Prediabetes and type 2 diabetes are major metabolic disorders that are strong determinants of cardiovascular disease risk. Prediabetes affects 1 in 3 U.S. adults (84 million) and 1 in 5 U.S. adolescents (8 million). Type 2 diabetes is diagnosed in about 1 in 10 adults (30 million), and it is increasing dramatically among youth in the last decade. Research studies at the Division of Research have examined the epidemiology of metabolic risk factors and endocrine disorders as they influence development of atherosclerosis and a range of cardiovascular complications across the life course from fetal life, childhood and adolescence, reproductive course and outcomes, and later life.
These include longitudinal, ongoing, community-based research cohorts such as the 30-year Coronary Artery Risk Development in Young Adults (CARDIA) Study, the Study of Women, Infant Feeding and Type 2 Diabetes after gestational diabetes (SWIFT Study), the SWIFT Study of the Growth of the Offspring (SWIFT Offspring Study), the Study Women’s Health Across the Nation (SWAN Study), and other studies based on the Kaiser Permanente Northern California membership involving a wide range of children, youth, women, and adults. A key focus has been endocrinologic and metabolic reproductive health, including metabolic perturbations in pregnancy and associated complications, lactation, polycystic ovary syndrome, and fertility. A large body of research focuses on pediatric and adolescent obesity, cardiometabolic health, and steatohepatitis in youth.
Pregnancy and cardiovascular health: A major research program focuses on the relationship of pregnancy complications, such as gestational diabetes and hypertensive disorders of pregnancy on future cardiovascular outcomes in women; how gestational diabetes and subsequent glucose intolerance may be related to higher risk of cardiovascular disease in women and children, and how obesity among adolescents is related to cardiovascular disease risk factors; the cardiometabolic health of youth exposed to gestational diabetes in utero; and the lasting influences of lactation on cardiometabolic risk factors and diseases predisposing to cardiovascular disease (e.g., non-alcoholic fatty liver disease, prediabetes and diabetes, dyslipidemia, endothelial dysfunction, and hypertension) in women. These latter studies also seek to understand the underlying metabolic mechanisms that affect the progression to type 2 diabetes and cardiovascular disease outcomes in women using metabolomics and epigenetics. Several large observational cohort studies, which complement research in cardiovascular health among reproductive women, examine cardiometabolic outcomes in children and adolescents with moderate and severe obesity, including the impact of regional initiatives targeting metabolic assessment in at-risk children.
Metabolic bone health: A second major research program focuses on metabolic bone health, including osteoporosis, fragility fracture, ethnic disparities, risk prediction, and the adverse complications of therapy. Since 1996, DOR has been 1 of 5 SWAN clinical sites that has focused on understanding bone loss during the menopausal transition. In 2007, large pharmacoepidemiologic surveillance study funded by the Food and Drug Administration has examined rare jaw complications associated with antiresorptive therapy (PROBE Study). In the past decade, Kaiser Permanente Northern California investigators have led multiple epidemiologic studies that continue to advance our understanding of the epidemiology of osteoporosis, population trends, treatment, and skeletal outcomes, including ethnic disparities and rare complications such as atypical femur. Findings from this work are highly relevant to the large and increasingly diverse Northern California population of adults over 65 years of age who are at risk for osteoporotic fracture.
Endocrinology and chronic disease: A third major research program focuses on endocrinologic complications of chronic disease, including obesity, chronic and end-stage kidney disease, human immunodeficiency virus infection, cancer, and cancer therapies. This work has now extended into the field of primary endocrine tumors, including thyroid cancer.