (Host): Thank you both so much for being here. I look forward to learning more about how the PLEDGE study will advance research in autoimmune diseases, especially as it relates to our children. We appreciate your time.

This podcast was accurate at the time it was recorded. Sanford Health has since expanded the ages of children eligible for the PLEDGE study to include 0-5 and 9-16 years.

Learn more about this topic

• Minnesota boy one of first to receive new diabetes treatment
• Podcast: Research screening works to end type 1 diabetes
• Sanford Health receives grant to enhance PLEDGE Study

Get more episodes in this series