Supporting New Generations of Diabetes Researchers: The Eli Lilly Clinician-Scientist Trainee Fellowships in Diabetes

For nearly a century, stretching back to the discovery of insulin in 1921, the University of Toronto has been a world leader in diabetes research. It’s an extraordinary legacy of discovery that has been further strengthened in recent years thanks to the generosity of Eli Lilly Canada.  

In 2018, the company made a philanthropic commitment of $480,000 to establish the Eli Lilly Clinician-Scientist Trainee Fellowships in Diabetes. In total, eight one-year fellowships will be supported over four years, with the final two fellowships selected and announced in 2021.

“We’re thrilled to support promising young diabetes researchers through these fellowships,” says Dr. Joanne Lorraine, Medical Director Lilly Diabetes, Eli Lilly Canada.  “We see this gift as a wonderful way to celebrate the 100th anniversary of the discovery of insulin and honour our company’s history as an early partner of the university, as well as to invest in the next generation of bright and innovative minds.” 

“We’re extremely grateful to Eli Lilly Canada for their support,” says Professor Trevor Young, Dean of the Temerty Faculty of Medicine. “Funding for early-career researchers like these helps us advance knowledge and drive innovation. The Eli Lilly Clinician-Scientist Trainee Fellowships in Diabetes are contributing to Toronto’s standing as a global centre of excellence for diabetes research.”

Investigating a gout drug’s impact on the health of people with diabetes

Clinical epidemiology — the study of how often different health events occur in different demographics and why — has always been something to which Dr. Alanna Weisman has found herself drawn.

“I love the challenge and enjoy pushing boundaries,” she says. “We need to understand why we, as physicians, do the things we do.”

When awarded one of the 2018-2019 Eli Lilly Clinician-Scientist Trainee Fellowships, Weisman investigated the effect allopurinol, a drug traditionally used to treat gout, has on people with diabetes. Her work was focused on assessing the drug’s impact on their likelihood of developing cardiovascular and kidney disease. 

“There’s been growing interest that allopurinol might actually be beneficial for people with diabetes,” says Weisman. “My colleagues and I collected health data from all over Ontario and looked at the impact over several years. While the drug doesn’t appear to have much of an effect on kidney disease, we were able to find a lowered risk of cardiovascular disease, which causes heart attacks and strokes. Now this is the focus  of clinical trials that may help people with diabetes lower their risk of developing these diseases in the future.”

Weisman believes U of T was the ideal place to pursue her work. 

“The University is world-renowned for its quality of medical education and research,” she says. “There aren’t many programs that support clinician-scientists in Canada. There’s also such depth of expertise on diabetes here. It’s a nice feeling to know that my work is tied to the legacy of Banting and Best.”

Building better transplant options for people living with diabetes

Dr. Paraish Misra describes the current treatments available to patients with type 1 diabetes for the management of their disease with one word: limited.

“There reality is there aren’t many options for people living with type 1 diabetes,” says Misra. “The most common way is by administering insulin — a process that can be very disruptive to patients’ lives. The other, is through pancreas or islet transplantion which, when it works properly, is extremely effective. The problem is few donated organs are available for transplant and, even when they are donated, there’s a high risk of rejection.”

Misra, who received the Eli Lilly Clinician-Scientist Trainee Fellowship in Diabetes in both 2018-2019 and 2019-2020, believes the solution to both these challenges lies in lab-grown organs.

“Lab-grown organs remove the limitations around supply,” he says. “And we’re currently growing our islets from (genetically) engineered stem cells which should have a much lower risk of rejection.”

Misra is optimistic his early work using animal and test tube models will confirm his hypothesis and that it could be the launching point for a major advance in the treatment of type 1 diabetes. 

He also points to the value his role as clinician-scientist in contributing to his research approach. 

“My lab may be focused on what we call ‘basic science,’ but there’s been a lot of synergy with my patient work. I’m always reminded of our goal to see our research applied in clinical settings.”

Assessing the accuracy of tools used to gauge the risk of cardiovascular disease in people with diabetes

Dr. Maneesh Sud believes in questioning everything — including how physicians currently assess patients living with diabetes’ risk of developing cardiovascular disease. 

“We use tools — basically equations — to calculate how likely someone is to develop heart attacks or strokes,” says Sud. “The problem is these tools were developed many decades ago based exclusively using American data. My project is to determine how these equations work and how well they can be applied to Canadian patients with diabetes.”
 
Sud, a 2019-20 recipient of the Eli Lilly Clinician-Scientist Trainee Fellowship in Diabetes, believes his research could result in improving how we advise Canadians living with diabetes about their future heart disease risk.
 
“These drugs can have side effects,” says Sud. “It’s no longer clear the patients we’re currently prescribing drugs for actually need to take them. Maybe some patients can be treated effectively through lifestyle changes and start these medications a few years down the road.”

Sud credits his clinical work as a cardiologist as the inspiration for his research. 

“I routinely see patients presenting with heart disease,” he says. “I was drawn to this field by the recognition that there are lots of patients with risk factors for heart disease, but that no modern prediction tools exist specifically for the Canadian setting. With big data, it looks like something we can do now. It’s a unique opportunity at a unique time.”