The risk of hypoglycemia remains an obstacle to effective implementation of intensive insulin therapy. In 2001, the Pediatric Growth and Nutrition Branch (PNGB) (formerly the Endocrinology, Nutrition, and Growth (ENG) Branch) established DirecNet, the world’s first research network devoted to studying children with type 1 diabetes mellitus (T1DM).
The Network consists of five clinical centers and a Data Coordinating Center (DCC). The primary goal of the network has been to investigate the potential use of glucose-monitoring technology and to create a closed-loop system (artificial pancreas) to improve the management of T1DM in children. DirecNet remains at the forefront of this important effort and has contributed many significant scientific advances toward this goal. In the decade of its existence, the network has conducted more than a dozen protocols. DirecNet researchers have published numerous abstracts and more than 50 peer-reviewed articles.
Initially, DirecNet’s main focus was to assess the accuracy, efficacy, and effectiveness of continuous glucose monitoring devices. Researchers in the network also examined the acute and delayed effects of moderate afternoon exercise on the risk of hypoglycemia in children and adolescents with T1DM. These studies provided additional insights regarding the pathophysiology of delayed hypoglycemia on nights following afternoon exercise, as well as the effect of age on counter-regulatory hormone responses to hypoglycemia. The ability to suspend the basal insulin infusion to reduce the risk of exercise-induced hypoglycemia was also examined. DirecNet researchers have recently focused their efforts on the neuroanatomical and neurocognitive effects of hyper- and hypoglycemia. An ongoing study utilizing state-of-the-art neuroimaging techniques and cognitive testing paradigms will assess the effects of diabetes on brain structure and function in young children with T1DM.