University of Vermont Endocrinology, Diabetes and Metabolism Fellowship

Fletcher Allen, the teaching hospital for the University of Vermont College of Medicine, offers a two-year fellowship training program in Diabetes and Endocrinology under the auspices of the Division of Endocrinology, Diabetes and Metabolism in the Department of Medicine.

The training program is accredited by the Residency Review Committee of the Accreditation Council of Graduate Medical Education, and provides eligibility for certification in Endocrinology, Diabetes and Metabolism from the American Board of Internal Medicine following completion. It is designed for physicians who are interested in a career in academic endocrinology, and includes opportunities for advanced study in nutrition,  human metabolism research techniques, and basic sciences. Usually, one fellow is taken into the program each year.

The Endocrinology, Diabetes and Metabolism outpatient program covers the full spectrum of endocrine services. It is based at 62 Tilley Drive in South Burlington and operates from 8:00 AM to 5:00 PM Monday through Friday, seeing approximately 6,000 outpatients per year.

The Endocrinology and Diabetes clinic provides comprehensive diagnostic and treatment services for pituitary, adrenal, parathyroid, and thyroid diseases, including fine needle thyroid aspiration and thyroid ultrasound.

There is a close working relationship with Pathology, Nuclear Medicine, and specialty surgical services, which makes for a smooth flow between preoperative testing and operative/postoperative management in persons with thyroid cancer and endocrine tumors.

Description   

Endocrinology, Diabetes and Metabolism provides clinical services for the care of patients with insulin and non-insulin dependent diabetes. Consultation and follow-up are provided for all problems in endocrinology,  diabetes and metabolism, both in the inpatient and outpatient setting. Patients are referred from Vermont and upstate New York for management of their diabetes and other endocrine disorders.

Endocrinology, Diabetes and Metabolism has gained worldwide recognition for its research in the areas of obesity, diabetes and the regulation of energy metabolism. Its current research programs include clinical studies in humans and bench research in animal models.

The Endocrinology and Diabetes clinic is a full-service diabetes program based on a team approach to the care of persons with diabetes. Patients are seen in referral by a multidisciplinary team of a diabetologist/nurse practitioner, diabetes nurse educator, and dietician.

Blood glucose control is maximized using tailored regimens including intensive insulin therapy and insulin pumps. The clinic contains two hemoglobin A1c machines that provide values for all patients as they are being seen.

A multidisciplinary obesity outpatient program exists including a 16-week program of intensive dietary instruction and behavioral modification through the Psychology Department and an active gastric bypass surgical program. The patient mix of common and unusual endocrine disorders is excellent, allowing fellows extensive exposure to thyroid disorders and cancer, pituitary tumors, hypercalcemic disorders, obesity, hypoglycemia, and a wide spectrum of diabetes care issues. 

The laboratories for basic research are located at the University's Colchester Research Facility (CRF). The Endocrinology, Diabetes and Metabolism division has combined adjacent general laboratory space of 2,400 square feet, including laboratory bench space, a state-of-the-art tissue culture facility.

An additional 1,000 square feet includes a cold room, darkroom, and special equipment rooms for molecular, biochemical, radioisotope, microscope/imaging, and whole animal investigation. The CRF has a modern animal facility with transgenic capabilities. Also available in the Given Complex on the UVM Campus is the UVM Microscope Imaging Center used for advanced microscopic techniques. A federally funded General Clinical Research Center with extensive facilities for human clinical metabolism studies is located adjacent to the Given Building within Fletcher Allen.

Teaching

All of the endocrinology physician faculty are involved in the teaching of medical students, residents, and fellows, and participate in the inpatient and outpatient clinical programs. In addition, they participate extensively in Continuing Medical Education programs regionally and around the country. The division holds particular interest in diabetes, with extensive participation in state and national committees regarding the design and delivery of diabetes care.The scientific faculty are members of multiple grant review panels and they review papers for numerous scientific journals.

Endocrinology, Diabetes and Metabolism Research Program

The Endocrinology section includes nationally recognized research programs in several areas, with the major underlying theme being the pathogenesis and therapy of metabolic disorders, in particular insulin resistance, obesity, and type 2 diabetes. The research program is made up of technicians, post-doctoral fellows, and the research faculty along with extensive collaborations within and outside the institution.

A notable element is the combining within the section of M.D. and Ph.D. faculty who have different backgrounds and research perspectives - state of-the-art molecular and biochemical expertise all the way to whole animal and human physiology - that allows a problem to be attacked from many dimensions.

The section has a long and lauded history of human clinical investigation, which continues today with facilities on the General Clinical Research Center for detailed studies of energy balance andmetabolism in man, both at rest and during physical exercise, muscle biopsy, and a mass spectroscopy core with state of the artinstrumentation.

Techniques used include measurements of oxygen consumption and respiratory quotient, body composition, euglycemic clamping to assess insulin sensitivity, endogenous glucose and fatty acid production and oxidation using radiolabeled and stable isotopes, and a wide range of substrate and hormone assays.

Faculty and Research Interests

The unit director, Jack Leahy, M.D. studies the pathogenesis of type 2 diabetes mellitus with a particular focus on the insulin secretory dysfunction. Molecular, biochemical, and whole animal techniques are used to identify how the insulin secreting islet beta-cell normally works, and how it is disrupted by altered metabolic environments such as  hyperglycemia or hyperlipidemia. Current interests are the molecular and biochemical basis for beta-cell "glucotoxicity,""lipotoxicity," and beta-cell growth and functional adaptive mechanisms.

Dwight Matthews, Ph.D. is internationally recognized for his use of stable isotopes and mass spectrometry to map out multiple aspects of human carbohydrate and amino acid metabolism, with current interests in how menopause and aging effects muscle protein synthesis, plus what effect dietary and exercise programs have to reverse abnormalities.

Tom Jetton, Ph.D. investigates the mechanisms that regulate the development, growth, and regeneration of pancreatic beta cells. Through several collaborative efforts, he is currently pursuing projects centered on identifying pancreatic islet progenitor cells in the adult and resolving the growth factor-regulated pathways that promote betacell regeneration. He uses state-of-the-art microscopic imaging,multiple-labelling confocal and epifluorescence microscopy, digital image analysis and in situ hybridization techniques in tissues from rodent models of accelerated new beta-cell development(neogenesis) to study the signaling pathways and tissue regulatory factors underlying compensatory pancreatic beta-cell growth.

Mina Peshavaria, Ph.D. uses multidisciplinary approaches toinvestigate the regulatory mechanisms controlling postnatal beta-cell development (neogenesis), growth, and function using in vivo and in vitrocell culture models and genetically modified mice models. In collaboration with Dr. Jetton, they use a wide variety of analytical techniques including RT-PCR, adenoviral infections, immunoblotting, multiple-labelling confocal and epifluorescence microscopy, digital image analysis, and laser scanning microdissection in conjunction with single-cell RT-PCR to identify known and novel proteins and their potential roles during islet neogenesis.

A number of clinical trials are being conducted through the outpatient clinics. Muriel Nathan, M.D., Ph.D. investigated parathyroid imaging in the evaluation of persons with hyperparathyroidism, and participated in a multicenter trial of an aldose reductase inhibitor to lower the incidence of diabetic retinopathy.  Finally, there are a large number of ongoing trials of new diabetes and hyperlipidemic therapies.

Annis Marney M.D.
Assistant Program Director