Pediatric Endocrinology & Diabetes Fellowship Program

The Joseph S. Bruno Pediatric Endocrinology training program consists of a three-year comprehensive experience that incorporates clinical care, research activities, and evidence-based learning. The program is ACGME accredited and accepts up to two fellows per year. Our program combines an interdisciplinary experience in clinical training and research based upon the ACGME core competencies. The Division of Pediatric Endocrinology and Diabetes covers a wide range of hormone-related disorders in children. We use a team approach to treat many children each day. About half of our patients are referred for Type 1 diabetes and Type 2 diabetes. Other areas diagnosed, followed, and treated by UAB pediatric endocrinologists include, but are not limited to, adrenal gland disorders, bone and calcium disorders, growth disorders, pituitary gland disorders, hypoglycemia, puberty disorders, thyroid disease, lipid disorders, and genetic disorders with endocrine manifestations.

First Year

The first year of fellowship is predominantly clinical. The fellow does 6 outpatient months, during which time they attend 5-6 half-day clinics per week, divided equally between diabetes and endocrine clinics (including multidisciplinary clinics), working alongside medical students, clinic nurses, diabetes educators, nurse practitioners, and residents. In addition, they have 3 inpatient months, where they assist with the in-patient service, providing guidance for the resident on service, performing all in-patient consults, and handling phone consultations and overnight pages from outside physicians. As the primary referral center for the entire state of Alabama and portions of Mississippi as well, fellows are exposed to a large and varied patient population. The after-hours pager calls include urgent or emergent calls from patients and/or families of patients with diabetes or endocrine disorders as well as outside physician pages. Approximately 1 weekend a month, the fellow is on call for the diabetes/endocrine service. During this time, the fellow takes admission calls, phone consultations from outside physicians, and makes rounds on the in-patient service, weekly fellow endocrine clinic and monthly diabetes clinic.

They also have 3 months of research during which time they have 1-2 clinics of their own each week along with up to 3 attending diabetes or endocrine clinics as they work to develop their interests in research. During the second half of the first year, the fellow begins to visit various laboratories and meet with potential mentors so that, by the end of the 1st year, a research project and mentor are established.

Second Year

In the second year of fellowship, the fellow's clinical duties decrease. They have 2 inpatient and 2 outpatient months much like those during their first year. They then have 6 months of research time with only their 1-2 half days of clinic so they have protected time to develop their research interests. They continue to cover the inpatient service for one weekend each month. In-patient duties remain the same. The fellow begins the process of writing grants and/or submitting paperwork to the IRB for approval of his/her research project. Fellows meet regularly (at least quarterly or as needed) with mentors to discuss progress with projects. We encourage our second year fellows to take their elective time (see below) for 2-4 weeks during this year, if interested.

Third Year

In the third year, the fellow continues his/her research. He/she has 1 month each of outpatient and inpatient rotations. Our third year fellows are encouraged to shape these months to best prepare them for their future careers. Examples include – extra clinics per week to match their upcoming clinical load and rounding separately from attendings during inpatient rotation as their "pre-attending months". The remaining 10 months are devoted to research and their own 1-2 half days each week of clinic. They begin to function more independently, with the option to create his/her own separate clinic. In-patient duties remain the same. The fellow continues to meet regularly with his/her mentor.

We offer available elective rotations including genetics, reproductive endocrinology, surgical endocrinology and adult endocrinology. The Division of Pediatric Endocrinology and Diabetes offers an energetic research environment. Faculty and fellow research projects include the entire spectrum of pediatric endocrinology conditions, both basic science and clinically-oriented projects. A Comprehensive Diabetes Center was established in 2007. The Center’s research interests include T- and B-cell immunology, pancreatic β cell biology and developmental biology. Our Center’s research is directed at understanding the fundamental issues related to the development of type 1 diabetes. The goal the TCDC is to identify novel mechanisms or strategies to prevent or cure this disease. The endocrine division collaborates with the Alabama State Screening program to optimize immediate and long-range follow up care of newborns with congenital hypothyroidism and adrenal hyperplasia. Longitudinal data analysis of clinical outcomes is a key component. Upon completion our fellows will have met or exceeded the requirements for the qualifying board examination in Pediatric Endocrinology.

Quality improvement and patient safety are key education components to fellowship training as well. UAB has a unique Graduate Certificate Program in Healthcare Quality and Safety. This program can lead to a master’s degree via the UAB School of Health Professions. Realizing that all fellows may not desire to obtain this certificate, a UAB Mini Quality Academy (MQA) has been developed to provide a standard curriculum in Quality Improvement and Patient Safety. All Pediatric Endocrinology fellows are required to participate in the MQA. Our site is involved with the T1D Exchange QI collaborative nationwide.

During the three year training, all fellows will complete a minimum of two years in academic research under the supervision of a mentor and scholarly oversight committee. Research interests of the division are broad with participation in multi-center studies:

Pathogenesis of Type 1 and Type 2 diabetes
Optimizing current and long term health and well- being of endocrine disorder patients
Effect of GABA or Combination of GABA/GAD on the Progression of Type I Diabetes in Children
Racial differences in the incidence of Type I Diabetes
Factors influencing the recovery from Type 2 Diabetes
Characteristics and co-morbidities of polycystic ovarian syndrome (PCOS) in children
Hypertriglyceridemia- etiology, outcomes, and treatments
Lipid disorders in diabetes and obesity
Growth hormone disorder treatment and therapies
Long-acting growth hormone treatments compared to daily injections
Long-acting insulin therapy
Current clinical therapies in cystic fibrosis related diabetes
Assessment of un-methylated Insulin DNA with Droplet Digital PCR in Adolescents with Type 2 Diabetes and its Relationship to Mixed Meal Tolerance Testing
Measurement of un-methylated insulin DNA as a predictor of β cell death in patients with cystic fibrosis
Long-term follow-up registry of patients with hypophosphatasia

Currently the Division has several active research projects approved by the University of Alabama Institutional Review Board. The Division avidly pursues publication of original scientific work well-respected peer-reviewed journals. We also participate in industry sponsored clinical trials that test new treatments for Type I Diabetes, Type 2 diabetes, and growth hormone treatment modalities

The three years in fellowship training with the Division of Pediatric Endocrinology and Diabetes will better prepare every physician for a successful career in the exciting field of Endocrinology!