Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
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 14,000 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.
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 Clinical Research Center with extensive facilities for human clinical metabolism studies is located adjacent to the Given Building within Fletcher Allen.
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 Clinical Research Center for detailed studies of energy balance and metabolism in man, both at rest and during physical exercise, muscle biopsy, and a mass spectroscopy core with state of the art instrumentation.
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 Research Interests
Co-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 cell biological basis for β-cell adaptive mechanisms involving endoplasmic reticulum stress and insulin signaling pathways.
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 neural and dietary influences on β-cell mass and function.
Jay Gupta, Ph.D. investigates the role of transcription factors as molecular switches in regulation of islet β cell compensation and the mechanisms of de-compensation causing islet beta cell dysfunction in the setting of insulin resistance and T2DM. He uses a variety of bioinformatics tools to generate molecular models of transcriptional networks in islet beta cells and evaluate their target specificity by performing nuclear binding assays, chromatin immunoprecipitation, site-directed mutagenesis, and reporter assays. The physiological relevance of islet transcriptional machinery is tested by in vitro knockdown assays using RNAi in beta cell lines and conditional knockout animal models along with established animal models of obesity and acute beta cell loss.
Annis Marney, M.D. conducts clinical research with a diversity of interests all tied to diabetes, obesity, insulin resistance, and cardiovascular risks associated with diabetes including hypertension and heart failure. She has an interest in the hormone B-type natriuretic peptide (BNP), which regulates plasma sodium and volume and which is paradoxically low in obese populations and has lipolytic properties. In addition, she has studied the blood pressure effects of a class of anti-diabetic agents, dipeptidyl peptidase-IV (DPP-4) inhibitors, and found that DPP-4 inhibitors interact with ACE inhibitors. Since DPP-4 inhibitors help degrade BNP, the effects of DPP-4 inhibition on BNP and its metabolism are current research interests. She is actively researching the potential of DPP-4 inhibitors to mitigate steroid-induced hyperglycemia. In addition, she collaborates on the potential effects of exercise to reverse hyperglycemia in newly diagnosed Type 2 DM. Finally, she has experience using continuous glucose monitoring (CGM) to study glucose variability and risk for hypoglycemia in patients with heart failure and autonomic neuropathy.
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.