Endocrinology, Diabetes and Metabolism

Lisa Ceglia, MD Research 

Dr. Ceglia’s research interests involve the role of nutrition, acid-base balance and hormones in aging musculoskeletal health. Current topics of research include:

• The effects of higher protein diets combined with alkali supplementation on skeletal muscle strength, power, and mass in older adults. 
• Collaboration with Dr. Pittas on the effects of cholecalciferol supplementation on bone metabolism in patients with pre-diabetes.
• Collaboration with Dr. Dawson-Hughes on several pilot studies investigating novel pharmacologic approaches to improve bone and muscle mass and performance. 
• International collaboration with Dr. Heike Bischoff-Ferrari on the impact of calcifediol and cholecalciferol on skeletal muscle-specific concentration of the vitamin D receptor, skeletal muscle fiber size, and concentration of muscle satellite cells in postmenopausal women. 
• Quality improvement studies on the post-fracture assessment of older patients at Tufts Medical Center.

Bess Dawson-Hughes, MD Research

• The mission of the Bone Metabolism Laboratory is to identify ways in which the diet in combination with exercise and hormones influences bone and muscle, contributing to risk for osteoporosis and impaired physical function in older adults.
• This laboratory has published over 100 peer-reviewed articles describing mechanisms by which calcium and vitamin D affect bone and the role of their intake level in bone health and other health outcomes. 
• The laboratory has conducted several large clinical trials that identified an important role of the acid-base balance on the diet on both bone and muscle. 
• The laboratory is now conducting several pilot studies that explore novel approaches to improving bone and muscle mass and function.
• Collaborations within the Endocrine Division - The Bone Metabolism Laboratory has enjoyed extensive and productive collaborations with Drs. Lisa Ceglia and Anastassios Pittas over the last 15 years.
• International collaborations – Dr. Dawson-Hughes has worked with colleagues around the globe to compile estimates of vitamin D levels and calcium intake, work that resulted in highly cited publications. She was lead author of the International Osteoporosis Foundation (IOF) Position Statement on vitamin D. Currently she is Chair of the Steering Committee that oversees a major IOF initiative to increase secondary fracture prevention through the Capture the Fracture Partnership. This goal of this program is to expand the use of appropriate therapeutic interventions in patients who have sustained a fracture to reduce their risk of subsequent fractures.

Andy Greenberg, MD Research

• The Laboratory studies the molecular and cellular regulation of adipocyte and lipid metabolism
• The role of adipocyte metabolism and other organ systems in influencing systemic insulin resistance, diabetes, obesity, and inflammation
• Interaction between nutrients and aging to modulate insulin resistance, obesity, diabetes, and inflammation
• Hormonal and genetic basis of insulin resistance and obesity, which encompasses the study of very basic molecular mechanisms, as well as human investigation

Jacqueline T. Kung, MD Research

• Distinguishing between benign and malignant thyroid nodules based on characteristics of the nodules on ultrasound

Ronald M. Lechan, MD Research

Dr. Lechan has devoted much of his career to the study of the anatomy and neuroendocrine regulation of the hypothalamus with particular emphasis on the hypothalamic-pituitary-thyroid axis.  Seminal work from his laboratory has demonstrated how hypophysiotropic TRH neurons are integrated into the energy control system within the brain, and the central mechanisms involved in the reduction of circulating thyroid hormone levels in the nonthyroidal illness syndrome, a disorder commonly observed in intensive care unit patients. Dr. Lechan also has had a long interest in elucidating the unique, biological role that hypothalamic tanycytes have in neuroendocrine regulation due to their production of type 2 deiodinase (D2) and hence, feedback regulation of the thyroid axis, and in neurogenesis by contributing to the population of the satiety, POMC-producing neurons in the hypothalamic arcuate nucleus. Ongoing basic and clinical research studies include:

• Role of the hypothalamic parasubthalamic nucleus (PSTN) in the regulation of appetite and satiety.
• A data collection survey on patients with active acromegaly currently on pharmacologic treatment (The Management of Acromegaly (MACRO) Registry

Anastassios G. Pittas, MD Research

Below is an outline of research interests and accomplishments and opportunities for collaborations and mentorship in Dr. Pittas laboratory. Colleagues and trainees are encouraged to bring ideas, energy, enthusiasm and time to the development and execution of collaborative projects with meaningful impact in patient care. For details, including a complete list of publications, please visit https://agpittas.com/

• Understanding of the role of vitamin D in type 2 diabetes. Through a methodical approach that included cross-sectional and longitudinal observational studies, post-hoc analyses of completed trials and short-term mechanistic trials, my colleagues from different institutions and I worked in a highly collaborative approach to uncover a link between vitamin D and risk of type 2 diabetes. Databases and specimens (blood / urine) are available from observational studies and randomized trials for ancillary studies by colleagues and trainees. Details can be found at www.vitaminDfordiabetes.org  and www.d2dstudy.org.
  
  
• Precision-Nutrition for prevention and management of diabetes and cardiometabolic disease. Based on animal work by others, my colleagues and I demonstrated that the effect of the dietary glycemic load on weight change depends on baseline insulin secretion, a finding which was subsequently confirmed by others.
  
  
• Comparative Effectiveness Research as it relates to the care of patients with diabetes. Working collaboratively and effectively with researchers from the Tufts Evidence Based Center (for over 10 years) and currently with the Brown Evidence Based Center, my colleagues and I have conducted and published more than 10 high-impact systematic reviews and meta-analyses on topics that are timely and clinically applicable. 
  
  
• The application of virtual medicine and digital connectivity in the care of patients with diabetes and other endocrine conditions. Our team has conducted research in the use of continuous glucose monitoring in patients with pre-diabetes and diabetes, focusing on understanding its role in clinical care. Databases are available for analyses.
  
  
• Mentorship of trainees. Under many roles in the Tufts educational environment (Associate Director of the Endocrinology Fellowship Program, Instructor for the Study Design and Clinical Trials courses at Tufts University), Dr. Pittas has served as mentor for a number of trainees at many academic levels and in wide areas of clinical research, including observational studies, trials and comparative effectiveness research. His trainees and Dr. Pittas have co-authored more than 40 manuscripts in the area of diabetes and metabolism. 

Jeffrey Vercollone, MD, MS Research

• Inpatient Glycemia Consult Service. In 2018, Dr. Vercollone started the inpatient Glycemia Consult Service aiming to improve glycemic management in hospitalized patients. The service, which is currently staffed by a stellar NP (Rachel N. Lehouillier, NP, MSN) and an outstanding clinical pharmacist outstanding clinical pharmacist (John Aurora) services 3 floors of the hospital and the service will be expanding to cover the entire hospital. The team works as a nonconventional consultation service that seeks patients that need the service the most, based on meeting certain criteria in the electronic medical record and automatically consults on the patient to reduce the burden on primary teams and improve outcomes. We focus not only on acute care management, but also on educating the patient and staff to help with adherence and timely administration of medications in a logical patient-centered outpatient plan. Some of the highlights of the service and research projects include:
- Continuous Glucose Monitoring (CGM) use during COVID to help reduce staff and patient exposure (COVID can be transmitted in both directions).
- Continuous Glucose Monitoring (CGM) placement on discharge to help establish continuity care by linking to the CGM tracings for review of blood sugars remotely as the patient transitions to their home environment.
- Educational initiatives for inpatient diabetes education of staff and patients. Medicine Resident Interns are required to spend one week on the service to understand the service and diabetes care in the hospital.
- Transitions of Care service that is being piloting with pharmacy to help navigate the complexities of diabetes medication and blood sugar monitoring on discharge.