Q&A

Illustration: Hang Yu Lin

Dr. Julie Lovshin

Dr. Julie Lovshin joined Sunnybrook Research Institute as a clinician-scientist in September 2017. She is also an assistant professor of medicine in the division of endocrinology and metabolism at the University of Toronto. She spoke with Betty Zou about her research.

What is the focus of your research?

I am interested in reducing the complications of Type 2 diabetes. My research focuses on diabetic heart and kidney disease, which are the leading causes of premature death among people with Type 2 diabetes. Over the last three years, there have been big changes in the way we treat Type 2 diabetes. In 2015 the first large-scale trial in patients with Type 2 diabetes with heart disease was done for a newer class of diabetes drugs known as SGLT-2 inhibitors, showing these drugs were not only safe, but were also protective in the kidney and heart. Surprisingly, these effects were happening within three to six months. No diabetes drug had shown such positive effects before. A few years later, another diabetes drug that is a GLP-1R agonist showed similar protective effects. At the time, I was studying how these drugs lower blood pressure and affect kidney function. These results launched a whole new area of investigation for me.

Why were you interested in studying the effects of diabetes drugs on sodium metabolism?

In a prior study, we were investigating mechanisms of blood pressure reduction for GLP-1R agonists, which led us to study urinary sodium excretion. We wanted to ask whether another class of diabetes drugs known as DPP-4 inhibitors also increases urinary salt loss. In this study, we found that in patients with Type 2 diabetes DPP-4 inhibitors increase urinary sodium excretion. Curiously enough, it didn’t immediately impact kidney hemodynamic function. What are these sodium pathways important for, then? One reason might be for reducing inflammation in the kidney. Sodium excretion seems to be common to all three of these newer diabetes drugs, so it’s important to understand how each of these drugs impacts sodium metabolism, because many of these drugs are used in combination to treat patients with Type 2 diabetes.

What are the most pressing questions in Type 2 diabetes complications research?

A new area in diabetes research is focusing on the effects of diabetes on the brain. It’s an evolving area where researchers are asking if there are any links between diabetes and cognition and executive function, and even brain diseases such as Alzheimer’s disease. If so, is it because of diabetes and blood sugar control, or other factors associated with diabetes, like increased inflammation? These are critical questions, as we know that as we reduce heart and kidney disease in people with diabetes, these patients will live longer and be at risk for dementia.

Why did you become a clinician-scientist?

I did my PhD in basic science on the gut hormones known as GLP-1 and GLP-2. I started as a master’s student. I was never intending to do a PhD; I just got drawn into it. To me, the questions we were asking were so interesting and relevant to the treatment of diabetes. Once I finished my PhD, I entered medical school and completed my residency in internal medicine and endocrinology. Now, as a clinician-scientist, it’s very impactful for me to ask my research questions in humans to see if basic science findings are translatable to human disease.

Lovshin’s research is funded by the department of medicine at the University of Toronto, Merck and Sanofi. For more, visit sunnybrook.ca/research.