Q&A: Silva A. Arslanian, MD, balances family, breakthroughs in youth-onset type 2 diabetes
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SAN DIEGO — Silva A. Arslanian, MD, wishes she could pick the brain of “visionary” Apple founder Steve Jobs — “How did he come up with these ideas? Did he dream them at night?” — and respects billionaire MacKenzie Scott’s mammoth charitable donations.
But when asked who she admires, Arslanian thought first of her mother and father, who created new lives in Aleppo, Syria, after escaping the Armenian genocide. Her mother grew up in a refugee camp, reading avidly and dreaming of becoming a nurse, while her father, after his children were born, studied dentistry in France and came back to practice in Aleppo. Arslanian said she admires her parents for their “persistence, their resilience, their love of education that they instilled in their three daughters.”
“I feel I owe everything to them in a way,” she said. “My sisters may not agree with that, because they thought they were too tough with us, but I’m fine with that.”
Now Arslanian, whose pioneering research broke open the study of youth-onset type 2 diabetes and continues to explore new therapies, is set to receive the Outstanding Achievement in Clinical Diabetes Research Award at this year’s American Diabetes Association Scientific Sessions, held Friday to Monday.
In an interview with Healio, Arslanian, the Richard L. Day endowed professor of pediatrics and clinical and translational science at the University of Pittsburgh, Children’s Hospital, talked about her trailblazing research, her path from Lebanon to Pittsburgh, and the family life that has kept it all going.
Healio: What was it that initially led you to your field? Was there a defining moment?
Arslanian: I graduated from the American University of Beirut, in Lebanon, and did my pediatric residency there during the Lebanese Civil War. I did my training in the U.S., and I thought, OK, 3, 4 years, I would get my fellowship training in pediatric endocrinology, the war would be over, and we’d go back home. But the war took another 10, 12 years. We never went back home. We had kids. I finished my training. I stayed on board at the University of Pittsburgh as faculty. And being what was then called a “foreign medical graduate,” there weren’t many opportunities, so I delved into research, got NIH funding, and one thing led to another. That’s how I ended up doing what I do.
Healio: Who are you outside of your job in endocrinology? What interests you outside of your field?
Arslanian: First of all, I tell everybody, I’m Silva. I’m a human being before being a pediatrician. I’m a wife, a mother and grandmother. My husband is a vascular surgeon, extremely busy, division chief, etc. I have two grown-up children, both doctors: a maternal-fetal medicine doctor and a geriatrician. The advice I give to junior colleagues is that having a profession together with being a mom is the best scenario. It is very hard, but each is rewarding in its own way. Combine both, because you get satisfaction from being a physician-scientist, being a clinician, but at the same time being a mother and raising children with the proper support. The juggling act is not easy, for sure. But we were fortunate to have a lady who lived with us for 12 years. She was like a mother to all of us. And now I’m the grandmother of four little ones who brighten my skies.
When I was informed about the award, I was talking to my kids with the grandkids present. My 8-year-old granddaughter said, “They should give you an award for outstanding achievement as the world’s best grandma.” That meant a lot to me.
Healio: What is the area of research in endocrinology that interests you the most, and why?
Arslanian: I started my research a long time ago. When I started, it was a hot topic: insulin resistance in adults. Everything was insulin resistance and trying to find treatment, and insulin resistance leads to type 2 diabetes, to dyslipidemia, to this, to that. But we don’t turn adults by jumping from the crib to adulthood. We go through childhood. So, I wanted to investigate if the so-called insulin resistance exists in childhood, and what are its determinants.
My very first grant was to try to understand why, as we go through puberty, we develop insulin resistance, and then it subsides once we complete our puberty.
Initially, when I wanted to look at insulin resistance, my senior colleagues, who were advisers in a way, said, “Why do you want to study something that is an adult problem?” I said, “Well, you know, it may be an adult problem, but do we know what happens in pediatrics?” After that, I became aware that if you’re just looking at insulin resistance, it’s one aspect. You have to look at beta-cell function, because they’re married. If insulin sensitivity worsens, beta-cell function should increase to accommodate for that insulin resistance.
And then when I submitted my NIH grant to study insulin sensitivity together with beta-cell function in children, the review committee said, “Forget about beta-cell function. Just look at insulin sensitivity.” One more time I didn’t listen to them, and I examined both, and we made significant discoveries: what happens during childhood growth and development, how insulin sensitivity changes, how beta-cell function changes in the normal state, and then we translated that into what happens when children develop obesity, what happens when children develop type 2 diabetes, etc. The angle became wider and wider.
Healio: Have you ever seen health care history in the making?
Arslanian: In the early ’80s we started seeing adolescents with obesity presenting with diabetes that seemed to behave differently from type 1 diabetes that afflicts children. The discovery, or the identification, of this quote-unquote new type of diabetes was exciting. Initially people did not believe it. But later on, they came to realize that, no, it does exist, and that paved the road for NIH to fund several trials to understand the clinical course and complications of youth-onset type 2 diabetes and how its pathophysiology differs from that in adults.
In the last 2 or 3 years, some exciting moments have been working together with new therapeutic agents that have proven very effective in type 2 diabetes, as well as adolescent obesity. One of the trials that we did was dulaglutide (Trulicity, Eli Lilly), which is a GLP-1 receptor agonist. I worked with Eli Lilly and Co., whose scientists founded this molecule. We participated in the multinational trial, and we demonstrated that those adolescents with type 2 diabetes who received dulaglutide vs. placebo improved their HbA1c significantly better than those receiving placebo. So now this replaces insulin injections.
Healio: What do you think will have the greatest influence on your field 10 years from now?
Arslanian: In the last 10 years we have seen an explosion of pharmacological treatments for adult and adolescent type 2 diabetes and obesity. These compounds are called GLP-1 receptor agonists, and they dampen appetite, decrease gastric emptying, improve insulin sensitivity and beta-cell function, improve glycemic control and result in significant weight loss. It’s very hard to achieve meaningful weight loss trying to implement healthy lifestyle habits in the U.S. because you’re surrounded with unhealthy food choices, with tempting large portion sizes, with lack of daily habitual activity. It’s not as easy to bike as it is in Amsterdam or Denmark. It’s not as easy to walk as it is in the Mediterranean countries and things like that. So, obesity has been on the rise, and we needed some pharmacotherapeutic agents to combat it. These will have the greatest influence, but we still have barriers to overcome. The greatest influence, however, will be when we prevent and combat the obesity epidemic on a societal level.
Healio: What was the last book you read, and what did you think of it?
Arslanian: Unfortunately, as much as I would love to read — as a child, I was an avid reader. When we were supposed to take afternoon naps, I used to hide under the sofa to read my book — but lately I’ve been so busy that honestly, I can’t name you a book. Oh, wait. Maybe I flipped through the pages of The Prophet by Kahlil Gibran, who’s a Lebanese author and artist. Somebody gave it to me as a present because they knew I’d love it. So I flipped through the pages. Did I read it carefully from A to Z? No. I’m hoping to do lots of reading when I retire.
Healio: If you weren’t a physician or researcher, what would you be doing?
Arslanian: I would have liked to be a journalist, a good one who speaks the facts and the truth, who travels to war zones and remote ignored parts of the world and reports it as it is. It is critically important for journalists to get to the bottom of the truth, especially at this day and age when social media-perpetuated falsehoods are rampant.
Reference:
- Extraordinary leaders in diabetes research, prevention, and treatment to be recognized at the ADA’s 83rd Scientific Sessions. https://diabetes.org/newsroom/press-releases/2023/extraordinary-leaders-diabetes-research-prevention-treatment-recognized-at-ada-83-scientific-sessions. Published March 14, 2023. Accessed June 5, 2023.
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