In the July 2015 issue of Diabetes Care, CTSC-supported investigators published the results of an exciting pilot study showing that the order in which one eats carbohydrates at a meal can significantly affect post-meal glucose and insulin levels. In this small study, 11 patients with treated type 2 diabetes were given the same meal on two separate days, one week apart. At the first visit, they ate carbohydrates followed, after a 15-minute interval, by protein and vegetables. At the second visit, the food order was reversed. Over the two hours following the meal, glucose and insulin were significantly lower when carbohydrates were consumed last. These preliminary data suggest a promising, practical technique that may help patients manage their glucose and insulin levels by how they time their food consumption.
The study took advantage of the CTSC’s Clinical and Translational Resource Unit (CTRU), including our Adult Outpatient Unit and our Nutrition core, which helped prepare the test meals fed to the participants. Catherine E. Thomas, BS, one of the study’s authors, credits the CTSC for this invaluable support. “We couldn’t have done it without the CTSC,” she noted. “All the testing was done at the Outpatient unit, and the core lab analyzed the patient samples.”
Mrs. Thomas is a Clinical Research Coordinator for Louis Aronne, MD, the Sanford I. Weill Professor of Metabolic Research, head of the Comprehensive Weight Control Center at Weill Cornell, and senior author of this recent publication. She is also a student in the Master’s Degree in Clinical Investigation program of the CTSC’s Clinical and Translational Education Program (CTEP).
“This is my first publication as a co-author on a scientific study,” she explained, after having worked as a research coordinator for the last eight years at Weill Cornell—an experience that makes her unique in the Master’s program, where the majority of students have earned an MD or PhD.
Making the transition from coordinator to investigator was a gradual process for Mrs. Thomas. “I gained a lot of experience as a research coordinator on industry-initiated trials over the years, which gives you rigorous training in study design and logistics. I wanted to become more involved in the cerebral aspects of designing and executing research, so I applied to the Master’s program. Learning the material presented in the CTEP courses has only made me better at my job as a coordinator.”
Mrs. Thomas has appreciated the support of her mentors during this process, including her thesis mentors Dr. Aronne and Lorna Thorpe, PhD; and Alpana P. Shukla, MD, MRCP, an endocrinologist who has been the clinical research manager at the Comprehensive Weight Control Center. “It’s been a dream to have my education and employment so well aligned,” Mrs. Thomas noted, thanks in part to Dr. Shukla’s vision.
Thomas’ next challenge will be writing and defending her thesis. She explained, “I thought a lot about what my thesis project would be, given the resources I had, and the fact that I didn’t have access to a lab.” In the CTEP course Using Electronic Clinical Data for Research, she found the answer: during one class, Thomas Campion, PhD, presented a figure highlighting the place of T2 research in the translational pipeline (from an article by PJ Embi and PR Payne from the Journal of the American Medical Informatics Association). T2 research investigates the translation of clinical research findings into community practice.
“Seeing this slide made me realize that the CTEP Master’s degree was within my reach,” Thomas revealed. Without a lab and with limited resources, she realized she could conduct an electronic data record analysis that would assess how advances in anti-obesity pharmacotherapy were translating into patient care. By leveraging the relationships she had through the Comprehensive Weight Control Center, she has been able to access prescription data on anti-obesity medications in the US, allowing her to evaluate the adoption of these drugs. She hopes her research will shed light on the patterns underlying the significant undertreatment of obesity in this country. Physicians seem reluctant to prescribe medications, despite the substantial prevalence of obesity in this country. “I want to help encourage physicians to consider all the available options to treat this disease.”
As for the future of the food order research, Mrs. Thomas noted great things have happened following the publication, including media attention from major news outlets, such as NPR. Prior to this study, Dr. Aronne had only his anecdotal experience to support his idea. Thanks to having the ability to collect these pilot data, donors have come forward to offer additional support that will help the Comprehensive Weight Control Center do more expansive investigations. Mrs. Thomas noted that this was a wonderful example of taking clinical observations and the germ of an innovative idea, along with some well-timed and critical support from an organization like the CTSC, and realizing their potential to help patients meaningfully. “Further research may show that this approach can help patients transform their care, not only in diabetes but maybe in obesity as well.”
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Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care. 2015 Jul;38(7):e98-9. PMID: 26106234