“In First Nations communities, Type 2 diabetes is an intergenerational disease,” says Brandy Wicklow [B.Sc.(Med.)/03, MD/03], associate professor of pediatrics and child health in the Max Rady College of Medicine and researcher with the Children’s Hospital Research Institute of Manitoba.

The effects of colonization set the cycle in motion, Wicklow says, and many Anishininew people of the Island Lake area carry a gene variant that puts them at increased risk.

“The kids bear witness to what diabetes does in their communities,” Wicklow says. “They may have a grandmother on dialysis or a parent who’s had an amputation because of complications.

“Our research shows that these kids live with a chronic level of distress. If they’re diagnosed themselves – often around the time of puberty – they experience fear, shame and stigma.”

Wicklow, who was born and raised in Winnipeg, is a pediatric endocrinologist – an expert on hormones in children. She is fiercely committed to caring for underserved kids and teens in northern Manitoba communities.

The UM medicine grad, who joined the faculty in 2010, holds a master’s in epidemiology from the London School of Hygiene and Tropical Medicine.

Much of her research has sought ways to halt the intergenerational cycle that contributes to First Nations children in Manitoba having one of the highest rates of pediatric Type 2 diabetes and early kidney disease worldwide. We asked Wicklow three questions.

What’s involved in the five-year study you’re leading on the developmental origins of pediatric Type 2 diabetes?

The project includes lab scientists who are studying, in animal models, how exposure to the mother’s Type 2 diabetes in the womb affects the kidneys and pancreas of the fetus. Another lab team is looking at the role of epigenetic programming in transmitting risk of the disease.

My role is monitoring the health of nearly 400 kids and teens who belong to the Next Generation research cohort. They were born to mothers and fathers who were diagnosed themselves with Type 2 before they were 18.

We follow the kids from before birth and do regular screening to detect abnormal blood sugars. If we intervene at that point, we can prevent diabetic ketoacidosis, which prevents the need for intravenous insulin therapy and hospitalization. We have prevented that outcome for about 30 per cent of kids in the study.

What’s the goal of your project with another youth cohort, aged 10 to 14, who have been diagnosed with the disease?

It’s a 16-week mental health pilot program using dialectical behavioural therapy, or DBT. The goal is to give them skills to increase their tolerance for distress, decrease negative emotions, and help them do the self-care to stay healthy.

We now have funding to add a traditional knowledge arm to this program. When we talked to Elders, they said, “We have done this DBT for centuries. We have done mindfulness for centuries. This is how we used to live.”

Indigenous people have many traditional practices that promote health. We need to marry some of those teachings with the Western approach.  

You travel to northern First Nations communities about five times per year as a physician and twice per year as a researcher.  What are your priorities on the research trips?

First and foremost, to give back to community, share our recent findings and discuss how they can be used to improve the kids’ care. On both cohort studies, we have local advisory groups who help us improve the study design and interpret the data in the context of people’s lives.

We have had Indigenous moms as research co-authors. The communities are so engaged. We’re partners in looking for the best ways to identify kids who are most at risk, and modify those risk factors.

UM Knowledge Exchange is an important opportunity for UM researchers to share emerging knowledge with members of the public and the wider UM community. UM Knowledge Exchange is hosted by the Associate Vice-President Research, with support from the UM Learning for Life Network.

Each year more and more children in Manitoba present with the life-disrupting disease type 2 diabetes. Why is this happening, which children are at highest risk how it impacts health and quality of life, and what can be done to best care for children living with disease? 

Moderator

Allison Dart MD, MSc FRCPC or Vern Dolinsky PhD, associate professor, pediatrics and child health, Max Rady College of Medicine

Panelists

Brandy Wicklow MD, MSc FRCPC Associate Professor, pediatrics and child health, Max Rady College of Medicine

Christine Doucette PhD, Associate Professor, Physiology and Pathophysiology, Max Rady College of Medicine

Meaghan Jones PhD, Assistant Professor Type 2 diabetes in children, Biochemistry and Medical Genetics, Max Rady College of Medicine

Samantha Bonneteau, Parent Advisor, Next Generation DREAM study

Diabetes in Children, May 8, 7pm-8:30pm (CDT) at Degrees Diner. UM Knowledge Exchange is a hybrid event with in-person and online options to attend.

Please register by May 3 to join the discussion.

Add Diabetes in Children to your calendar. Coffee and other refreshments will be provided, and the kitchen at Degrees Diner will be open for specialty coffee and full food service. Parking is available with registration.

Or join us for online viewing 7 pm CDT to watch the live stream. Participate during the live session by asking your questions via email to: Research [dot] Communications [at] UManitoba [dot] ca

The seven-part UM Knowledge Exchange panel-discussion series is ongoing until May 2024. More details can be found on the UM Knowledge Exchange webpage.

“Congratulations to the successful applicants in the Fall 2020 round of funding. This is an impressive showing by UM investigators,” said Dr. Peter Nickerson, vice-dean research of the Rady Faculty of Health Sciences. 

“Some of these projects focus on improving the lives of people with conditions such as kidney disease, Type 2 diabetes and mental health disorders. Others are lab studies that will advance knowledge about illnesses such as Ebola, leukemia, HIV and metabolic diseases.

“Our researchers are also analyzing data to reveal new evidence about interlinked social and health factors in Manitobans’ lives. And they’re studying areas such as Indigenous-led wellness programs and children’s rehabilitation knowledge sharing in order to identify and build on strengths.”

UM Today recently reported on two of the funded projects, which relate to COVID-19: a randomized trial of a home monitoring platform for patients with chronic kidney disease, led by Dr. Claudio Rigatto, and a study of the lived experiences of families with children who are immunocompromised, led by Dr. Roberta Woodgate.  

Here’s a look at the other projects:

Dr. Clara Bohm, associate professor, internal medicine, Max Rady College of Medicine

Grant: $439,874

Bohm’s team will conduct a randomized trial to assess whether stationary cycling during kidney dialysis treatments reduces heart “stunning” (poor pumping, which can cause heart damage) and improves symptoms such as fatigue. The trial involves participants in Canada, the U.S. and Australia.

Dr. Shay-Lee Bolton, assistant professor, psychiatry, Max Rady College of Medicine

Grant: $100,000

Bolton will evaluate whether a psychotherapy and mindfulness program that is delivered virtually helps public safety personnel, such as police officers and firefighters, cope with stress, maintain mental wellness and remain resilient.

Dr. Dan Chateau, assistant professor, community health sciences, Max Rady College of Medicine; research scientist, Manitoba Centre for Health Policy (MCHP)

Dr. Marni Brownell, professor, community health sciences, Max Rady College of Medicine; associate director, research, and senior research scientist, MCHP; researcher, Children’s Hospital Research Institute of Manitoba (CHRIM)

Grant: $432,226

Chateau’s team will use health data to investigate the effects of prescription opioid and psychotropic medication use during pregnancy, looking at patterns of prescription opioid use, short-term effects on children exposed in the womb, and longer-term outcomes for these children.

Dr. David Collister, assistant professor, internal medicine, Max Rady College of Medicine

Grant: $100,000

Collister’s project is a trial comparing oral and topical nabilone (a synthetic form of cannabis) to placebos to determine whether nabilone is safe and effective at reducing itching in patients who are on dialysis for kidney disease.

Dr. Shyamala Dakshinamurti, professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $784,125

This study looks at newborn pulmonary hypertension, which prevents some babies from getting enough bloodflow to their lungs. By focusing on a system of signals in the body called the adenylyl cyclase pathway, Dakshinamurti aims to help these infants’ lungs relax and hearts pump strongly.

Dr. Allison Dart, associate professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Dr. Brandy Wicklow, associate professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $1,300,500

Dart and Wicklow will study biopsychosocial risk factors for worsening kidney disease in children and teens with Type 2 diabetes. They will also test a skills-based mental health program to help Indigenous youth with Type 2 diabetes manage their emotions and their disease.

Dr. Andrew Hatala, associate professor, community health sciences, Max Rady College of Medicine; researcher, CHRIM

Dr. Sabina Ijaz, family physician; Giigewigamig health advisor

Elder Dave Courchene, founder, Turtle Lodge

Grant: $1,748,025

This team will conduct an Indigenous-led study of the Turtle Lodge in Sagkeeng First Nation as a model of Indigenous education, wellness and flourishing. The objectives include developing a framework for stronger relationships between Indigenous Knowledge Holders and biomedical practitioners.

Dr. Jason Kindrachuk, assistant professor, medical microbiology and infectious diseases, Max Rady College of Medicine; Canada Research Chair in molecular pathogenesis of emerging and re-emerging viruses; researcher, CHRIM

Grant: $726,750

Kindrachuk’s project focuses on the fact that some men who have recovered from Ebola continue to carry the virus in their reproductive tracts. The study will investigate how the virus persists in the testes and is sexually transmitted. It will also look at Ebola’s long-term effects on reproductive health.

Dr. Ted Lakowski, associate professor, College of Pharmacy

Grant: $699,975

Lakowski’s study aims to develop new cancer therapies that target the specific genes involved in a type of leukemia. These treatments are expected to be more effective and cause fewer side effects than current therapies. The strategy could lead to gene-specific treatments for other cancers.

Dr. Lyle McKinnon, assistant professor, medical microbiology and infectious diseases, Max Rady College of Medicine; researcher, CHRIM

Grant: $100,000

McKinnon will study the role of regulatory T cells, a type of immune cell, in controlling female genital inflammation. Because this inflammation puts women at higher risk of HIV infection, the study is relevant to finding better prevention strategies for women who are at risk of HIV exposure.

Dr. Suresh Mishra, professor, internal medicine, Max Rady College of Medicine

Grant: $100,000

Mishra will focus on prohibitin, a protein that plays an important role in sex differences in fat and immune cells. Using mouse models, he will investigate why men and women display differences in susceptibility and resistance to metabolic and immune diseases.

Dr. Rae Spiwak, assistant professor, surgery, Max Rady College of Medicine

Grant: $60,000

Spiwak will use Manitoba data to investigate what social factors place children at greater risk for physical injury. The study will look at a cohort of children who were hospitalized for traumatic physical injury and compare them with uninjured children, examining factors such as parental socioeconomic status and education.

Dr. Elizabeth Wall-Wieler, assistant professor, community health sciences, Max Rady College of Medicine; research scientist, MCHP; Canada Research Chair in population data analytics and data curation

Dr. Marilyn Bennett, assistant professor, Faculty of Social Work

Dr. Marni Brownell, professor, community health sciences, Max Rady College of Medicine; associate director, research, and senior research scientist, MCHP; researcher, CHRIM

Dr. Marcelo Urquia, associate professor, community health sciences, Max Rady College of Medicine; research scientist, MCHP; Canada Research Chair in applied population health

Grant: $393,976

Wall-Wieler’s team will analyze Manitoba data to determine whether parents with specific health conditions are more likely to have a child taken into care, and how having a child taken into care affects parents’ health. The study will compare First Nations, Métis and all other Manitoban parents.  

Dr. Jun-Feng Wang, associate professor, pharmacology and therapeutics, Max Rady College of Medicine

Grant: $623,475

Wang will investigate the role of a protein, Txnip, in chronic stress-induced neuronal dysfunction. The research will use an animal model for depression, aiming to determine if inhibiting Txnip could be used in treating human depression.

Dr. Brandy Wicklow, associate professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $100,000

Wicklow will examine beta cell and kidney function in First Nations children whose mothers were diagnosed as children with Type 2 diabetes. The offspring will be studied in early childhood and compared with children not exposed to Type 2 diabetes in the womb. The results will contribute to strategies for early intervention.  

Dr. Kristy Wittmeier, assistant professor, pediatrics and child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $100,000

Wittmeier’s team will study how knowledge about research and treatments is shared via networks between researchers, therapists and families of children with development or rehabilitation needs. The goal is to identify strengths and gaps in these knowledge-sharing networks and make recommendations to improve them.

Dr. Roberta Woodgate, distinguished professor, College of Nursing; Canada Research Chair in child and family engagement in health research and healthcare; researcher, CHRIM

Grant: $761,176

Woodgate’s study will involve young immigrants and refugees in co-designing culturally sensitive mental health supports for youth like themselves. Parents and community-based organizations will also participate. The researchers will develop a digital mental health self-management prototype.