From Research to Reality: Transforming Rural Health Through Innovation

From pioneering treatments that save lives to innovative technologies that improve quality of care, medical research is a driving force behind the advancements we see in health care today.

These innovations not only pave the way for new therapies and improved patient outcomes but also bridge the gap between theory and practice. This science-to-service pipeline is crucial, especially in underserved areas like rural communities, where access to cutting-edge medical treatments can be limited.

At Sanford Research , a multisite biomedical research institute headquartered in Sioux Falls, South Dakota, research is conducted to innovate health care through cutting edge science, working to build the foundation for future treatments and driving evidence-based care.

Access to clinical trials, close to home

Sanford Research is involved in over 400 clinical trials that aim to improve the prevention, detection, treatment and survivorship of a wide range of diseases, from diabetes, cystic fibrosis and COVID-19 to eating disorders and cancers.

The Sanford PLEDGE Study is an initiative focused on the early detection of type 1 diabetes (T1D) and celiac disease in children through a simple blood test. The study, developed and led by Dr. Kurt Griffin, was launched by Sanford Health in 2020, thanks to grant funding from The Leona M. and Harry B. Helmsley Charitable Trust. This summer, the PLEDGE study reached a milestone of 10,000 enrolled participants – the halfway point of its enrollment goal of 20,000 and a key step toward making this part of standard care for all kids.

Over the past four years, the PLEDGE study has identified more than 70 children with autoantibodies that indicate a risk for developing T1D. These children are now followed under a monitoring protocol so that they can receive interventions if and when needed before they progress to diabetic ketoacidosis (DKA) – a life-threatening condition common when children are first recognized as having T1D.

"So far, we have had five children progress to clinical care for diabetes, none of whom had DKA – or even overt symptoms," said Dr. Kurt Griffin.

International consensus guidance for monitoring people with pre-symptomatic, "early stage" T1D was published recently in Diabetes Care, a publication that provides health care professionals guidance on how to care for patients with diabetes. Dr. Griffin had a key role developing the guidance specific to pediatric monitoring.

The PLEDGE study is already improving health care outcomes in communities across the globe.

For over a year, Dr. Griffin has worked with Sharon Hunt, Head of World Clinic Integration, and Hospital Metropolitano in Costa Rica, to develop a clinical program to offer screening for T1D autoantibodies to their pediatric patients. Through the Sanford World Clinic partnership, Dr. Griffin collaborated with the health system's leaders and physicians to share more about the PLEDGE study. In Costa Rica, the type 1 diabetes screening and monitoring program is based on PLEDGE, but designed to align with Costa Rican culture and practice. The children at risk for T1D will be followed in a monitoring program according to the recently published consensus guidelines.

"Our hope is that further results from PLEDGE will support moving this screening into standard clinical practice, not just at Sanford, but as part of national guidelines," said Dr. Griffin.

While the PLEDGE study focuses on the early detection of type 1 diabetes (T1D) and celiac disease in children, Sanford Health's EVOLVE clinical trial has reshaped cancer treatment by reducing side effects through lower intensity protocols. Developed by Dr. Miran Blanchard, a radiation oncologist at Sanford Health, this trial has offered a condensed treatment timeframe with innovative approaches to radiation therapy.

A typical radiation treatment for head and neck cancer often consists of a once-a-day treatment, five days a week, for six weeks. EVOLVE's lower-dose radiation treatment composed of 20 treatments, but two a day, cutting the treatment time from six weeks to ten days.

"Throat cancer is probably the predominant cancer we're seeing here now in terms of the head and neck region. We've learned that there's subsets of these that have a very good prognosis. Unfortunately, we treat those patients the exact same way as we treat somebody that has a very aggressive form of cancer – so they get the full intensity of therapy," said Steven Powell , MD, medical oncologist. "What we're starting to learn from our research is maybe those patients with less risky disease could get lower intensity treatments and do better."

These lower intensity treatments allow for fewer side effects, including trouble swallowing, eating issues, and dry mouth. The EVOLVE study was open for roughly four years and enrolled over 70 patients.

"The study constantly evolved," said Dr. Powell. "We added different arms to it, hence the name. Anytime we saw an impressive new approach that maybe could allow us to decrease the intensity of the treatment, we would add it to the study."

A decade of precision medicine

Ten years ago, utilizing a person's DNA and genetic history to guide a patient's healthcare journey was unique. Today, "precision medicine" is the future of healthcare, with advanced technology playing a crucial role.

Sanford Imagenetics has been a leader in this transformation over the past decade, implementing programs across the Sanford Health system, and beyond, to harness the power of precision medicine.

Key initiatives of Sanford Imagenetics, which just celebrated its tenth anniversary, include:

• Genetic Counseling: Recognizing the critical role of genetic counseling, we have partnered with Augustana University (SD) to support the Augustana-Sanford Genetic Counseling Graduate Program, addressing the need to build the genetic counseling workforce.
• Pharmacogenomics (PGx): This practice, which examines genetic makeup to determine medication metabolism, led to a partnership with the U.S. Department of Veterans Affairs for the PHASER program, providing veterans with access to free PGx testing. Through this partnership, over 80,000 veterans have been given access to free PGx testing.
• Pre-emptive Genetic Screening: In collaboration with Helix , the leading precision health organization, Sanford Health launched the ImagineYou genetic screening research study, offering a no-cost genetic screening of conditions with increased risk for certain cancers and heart disease.
• Medical Genetics Laboratory: Providing comprehensive genetic and cytogenetics testing and interpretation services, Sanford Health's lab is equipped to conduct complex diagnostic tests, such as Pharmacogenomics, DNA sequencing, Chromosome Analysis (i.e. G-banding), Chromosomal Microarray (CMA), Fragile X repeat expansion and methylation analytics, and more.

What's next?

As we continue to push boundaries of medical innovation, we continue our dedication to improving patient care, advancing medical research, and enhancing healthcare deliver worldwide.