At the glitzy Research Dinner, organised by the American Diabetes Association (ADA) on 20 April to recognise the latest outstanding efforts to find a cure for diabetes, the name of Professor Benjamin Udoka Nwosu commanded special attention. He was honoured and presented with a prestigious award that had the inscription – “For all you do to help those living with diabetes”.
What particularly drew the attention of ADA and indeed the entire scientific world to celebrate Nwosu was the ground-breaking research he published earlier in November 2022. Findings of the research showed that giving children high doses of vitamin D (a relatively cheap and very accessible product), when they are first diagnosed, drastically slows the progression of type 1 diabetes (T1D) and consequently prevents potential complications.
Type 1 diabetes – a condition in which the pancreas produces little or no insulin – is one of the most common chronic diseases in children. Without timely treatment, it can cause serious long-term health damage, including blindness, kidney failure, heart attacks, stroke and lower limb amputation. This is particularly alarming as figures show a continued global increase in diabetes prevalence. In Nigeria alone, there are over 100,000 diagnosed cases of type 1 diabetes annually.
Currently, however, the medical world is heaving a sigh of relief – thanks to the landmark efforts of Nwosu. According to the medical scientist, the prolongation of the “honeymoon phase” of type 1 diabetes results in significant reductions in the degree and occurrence of long-term complications of type 1 diabetes. He showed that high-dose vitamin D could reduce inflammation at the level of the pancreatic beta-cells and lead to more prolonged survival of the remaining beta-cells.
Nwosu’s work – the very first to demonstrate beta-cell protection by vitamin D in children – now guides early approaches to the management of children with newly diagnosed type 1 diabetes in many hospitals across the world.
Renowned trailblazer
Prof. Nwosu is no neophyte to revolutionary methodologies in the treatment of diabetes and the health conditions of children. He previously did a study that was the first to characterise a predictive model for the lack of partial clinical remission in children with new-onset type 1 diabetes. The work, which was described as a milestone discovery, was featured in the ADA News Brief. He was the first to report a high prevalence of vitamin D deficiency in irritable bowel syndrome in children, which has led to routine screening for vitamin D deficiency in patients with irritable bowel syndrome.
Nwosu also previously announced that routine nutrition counselling can reverse elevated blood sugar and prevent the development of type 2 diabetes in children and adolescents with prediabetes. According to him, “All children with prediabetes should see a nutritionist. This has been part of the standard of care, but with no empirical, supporting data for its efficacy. Our study has provided the much-needed data to support medical nutrition therapy for children and adolescents with prediabetes.”
For that particular study, Nwosu and his team took a look back at 46 boys (mean age 12 years) and 62 girls (mean age 13 years) with prediabetes (HbA1c 5.7 per cent to 6.4 per cent) who were recommended to receive nutrition therapy every three months. This consisted of a nutritionist or registered dietician meeting with families to educate them on reading food labels, making food choices and assessing their nutritional intake. Altogether, 44 youngsters (41.5 per cent) received two or more nutrition visits per year (adherent group) and 62 (58.5 per cent) received none or only one nutrition visit per year (non-adherent group). Two of the youngsters lacked nutrition visit information.
In a period of four years, 18 youth (17.0 per cent) progressed to type 2 diabetes, including 14 of the 62 non-adherent youth (22.6 per cent) and four of the 44 adherent youth (9.1 per cent). Adherence to nutrition visits was associated with a four-fold reduction in the likelihood of progressing from prediabetes to type 2 diabetes (hazard ratio 3.88; 95 per cent confidence interval 1.26 to 11.98, P=0.02).
Nwosu explained, “Interestingly, this positive effect can be seen without changes in body weight. Our data suggest that adherence to nutrition visits could reverse prediabetes by decreasing insulin resistance. This new information should encourage parents of children with prediabetes to optimize their children’s adherence to nutrition visits.”
Similarly, in 2019, the paediatric endocrinologist established the relationship between the phenomenon known as “partial clinical remission” in children newly diagnosed with type 1 diabetes and their cholesterol levels when they reach puberty. As published by the Journal of the Endocrine Society, the study found that children with type 1 diabetes who did not experience partial clinical remission following initiation of insulin treatment have higher cholesterol levels in puberty than those who did. Elevated cholesterol in non-remitters is an early indication that they are at higher risk for cardiovascular complications later in life.
Speaking on the crucial study, Nwosu said, “This is the first study to characterise the pattern of lipid profiles in children and adolescents with type 1 diabetes as they traverse through puberty based on stratification by remission status and compared to their healthy peers. A child with a history of partial clinical remission is going to have a better lipid profile during puberty, and that can extend throughout life.”
Background and education
Prof. Nwosu is presently the chief of Endocrinology Department at the Cohen Children’s Medical Centre of New York. He is also a professor of Paediatrics at the Zucker School of Medicine at Hofstra/Northwell, also in New York.
He attended University of Nigeria, Nsukka, where he obtained his medical degree in 1995. He had his residency training in Paediatrics at the Howard University Hospital, in Washington DC (1997-2000) and obtained his fellowship training in Paediatric Endocrinology at the National Institutes of Health, in Bethesda, Maryland, USA (2000-2003).
Nwosu is a review editor at Frontiers and sits on the Editorial Board of several scientific journals. He is also the director of Outreach Sub-Committee of the Communications Committee of the Society for Paediatric Research. He served as an invited author and editor at the PREP Endocrinology of the American Academy of Paediatrics from 2013-2016.
