I am a neuromuscular specialist with expertise in clinical investigation of metabolic nerve and muscle disease. My research has focused on the relationship between early hyperglycemia, dyslipidemia, obesity and length dependent nerve injury, and this sustained research program has yielded continuous NIH funding for 15 years. Our research group established an epidemiological link between otherwise idiopathic sensory predominant neuropathy and prediabetes, identified obesity and hypertriglyceridemia as risk factors for diabetic neuropathy independent of glucose control, and showed that small fiber aspects of prediabetic neuropathy improve with diet and exercise. We developed and validated a clinical exam scale for sensory predominant neuropathy, the Utah Early Neuropathy Scale, and showed that skin biopsy for intraepidermal nerve fiber density (IENFD) determination is a sensitive measure of early neuropathy that predicts progression to clinical neuropathy symptoms in diabetic patients. We have adapted IENFD following capsaicin axotomy to demonstrate that prediabetes inhibits, and intensive exercise improves cutaneous re-innervation. We have used this paradigm to examine re-innnervation following bariatric surgery, and have shown that lifestyle intervention improves IENFD and reduces progression to clinical neuropathy in diabetes (the Utah Diabetic Neuropathy Study) and prediabetes (the Impaired Glucose Tolerance Neuropathy study). We run a two center NIDDK randomized trial of mentored exercise and actigraphy based anti-sedentary behavioral counseling to reduce IENFD loss progression in patients with diabetic neuropathy, the ADAPT study. A DBRCT of topiramate in sensory neuropathy with metabolic syndrome is active in NINDS NeuroNEXT for 2017-2021.
Since 2010 I have directed the Utah CTSA award site Clinical Trial Services Foundation, and oversee the 92 protocols currently using the CTSF. In this role I have implemented predictive instruments for nursing effort and utilization, collaborated to develop a protocol performance tracking database responsive to NCATS/CTSA common metrics, and spearheaded an opt-out Epic based participant registry. I lead the CCTS Internal Advisory Committee, which reviews protocols for CTS performance, and serve as the Director of our CCTS Hub Liaison Team.