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Q & A with Margaret Lawson

You are both a researcher and a doctor. How does that work?
I’m a pediatric endocrinologist and care for endocrine and diabetes patients every day, but I also have protected time which allows me to focus on my research.

What is the specific area of your research?
We’re working to understand the causes of type 1 diabetes and trying to prevent it for kids at risk. We’re also working to improve the tools that we have to manage type 1 diabetes; for example, tools to improve the way we test blood sugar and the way we give insulin.

Why is this work important?
The number of Canadians living with some form of diabetes is increasing every year, and the greatest rise amongst those with type 1 diabetes is in children under five years of age. Diabetes has many complications – our ultimate goal is to prevent type 1 diabetes from developing. But until we can do that, we want to identify diabetes earlier and treat it more effectively so kids can achieve better diabetes control and prevent future complications. We also want them have a better quality of life while living with diabetes so we need to make sure the tools we use to manage diabetes enable us to achieve this goal too.

You talked about tools. What tools are you studying in your research?
One common tool is an insulin pump, used with kids and adults as well. It’s a device, about the size of a pager, that delivers insulin on a continuous basis, matched to the child’s needs. Kids like pumps because they don’t have to give themselves daily injections of insulin and the pump enables them to have a more normal lifestyle. Pumps can also improve diabetes control and prevent future complications because they mimic the way the pancreas normally delivers insulin. But in order for the pump to be safe and effective, pump users have to check their blood sugar (glucose level) by poking their finger, up to 10 times per day and many kids don’t like doing this. We are studying another tool called Continuous Glucose Monitoring (known as CGM) that automatically measures the blood glucose every 5 minutes, up to 288 times per day, using a disposable glucose sensor that is put under the skin. Finger prick blood glucose readings provide a snapshot of what is happening with diabetes control at specific times of the day (for example, before and after meals), whereas CGM is like a live video recording, providing information that people with diabetes can use throughout the day and night to better manage their diabetes and prevent life-threatening complications.

In November 2011 your lab announced an exciting research project related to insulin pumps and diabetes management for young people. Can you tell us about it?
We are being funded by the Juvenile Diabetes Research Foundation Canadian Clinical Trials Network to lead a Canadian study involving 128 children and teenagers aged five to 18 years who have type 1 diabetes, who have decided to start insulin pump therapy, and are considering use of Continuous Glucose Monitoring (CGM). The effectiveness of CGM in pediatrics may depend on when it is started. The purpose of the CGM TIME Trial (Timing of Initiation of Continuous Glucose Monitoring in Established Pediatric Diabetes) is to determine the best time to start CGM use in children and youth with type 1 diabetes so they can manage their diabetes more effectively, have the best quality of life, and prevent future diabetes-related complications.

Why is this research project important?
We know that insulin pumps are popular with children, teens and their parents. Despite this popularity, most pump users don’t adequately control their diabetes and they’re still at risk of developing diabetes-related complications. Research has clearly shown that when adult pump users wear CGM on a regular basis, it improves their diabetes control. However, most studies have not been able to show a benefit of CGM for children and youth. Research about the effectiveness of CGM is urgently needed so that children and youth with type 1 diabetes can start benefitting from its use the way that adults already do.

Is the CHEO Research Institute the only organization involved in this project?
No, it’s a collaboration. CHEO developed the study and is leading it with participation from four other Ontario pediatric diabetes centres: Markham Stouffville Hospital, the Children's Hospital at London Health Sciences Centre, The Hospital for Sick Children (SickKids) and McMaster Children's Hospital.
The CHEO Research Institute’s tag line is “Discoveries today for healthier kids tomorrow.” Is there a transferable lesson in what you do?
I have been devoting much of my time to studying and developing the JDRF TIME Trial diabetes project. I truly believe that it has the potential to greatly improve outcomes for children with diabetes. I also believe that CHEO has the potential to be an international leader in this area.

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