In 2001, the most pressing mission was to develop a fellowship program given the relentless decline in pediatric residents wishing to pursue a career in endocrinology which, alarmingly, paralleled the aforementioned nationwide rise in the incidence of both type I and II diabetes. With the proliferation of endocrine disorders and concomitant decline in the number of young endocrinologists, these antithetical trends did not bode well for endocrine care in Alabama. Fortuitously, and timely, funding for the three-year fellowship was ensured by an endowment from the Bruno Diabetes Foundation. Parenthetically, years before 2001, the largess of the Joseph Bruno family supported not only the endocrine fellowship but also multiple diabetes-related academic/clinical activities. Accreditation of the fellowship program was announced in 2002.

Endocrine fellows are listed in chronological order:

Ambika Ashraf 2003-2006

Whitney Brown 2005-2008

Amy Burton 2007-2010

James Gardner 2008-2011

Alison Lunsford 2010-2013

Caroline Colvin 2011-2014

Linnea Larson-Williams 2012-2015

Alexandra Martin 2013-2015

Shelly Mercer 2015-2018

Heather Choat 2016-2019

Bhuvana Sunil 2017-2020

Jessica Schmitt 2017-2020

Jurhee Freese 2018-2021

Erin Greenup 2018-2021

As of 2018, the division was comprised of nine board-certified endocrinologists, one instructor, nine nurse practitioners, 12 clinic nurses, six hormone stimulation testing nurses, 14 diabetes educators, five diabetes pump nurses, two nutritionists, two social workers, and one shared child family therapists. Note: many of the staff are part-time.

Fellowship Pogram

Our ACGME-accredited fellowship program currently has the capacity to train six fellows across three years, with a curriculum emphasizing clinical acumen, multidisciplinary exposure, scholarly productivity, and professional growth. We consider ourselves to be a “fellow driven” program, not “fellow dependent”, and value clinical exposure and education for our trainees, but we do not make them do more if there are fewer fellows. We support fellows’ involvement in programs and activities that will help best prepare them for a successful career in pediatric endocrinology.

Our faculty serve in national leadership roles across the American Board of Pediatrics, the Pediatric Endocrine Society and the American Academy of Pediatrics.

Since 2001, research conducted by pediatric endocrinology faculty encompassed cystic fibrosis-related bone health/growth, treatment and etiology of type 1 diabetes (T1DM), lipoprotein metabolism, Vitamin D deficiency, congenital hypothyroidism, endoplasmic reticulum luminal redox effect on cortisol production in isolated microsomes and β-cell apoptosis in cystic fibrosis (CF). 

Publications have appeared in several high-impact journals, including: J Peds, JAMA Pediatrics, Arch Internal Med, Journal of Biological Chemistry, Biochemical Journal, Journal of Steroid Biochemistry, Pediatrics, Journal of Clinical Endocrinology and Metabolism, PLOS ONE, Obesity, Journal of Clinical Lipidology, Endocrinology, Journal of Endocrinology and Biochim Biophysics Acta to name a few.

Ongoing research studies and clinical projects include such topics as:

• The biological defect in the CF transmembrane conductance regulator (CFTR) protein impact on both growth and bone health

• GABA intervention in new-onset Type1 diabetes to preserve β-cell function. This pioneering double-blind, placebo- controlled, project is the first clinical trial of oral gamma aminobutyric acid (GABA) to preserve or restore endogenous insulin secretion, reduce prandial glucagon secretion, improve metabolic/glycemic control, and modulate favorably the autoimmune milieu. This is an investigator initiated study funded through JDRF.

• Increased incidence of Type1 diabetes in African American youth, a cross-section investigation

• Anti-N-acetylglucosamine antibodies from B lymphocytes, their prevalence and their role in the etiology of Type1 diabetes

• Immunology of Type1 diabetes the first year post diagnosis

• Redox regulation of endoplasmic calcium ATPase and uptake in isolated hepatic microsomes

• Modulation of macronutrient composition for management of lipid disorders and non-alcoholic fatty liver disease.

• Natural history of Type1 diabetes (NIH multicenter study)

• 11-Ketotestosterone concentrations in children with CAH and other adrenal disorders

• Cystic fibrosis diabetes and β-cell apoptosis by assaying unmethylated insulin DNA(in collaboration with Pennington Biomedical Center)

• ECHO (Extension for Community Healthcare Outcomes) video-conferencing program covering Pediatric Diabetes and Obesity - Spring 2018

• Diagnostic value of a second newborn screening test for congenital hypothyroidism

• Vitamin D deficiency in pediatrics and its role in glucose homeostasis and vascular health

• Dyslipidemia, obesity, and pre-diabete

• Participation in at least 10 pharmaceutical-sponsored investigative drug studies concerning Type2 diabetes, growth hormone deficiency, hypophosphatasia, FGF23 excess, Prader Willi syndrome

Research Highlights

Our division participates in NIH grants, including:

• The Youth-Onset Type 2 Diabetes Consortium – Discovery study(U01DK134966, Ashraf/Gower) 

• Dietary intervention trials in NAFLD (R01DK128457, Ashraf/Goss)

Other notable areas of research include:

• Epigenetics and social determinants of type 2 diabetes (Dr. Christy Foster)

• Gut microbiome studies in pediatric metabolic disease (Dr. Ambika Ashraf)

• Expanded access therapy for rare conditions such as MCT8 deficiency (Dr. Leen Matalka)

• Multicenter trials in CAH and thyroid disorders (Dr. Gail Mick)

• T1D Exchange (Dr. Mary Lauren Scott, Dr. Jessica Schmitt)

• QI projects (Dr. Jessica Schmitt, Dr. Christy Foster)

The division also leads in Quality Improvement initiatives through participation in the T1D Exchange, Type 2 Diabetes Education Collaboratives, and transition care innovations, ensuring equitable access to advanced diabetes technologies and empowering patients and caregivers alike.