National Medical Research Council Collaborative Grant (NMRC CG): S$1.5 million

• Collaboration with National University Health System (NUHS)
• Focus on metabolic medicine and a federated data repository using cohorts and clinical epidemiology
• Bio-banking for cohort studies in KTPH, supporting over 200,000 bio-specimens gathered from 17,824 participants
• Goal is to link healthcare and research (including “-omics”) data for each individual in the existing cohorts and configure the data for federated analysis with NUHS

We were awarded NMRC Centre Grant (CG) to comprehensively develop our clinical research capability to meet the growing challenge of Common and Complex Chronic Conditions (4Cs).

The quantum of CG awarded is $1.5 millions for 4 years. It consists of 3 main cores i.e. Facility Core, Research Personnel Core, and Administrative Core.

Facility Core: The core will provide equipment and consumables necessary for maintaining the biobanking activities. A portion of this core will be used to facilitate federated data repository through collaboration with the National University Health System (NUHS).

Research Personnel Core: The core will provide manpower support for biobanking of human specimens and conducting epidemiological studies. A portion of this core will be supporting manpower in NUHS for data repository.

Administrative Core: The core will provide an oversight of biobanking and research data from ethical, operational and managerial perspectives. Our current staff employed by CG include:

DORIS (Diabetic Kidney Disease – Onset and Progression Risk Factors Cohort)

• Successor of the long-running Diabetic Nephropathy cohort, which has produced more than 20 publications
• Aims to better understand the determinants of the onset and progression of Diabetic Kidney Disease in the Singapore population

DORIS is the abbreviation for “Diabetic Kidney Disease – Onset and Progression Risk Factors Cohort”, the latest upcoming cohort study by Clinical Research Unit. It is the successor of our long-running Diabetic Nephropathy cohort, which has produced more than 20 publications to date. In the next-phase, our aim is to recruit approximately 1920 multi-ethnic patients with Type 2 Diabetes (T2DM) to better understand the determinants of onset and progression of Diabetic Kidney Disease (DKD) in the Singapore population.

DKD is the leading cause of end stage renal disease in Singapore, and an established risk factor for cardiovascular disease and mortality in people with diabetes. Recent data suggest that while major complication related to diabetes (e.g. cardiovascular disease) is declining, the incidence of DKD remains unabated. Through our DORIS cohort, we hope to better understand the range of factors that drive DKD.

Therefore, continue to watch this space for more updates on the DORIS cohort!

Smart2D (Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes)

• Launched in 2011 to study the impact of diabetes in blood vessel function and common diabetes-related complications
• Part of a nation-wide, multi-institution consortium to study diabetic kidney disease and retinopathy
• With the award of S$1.5 million in 2019 from the National Medical Research Council (NMRC), SMART2D has been granted a total of nearly S$5 million in funding (FY2012 to FY2021).
• In this third phase of the study, all 1,800 past participants are recalled, to monitor the progression of their disease over three years, until 2022.
• Emphasis on lifestyle factors; in addition to bio specimens and follow-up data on diabetic complications, data is collected on diet, physical activity and frailty
• Published 33 papers in peer-reviewed scientific journals and shared at numerous national and international conferences
• Findings on association of early-onset diabetes with cognitive impairment awarded best oral presentation at 13th International Congress of the Asian Society Against Dementia and 6th Singapore International Neuro-Cognitive Symposium
• Abstracts selected as competition finalists for Singapore Health Biomedical Congress (SHBC) 2019

The Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D) is funded by the highly competitive National Medical Research Council’s Program Project Grant (PPG) and Clinician Scientist Individual Research Grant (CS-IRG). The SMART2D study was launched in FY2011 to study the impact of diabetes on blood vessel function and commonly encountered diabetes-related complications among Singaporeans. Funded by a SGD 2-million PPG, Drs Lim Su Chi, Tavintharan Subramaniam, Yeoh Lee Ying and Sum Chee Fang led the study and recruited 2,057 Type 2 Diabetic patients with and without vascular complications.

Upon the completion of the PPG (which is a cross-sectional study) in FY2013, our institution was further awarded a SGD 1.5-million CS-IRG in FY2014 to conduct a follow-up prospective study aimed at recalling all of the initial participants for re-evaluation and to collect new data to study disease progression in relation to changes in risk factors. By exploiting the synergy between clinical and genetic epidemiology, SMART2D will continue as a longitudinal study that investigates the relationship between risk factors (genetic and non-genetic), vascular function (i.e. intermediate phenotype - endothelial reactivity and arterial stiffness) and final phenotypes (diabetic foot syndrome, nephropathy, retinopathy, cognitive dysfunction and mood disorders).

The SMART2D study involves collaboration with prestigious institutions such as the Genome Institute of Singapore (GIS), National University of Singapore (NUS), National Healthcare Group Polyclinics (NHGP) and the Wellcome Trust Centre for Human Genetics at Oxford, UK. In addition, the cohort is part of a nation-wide, multi-institution consortium (DYNAMO: Diabetes study in Nephropathy And other Microvascular complications) devoted to studying diabetic kidney disease and retinopathy. Observations from SMART2D have also been published in several renowned peer-reviewed journals and presented at conferences worldwide and the finding that central obesity is associated with young onset diabetes and increased susceptibility to diabetes-related complications such as chronic kidney disease (CKD) has been reported in Singapore’s national newspaper and in the Singapore Medical Journal. We are currently recruiting volunteers to participate in our follow-up prospective study. Various health assessment tests, including blood and urine tests, foot screening, calculation of body composition and cognitive tests may be conducted. The results obtained from these tests can be used to inform the volunteers (and their doctors) of any changes in their health status and blood vessel functions. If you are interested in learning more about the study or would like to join us as a study volunteer, please contact Dr Keven Ang (Project Manager) at 6602-2343 or Ms Amy Ou (Project Lead-Research Nurse) at 8128-9442. Collection, use and disclosure of your personal data shall be in accordance with our privacy policy

Publications (Manuscript):

1. Gurung RL, Yiamunaa M, Liu S, Liu JJ, Lim SC, for SMART2D study. Short leukocyte telomere length predicts albuminuria progression in individuals with type 2 diabetes. Kidney International Reports (2018), doi: 10.1016/j.ekir.2017.12.005.
2. Zhang X, Low S, Kumari N, Wang J, Ang K, Yeo D, Tavintharan S, Sum CF, Lim SC. Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore. PloS one, 12(7), e0180949.
3. Liu JJ, Pek T, Li S, Ang K, Tavintharan S, Lim SC. Plasma Leucine-rich Alpha-2-glycoprotein 1 Predicts Rapid eGFR Decline and Albuminuria Progression in Type 2 Diabetes. J Clin Endocrinol Metab 102: 3683–3691, 2017
4. Pek SL, Sum CF, Yeoh LY, Lee SB, Tang WE, Lim SC, Tavintharan S. Association of apolipoprotein-CIII (apoC-III), endothelium-dependent vasodilation and peripheral neuropathy in a multi-ethnic population with type 2 diabetes. Metabolism. 2017 Jul 31;72:75-82.
5. Zhang X, Low S, Sum CF, Tavintharan S, Yeoh LY, Liu J, Li N, Ang K, Lee SB, Tang WE, Lim SC. Arterial stiffness is an independent predictor for albuminuria progression among Asians with type 2 diabetes—A prospective cohort study. Journal of Diabetes and its Complications. 2017 Jun 30;31(6):933-8.
6. Moh MC, Sum CF, Tavintharan S, Ang K, Lee SB, Tang WE, Lim SC. Baseline predictors of aortic stiffness progression among multi-ethnic Asians with type 2 diabetes. Atherosclerosis. 2017 May 31;260:102-9.
7. Zhang X, Liu JJ, Sum CF, Ying YL, Tavintharan S, Li N, Su C, Low S, Lee SB, Tang WE, Lim SC. Ethnic Disparity in Inter-Arm Systolic Blood Pressure Difference and its Determinants among Asians with Type 2 Diabetes: A Cross-Sectional Study. Journal of the ASEAN Federation of Endocrine Societies. 2016 Nov 4;31(2):81.
8. Lim SC, Dorajoo R, Zhang X, Wang L, Ang SF, Tan CS, Yeoh LY, Ng XW, Li N, Su C, Liu S. Genetic variants in the receptor for advanced glycation end products (RAGE) gene were associated with circulating soluble RAGE level (sRAGE), but not with renal function among Asians with type 2 diabetes: a genome-wide association study. Nephrology Dialysis Transplantation. 2016 Jul 21:gfw263.
9. Moh MC, Sum CF, Tavintharan S, Pek SL, Yeoh LY, Ng X, Lee SB, Tang WE, Lim SC. Association of the anti-angiogenic factor secreted protein and rich in cysteine (SPARC) with vascular complications among Chinese type 2 diabetic patients in Singapore. Journal of Diabetes and its Complications. 2016 Mar 31.
10. Zhang X, Liu JJ, Fang Sum C, Ying YL, Tavintharan S, Ng XW, Su C, Low S, Lee SB, Tang WE, Lim SC. Central arterial stiffness is associated with systemic inflammation among Asians with type 2 diabetes. Diabetes and Vascular Disease Research. 2016 Jul;13(4):303-6.
11. Zhang X, Liu JJ, Sum CF, Ying YL, Tavintharan S, Ng XW, Low S, Lee SB, Tang WE, Lim SC. Ethnic disparity in central arterial stiffness and its determinants among Asians with type 2 diabetes. Atherosclerosis. 2015 Sep 30;242(1):22-8.
12. Pek SL, Tavintharan S, Wang X, Lim SC, Woon K, Yeoh LY, Ng X, Liu J, Sum CF. Elevation of a Novel Angiogenic Factor, Leucine-Rich-α2-Glycoprotein (LRG1), Is Associated With Arterial Stiffness, Endothelial Dysfunction, and Peripheral Arterial Disease in Patients With Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2015 Jan 30;100(4):1586-93.
13. Liu JJ, Yeoh LY, Sum CF, Tavintharan S, Ng XW, Liu S, Lee SB, Tang WE, Lim SC. Vascular cell adhesion molecule-1, but not intercellular adhesion molecule-1, is associated with diabetic kidney disease in Asians with type 2 diabetes. Journal of diabetes and its complications. 2015 Jul 31;29(5):707-12.
14. Low KMS, Sum CF, Yeoh LY, Tavintharan S, Ng X, Lee SBM, Tang WE, Lim SC. Prevalence of Chronic Kidney Disease in Singaporean Adults with Type 2 Diabetes Mellitus. ANNALS Academy of Medicine Singapore. 2015;44:164-171.
15. Moh MC, Sum CF, Lam BCC, Ng X, Su C, Tavintharan S, Yeoh LY, Wong MDS, Lee SBM, Tang WE, Lim SC. Evaluation of body adiposity index as a predictor of aortic stiffness in multi-ethnic Asian population with type 2 diabetes. Diabetes & Vascular Disease Research. 2014;12(2):111-118.
16. Yeoh CKE, Sum CF, Su C, Low KMS, Lim SC, Yeoh LY, Ng X, Tang WE, Lee SBM, Tavintharan S. Low-density Lipoprotein Cholesterol levels in adults with Type 2 Diabetes: an alternative equation for accurate estimation and improved cardiovascular risk classification. Diabetes & Vascular Disease Research. 2014 Nov;11(6):431–439.
17. Liu JJ, Sum CF, Tavintharan S, Yeoh LY, Ng XW, Moh AM, Lee S, Tang WE, Lim SC. Obesity is a determinant of arterial stiffness independent of traditional risk factors in Asians with young-onset type 2 diabetes. Atherosclerosis. 2014 Oct 31;236(2):286-91.
18. Liu JJ, Tavintharan S, Yeoh LY, Sum CF, Ng XW, Pek SL, Lee SB, Tang WE, Lim SC. High normal albuminuria is independently associated with aortic stiffness in patients with type 2 diabetes. Diabetic Medicine. 2014 Oct 1;31(10):1199-204.
19. Tavintharan S, Pek LT, Liu JJ, Ng XW, Yeoh LY, Su Chi L, Chee Fang S. Osteoprotegerin is independently associated with metabolic syndrome and microvascular complications in type 2 diabetes mellitus. Diabetes and Vascular Disease Research. 2014 Sep;11(5):359-62.

Publications (Abstracts):

1. Gurung RL, Y. M, Liu S, Liu JJ, Lim SC. Short leukocyte telomere length is associated with increased risk for albuminuria progression in type 2 diabetes in Asians. Diabetologia 60(Suppl 1):S94 .
2. Zhang X, Neelam K, Low SM, Li N, Ying YL, Lee S, Tang WE, Tavintharan S, Sum CF, Lim SC. Central arterial stiffness is associated with the presence and severity of diabetic retinopathy among Asians with type 2 diabetes mellitus. Singapore Med J. 2016;57(1 Suppl):S50.
3. Wong DSM, Moh MC, Sum CF, Tavintharan S, Lim SC. Association of Fractalkine and Overt Albumin Excretion in Type 2 Diabetes. Singapore Med J. 2016;57(1 Suppl):S49.
4. Gurung RL, Liu S, Yeo SJ, Jeevith B, Li N, Sum CF, Lim SC. Novel association of NPAT variant and gastrointestinal side effects of metformin in patients with type 2 diabetes mellitus. Singapore Med J. 2016;57(1 Suppl):S36. (Top Poster Abstract Awards: Basic Science Research)
5. Goenadi CJ, Zhang X, Pek S, Tavintharan S, Sum CF, Lim SC, Yip CC, Neelam K. Elevated plasma leucine-rich alpha-2-glycoprotein 1 is associated with diabetic retinopathy in Asians with type 2 diabetes mellitus. Singapore Med J. 2016;57(1 Suppl):S29. (Top Oral Abstract Awards: Basic Science Research)
6. Pek SLT, Moh AMC, Yeoh LY, Lim SC, Sum CF, Tavintharan S. Prevalence of peripheral arterial disease and peripheral neuropathy in early-onset diabetes in a cohort of multiethnic patients with Type 2 Diabetes. AAMS. 2016;45(9 Suppl):S27. (Silver - Singapore Young Investigators Award)
7. Lim SC, Zhang X, Li N, Liu JJ, Moh MC, Su C, Low S, Tavintharan S, Yeoh LY, Sum CF. Prospective cohort study suggests that central arterial stiffness is an independent predictor of albuminuria progression among Asians with type 2 diabetes. JAFES. 2015;30(2):52 (Oral Abstract). Winner of Best Overall Oral Presentation & Best Section Oral Presentation.
8. Pek SLT, Yeoh LY, Lim SC, Sum CF, Tavintharan S. Plasma apoCIII is independently associated with peripheral neuropathy in patients with Type 2 Diabetes (T2D). AAMS. 2015;44(10 Suppl):S175.
9. Sandhya D, Woon K, Pek S, Lin M, Lee YY, Lim SC, Sum CF, Tavintharan S. Effects of Fenofibrate on Pigment Epithelium-Derived Factor (PEDF) in clinical human subjects and ARPE-19 eye cells. AAMS. 2015;44(10 Suppl):S51. (Winner of Gold Award)
10. Zhang X, Liu JJ, Sum CF, Ying YL, Tavintharan S, Ng XW, Low S, Lee SB, Tang WE, Lim SC. Central arterial stiffness is associated with systemic inflammation among Asians with type 2 diabetes. AAMS. 2015;44(10 Suppl):S333.
11. Wong MDS, Moh MC, Yeoh LY, Sum CF, Tavintharan S, Ng X, Lee SBM, Tang WE, Lim SC. Association between visceral adiposity and microalbuminuria in type 2 diabetes - potential role of inflammation and insulin resistance. Diabetes Research and Clinical Practice. 2014;106(1 Suppl):S241.
12. Liu S, Liu JJ, Sum CF, Tavintharan S, Ng X, Yeoh LY, Lee SBM, Tang WE, Lim SC. Plasma adiponectin is independently associated with soluble VCAM-1 but not ICAM-1 in patients with type 2 diabetes mellitus. Diabetes Research and Clinical Practice. 2014;106(1 Suppl):S47. 13. Liu JJ, Sum CF, Tavintharan S, Yeoh LY, Lee SBM, Tang WE, Ng X, Lim SC. Ethnic disparity in arterial stiffness among Asians with Type 2 Diabetes. Diabetes Research and Clinical Practice. 2014;106(1 Suppl):S57.
13. Moh MC, Sum CF, Ng X, Tavintharan S, Yeoh LY, Wong MDS, Lee SBM, Tang WE, Lim SC. Insulin resistance mediates association of elevated liver alanine aminotransferase and endothelial dysfunction among Type 2 Diabetes Chinese male patients in Singapore. Diabetes Research and Clinical Practice. 2014;106(1 Suppl):S44.
14. Wong MDS, Moh MC, Yeoh LY, Sum CF, Ng X, Tavintharan S, Lee SBM, Tang WE, Lim SC. Determinants of elevated high-sensitivity C-reactive protein in a type 2 diabetic multi-ethnic Asian population. Singapore Med J. 2014;55(1 Suppl):S60.
15. Pek SLT, Ng X, Yeoh LY, Lim SC, Sum CF, Tavintharan S. Alternative ankle branchial index predicts arterial compliance in patients with type 2 diabetes mellitus. Singapore Med J. 2014;55(1 Suppl):S62.
16. Woon K, Ong YC, Pek SLT, Ng X, Yeoh LY, Lim SC, Sum CF, Tavintharan S. Fenofibrate treatment is associated with increased expression of pigment epithelium-derived factor in patients with type 2 diabetes mellitus and HepG2 cells. Singapore Med J. 2014;55(1 Suppl):S28.
17. Moh MC, Yeoh LY, Sum CF, Ng X, Tavintharan S, Wong MDS, Lee SBM, Tang WE, Lim SC. Association of central obesity with renal function in early-onset type 2 diabetes. Singapore Med J. 2014;55(1 Suppl):S29.
18. Tavintharan S, Pek SLT, Wang X, Lim SC, Yeoh LY, Sum CF. Leucine-Rich-Alpha2-Glycoprotein1 (LRG1) Is Reduced in Males with Type 2 Diabetes Complicated with Peripheral Arterial Disease. Diabetes. 2014;63(1 Suppl):A109.
19. Moh MC, Tavintharan S, Sum CF, Yeoh LY, Ng X, Lee SBM, Tang WE, Lim SC. Relationship between Anthropometric Measurements of Adiposity and Arterial Stiffness in Subjects with Type 2 Diabetes. Diabetes. 2014;63(1 Suppl):A528.
20. Tavintharan S, Lim SC, Yeoh LY, Ng X, Tang WE, Lee SBM, Sum CF. The Impact of Ethnicity on Risk of Complications in Patients with Type 2 Diabetes— findings from Multiethnic Asian Population. Diabetes. 2014;63(1 Suppl):A372.
21. Moh MC, Sum CF, Ng X, Tavintharan S, Yeoh LY, Wong MDS, Lee SBM, Tang WE, Lim SC. Ethnic disparity in the relationship of insulin resistance and body mass index with serum alanine aminotransferase among a multi-ethnic Asian population with type 2 diabetes. AAMS. 2014;43(9 Suppl):S328.
22. Wong MDS, Moh MC, Sum CF, Ng X, Tavintharan S, Yeoh LY, Lee SBM, Tang WE, Lim SC. Association between visceral adiposity, inflammation (C-reactive protein), micro-vascular endothelial dysfunction and nephropathy in multi-ethnic Asians with type 2 diabetes (SMART2D cohort). AAMS. 2014;43(9 Suppl):S47.
23. Liu S, Liu JJ, Ng X, Sum CF, Tavintharan S, Yeoh LY, Lee SBM, Tang WE, Lim SC. Circulating vascular cell adhesion molecule 1, but not intercellular adhesion molecule 1, is associated with renal impairment in patients with type 2 diabetes mellitus. AAMS. 2014;43(9 Suppl):S296.
24. Ng X, Lim SC, Tavintharan S, Yeoh LY, Asrap A, Cheok J, Ou Y, Arof M, Lum NJ, Riffin N, Sum CF. Clinical Predictors of Established Diabetic Nephropathy in a Large Asian Population. Singapore Med J. 2012;53(1 Suppl):S25 (Also orally presented in AH Health Forum 2012).
25. Liu JJ, Lim SC, Tavintharan S, Yeoh LY, Ng X, Sum CF. Multiple Predictors of Arterial Stiffness in Type 2 Diabetes. AAMS. 2012;41(9 Suppl):S93.
26. Ng X, Lim SC, Tavintharan S, Yeoh LY, Asrap A, Arof M, Ou Y, Cheok J, Riffin N, Liew YT. Arterial Stiffness in Diabetic Nephropathy is Associated with Endothelial Dysfunction. AAMS. 2012;41(9 Suppl):S106.
27. Arof M, Asrap A, Ou Y, Cheok J, Riffin N, Ng X, Lum NJ, Tavintharan S, Yeoh LY, Sum CF. Validation of the Accuracy of Bio-impedence Body Composition Analyzer (InBody S20) in Estimating Waist Circumference among Subjects with Type 2 Diabetes. AAMS. 2012;41(9 Suppl):S39.

Media:

1. Short leukocyte telomere length is associated with increased risk for albuminuria progression in type 2 diabetes in Asians (Oral Presentation)

What is MODY?

• A type of diabetes caused by a single gene abnormality, often misdiagnosed as the common Type 1 or Type 2 diabetes
• Registry set up to identify individuals with MODY and provide a genetic diagnosis so that they can receive the best treatment

MODY stands for Maturity-Onset Diabetes of the Young. It is a type of diabetes that is caused by a single gene abnormality (mutation) and is also known as monogenic diabetes. MODY can often be misdiagnosed as the common Type 1 or Type 2 diabetes as they share similar features. Determining the gene mutation in MODY is important to confirm the diagnosis.

Mutation in more than 20 genes have been shown to cause MODY. The most common ones include HNF4A, GCK and HNF1A (MODY-1,-2 and -3) as well as KCNJ11 and ABCC8 (can cause diabetes as young as 1 year old or less, i.e. neonatal diabetes). These genes directly affect the ability of the insulin-producing cells in the pancreas to sense, produce and release insulin, which is required to control sugar levels in our body.

The KTPH-NHG MODY Registry is set up as part of our research study to identify individuals with MODY and to provide a genetic diagnosis for this group of individuals. A genetic diagnosis of MODY may aid doctors in providing the best treatment for these individuals (e.g. switching from insulin to tablets).

News Feature
Patient with rare diabetes tracked with new registry (The Sunday Times, 15/10/2017).

Related Publication
A preliminary study to evaluate the strategy of combining clinical criteria and next generation sequencing (NGS) for the identification of monogenic diabetes among multi-ethnic Asians.

What is Familial Hypercholesterolemia (FH) ?

Aims to raise awareness of this genetic condition that puts one at risk for early heart disease, its diagnosis and treatment options

Based on global statistics, Familial Hypercholesterolemia (FH) affects approximately 20,000 patients in Singapore but more than 90% are unaware of this condition and remain undiagnosed! Early diagnosis can allow affected individuals and theirfamily members to start treatment early and ultimately reduce the risk of getting early heart attack.

• FH leads to early heart disease, the #1 killer in the world.
• Men with FH have 50% risk of having heart disease by age of 50.
• Women with FH have 30% risk of having heart disease by age of 60.

Diabetic Nephropathy (DN)

The Diabetic Nephropathy (DN) cohort at Khoo Teck Puat Hospital (KTPH) (Alexandra Health Pte Ltd) has been initiated since 2002. It includes ~ 5,499 multi-ethnic patients with type 2 diabetes (age 58.3 ± 11.7 years old, duration of diabetes 12.0 ± 8.7 years, Chinese 67.5%, Malays 19.1%, Asian Indians 13.3% and others 0.2%). Blood and urine samples collected at baseline visit have been cryo-preserved. In collaboration with local and overseas institutions, we aim to study biomarkers (both genetic and non-genetic) associated with the development and progression of DN in multi-ethnic Asians with diabetes.

The cohort is enriched by subjects with renal impairment in accordance with the aim of the study (MDRD eGFR 67.8 ± 37.7 ml/min/1.73m2, CKD stage 1- 28.1%, stage 2-31.3%, stage 3-20.8%, stage 4- 9.0% and stage 5-10.7%). Approximately 30.0% of the subjects are classified as having microalbuminuria (urinary albumin-to-creatinine ratio, .i.e. ACR 30 to 299 mg/g) and 27.7% of them are classified as having macroalbuminuria (ACR >= 300 mg/g). The longitudinal trajectory of eGFR and ACR has also been recorded in a large proportion of the subjects.

The median follow-up duration of this cohort is 5.7 years. Incident diabetes related outcomes can be ascertained by linkage of cohort database with Singapore National Disease registries (Renal Registry, Myocardial Infarct Registry, Death/birth Registry, Stroke Registry and Cancer Registry).

Publications:

1. Genetic markers for urine haptoglobin is associated with decline in renal function in type 2 diabetes in East Asians. Gurung RL, Dorajoo R, Liu S, M Y, Liu JJ, Wang L, Guo L, Yu X, Liu JJ, Lim SC. Sci Rep. 2018 Mar 23;8(1):5109. doi: 10.1038/s41598-018-23407-1
2. Ong YH, Koh WCA, Ng ML, Tam ZY, Lim SC, Boehm BO; Adult-Onset Autoimmune Diabetes Mellitus Consortium (ADAMS). Glutamic acid decarboxylase and islet antigen 2 antibody profiles in people with adult-onset diabetes mellitus: a comparison between mixed ethnic populations in Singapore and Germany. Diabet Med. 2017 Aug;34(8):1145-1153. doi: 10.1111/dme.13358.
3. Liu JJ, Ghosh S, Kovalik JP, Ching J, Choi HW, Tavintharan S, Ong CN, Sum CF, Summers SA, Tai ES, Lim SC. Profiling of Plasma Metabolites Suggests Altered Mitochondrial Fuel Usage and Remodeling of Sphingolipid Metabolism in Individuals With Type 2 Diabetes and Kidney Disease. Kidney International Reports. 2017 May 31;2(3):470-80.
4. Low S, Lim SC, Yeoh LY, Liu YL, Liu JJ, Fun S, Su C, Zhang X, Subramaniam T, SUM CF. The effect of long term glycemic variability on estimated glomerular filtration rate decline among patients with type 2 diabetes mellitus–insights from the Diabetic Nephropathy Cohort in Singapore. Journal of Diabetes. 2016 Dec 1.
5. Low S, Lim SC, Zhang X, Zhou S, Yeoh LY, Liu YL, Tavintharan S, Sum CF. Development and validation of a predictive model for Chronic Kidney Disease progression in Type 2 Diabetes Mellitus based on a 13-year study in Singapore. Diabetes Research & Clinical Practice 2016; 123:49-54
6. Liu JJ*, Liu S*, Wong MDS, Gurung RL and Lim SC. Urinary haptoglobin predicts rapid renal function decline in Asians with type 2 diabetes and early kidney disease. J Clin Endo Metab 2016; 101(10):3794-3802 (* equal contributors)
7. SC Lim*, R Dorajoo*, X Zhang, L Wang, SF Ang, C Tan, Yeoh LY, XW Ng, Na Li, Chang Su, S Liu, M Wong, S Low, AY Ou, Jeevith B, S Fun, SY Zhou, Simon BM Lee, WE Tang, Subramaniam T, CF Sum, JJ Liu. Genetic variants in the receptor for advanced glycation end products (RAGE) gene were associated with circulating soluble RAGE level (sRAGE), but not with renal function among Asians with type 2 diabetes: a genome-wide association study. Neph Dial Transplant 2016; Jul 21. pii: gfw263. [Epub ahead of print]
8. Liu JJ, Lim SC, Yeoh LY, Su C, Tai BC, Low S, Fun S, Tavintharan S, Chia KS, Tai ES and Sum CF. Ethnic disparities in risk of cardiovascular disease, end stage renal disease and all-cause mortality- a prospective study among South East Asians with type 2 diabetes. Diabetic Medicine 2016; 33(3):332-9
9. Low S, Lim SC, Yeoh LY, Su C, Zhang X, Subramaniam T, Sum CF. Long-term diabetes outcomes in multi-ethnic Asians living in Singapore. Diabetes Res Clin Pract 2016; 111: 83-92.
10. Low S, Tai ES, Yeoh LY, Liu YL, Liu JJ, Tan KH, Fun S, Su C, Zhang X, Subramaniam T, Sum CF, Lim SC. Onset and progression of kidney disease in type 2 diabetes among multi-ethnic Asian population. J Diabetes Complications 2016; 30(7): 1248-54.
11. Liu JJ, Liu S, Morgenthaler NG, Wong MDS, Tavintharan S, Sum CF, Lim SC. Association of soluble α-klotho with endothelin-1 in type 2 Diabetes. Atherosclerosis 2014;233(2):415-418
12. Lim SC*, Liu JJ*, Tavintharan S and Sum CF. Elevated circulating alpha-klotho by angiotensin II receptor blocker losartan is associated with reduction of albuminuria in type 2 diabetic patients. Journal of renin-angiotensin-aldosterone system. 2014;15(4):487-90
13. Liu JJ, Liu S, Wong MDS, Tan CS, Tavintharan S, Sum CF and Lim SC. Relationship between circulating irisin, renal function and body composition in type 2 diabetes. J Diabetes Complications 2013;28(2):208-213
14. Liu JJ, Wong MDS, Toy WC, Tan CSH, Liu S, Ng XW, Tavintharan S, Sum CF and Lim SC. Lower circulating irisin is associated with type 2 diabetes mellitus. J Diabetes Complications (with editorial comments) 2013;27(4):365-369
15. JJ Liu, WC Toy, Melvin DS Wong, Clara SH Tan, Subramaniam T; MS Wong, CF Sum and SC Lim. Elevated undercarboxylated and reduced carboxylated osteocalcin are associated with metabolic syndrome in middle age Asian females. Exp Clin Endocrinol Diabetes. 2013;121:329-33. doi: 10.1055/s-0033-1334883.
16. Lim SC, Phua E J, Sharon F Nne, Amizah B Asrap, Wong DS Melvin, Tan SH Clara, Liu J Jun, Toy W Ching, Ng X Wei, Lau PX Dawn, Pek LT Sharon, Woon Kaing, Lin LF Bernice, S Tavintharan, Sum C Fang. Modifiable risk factors associated with arterial stiffness in diabetic nephropathy in an Asian Population Cohort. Journal of ASEAN Federal Endocrine Societies (JAFES) 2011; 26:163-167
17. SC Lim, Dollyn Quek L, WC Toy, Melvin Wong DS, Lee Ying Yeoh, C Tan MF, D Lau, C Tan, T Subramaniam, C F Sum. Adipocytokine zinc alpha-2 glycoprotein (ZAG) as novel urinary biomarker for normo-albuminuric diabetic nephropathy. Diabetic Medicine 2012;29:1-5
18. Toy W C, Liu JJ, Anton Cheng KS, C Tan, D Lau, M Wong, T Subramaniam, Sum C F, Lim SC. Adiponectin Gene Polymorphisms and Type 2 Diabetes among Singaporean Chinese Adults. J Diabetes Metab 2011, 2:8
19. S.C. Lim, J. J. Liu, H. Q. Low, N. G. Morgenthaler, Y. Li, L. Y. Yeoh, Y. S. Wu, S.K. Goh, C. Y. Chionh, S. H. Tan, Y. C. Kon, P. C. Soon, Y. M. Bee, T. Subramaniam, C. F. Sum, K. S. Chia. Microarray analysis of multiple candidate genes and associated plasma proteins for nephropathy secondary to type 2 diabetes among Chinese. Diabetologia 2009 52:1343-51
20. Lim, Su-Chi; Morgenthaler, Nils; Subramaniam, Tavintharan; Wu, Yew-Seng; Goh, Siew-Kheng; Sum, Chee-Fang. The relationship between adrenomedullin, metabolic factors and vascular function in individuals with type 2 diabetes mellitus. Diabetes Care 2007;30:1513-1519
21. SC Lim, H H Tan, SK Goh, T Subramaniam, CF Sum, I K Tan, B L Lee, C N Ong. Oxidative Burden in Pre-diabetic and Diabetic Individuals: Evidence from Plasma Coenzyme Q10. Diabetic Med 2006 23: 1344-1349
22. SC Lim, T Goh, YR Lai, WW Tee, Angela Koh, XH Xu, YS Wu, Eric Yap, T Subramaniam, C F Sum. Relationship between common functional polymorphisms of the p22phox gene (-930A>G & +242 C>T) and nephropathy due to type 2 diabetes among Chinese. Diabetic Medicine 2006 23:1037-1041

OMICS (Obesity – Metabolism & Intervention Cohort Study)

Multi-disciplinary research in fields such as epidemiology, genetics, metabolomics, lifestyle and nutrition to gain insights into functional changes related to obesity among multi-ethnic Asians in Singapore

Obesity is a complex multifaceted disease arising from interactions of biological, behavioural and environmental factors, and contributes to many comorbid conditions e.g. Type 2 diabetes (T2DM). Bariatric Surgery (also known as Gastrointestinal Surgery, or Bariatric and Metabolic Surgery) is highly effective in inducing weight loss among morbidly obese individuals thereby ameliorating adverse metabolic consequences.

The OMICS project is co-initiated by Dr Anton Cheng (Deputy Director of Weight Management Programme at our Health For Life Centre) and Dr Lim Su Chi (Clinical Director, Clinical Research Unit) to provide resources for conducting multi-disciplinary research in fields such as epidemiology, genetics, metabolomics, lifestyle and nutrition to elucidate obesity pathophysiology among multi-ethnic Asians in Singapore.

Constituting the core of OMICS is a prospective-cohort founded since 2007. To date, it has ~400 severely obese (mean BMI~40 kg/m2) individuals who underwent bariatric surgery. About one-third of them has T2DM, whom we have performed pre- and post-bariatric surgery multiple time-point OGTT. Additionally, we have established a rich bio-repository of bio-banked blood and urine samples, cryopreserved human primary adipocytes (both subcutaneous and visceral), skeletal myocytes and longitudinal clinical data collected from the research participants.

The goals of the OMICS project are:

1. To understand the best practice for candidate-selection to derive benefit from bariatric surgery
2. To unveil the mechanisms elicited by bariatric surgery so as to facilitate the development of powerful non-invasive interventions for improving obesity and/or T2DM
3. To identify biomarkers to better risk-stratify obesity/T2DM patients i.e. personalized medicine

Publications

1. Pek SL, Sum CF, Lin MX, Cheng AK, Wong MT, Lim SC, Tavintharan S. Circulating and visceral adipose miR-100 is down-regulated in patients with obesity and Type 2 diabetes. Mol Cell Endocrinol. 2016;427:112-23.
2. Toy WC, Liu JJ, Cheng AKS, Tan CSH, Lau DP, Wong MDS, Tavintharan S, Sum CF, Lim SC. Adiponectin gene polymorphisms and type 2 diabetes among Singaporean Chinese adults. J Diabetes Metab. 2011;2(8): 1000152.
3. Kiong KL, Ganesh R, Cheng AKS, Lekshiminarayanan R, Lim SC. Early improvement in type 2 diabetes mellitus post Roux-en-Y gastric bypass in Asian patients. Singapore Med J 2010; 51(12) 937.
4. Ngiam KY, Lee WJ, Lee YC, Cheng A. Efficacy of metabolic surgery on HbA1c decrease in type 2 diabetes mellitus patients with BMI < 35 kg/m2--a review. Obes Surg. 2014 Jan; 24(1):148-58.

Conference Abstracts

1. Moh MC, Lian M, Ang SF, Wong MDS, Zhang X, Lim SC. Whole exome sequencing on a large cohort of severely-obese individuals to investigate pancreatic β-cell function related protein-coding variants potentially protective against type 2 diabetes in the metabolically healthy non-diabetic group. AFES 2017, Yangon, Myanmar.
2. Moh MC, Lim SC, Lim BK, Tavintharan S, Sum CF, Cheng AKS. Evaluation on the early effects of bariatric surgery on the outcome of type 2 diabetes in obese patients. ICO 2014, 12th International Congress on Obesity, Malaysia, Kuala Lumpur.
3. Moh MC, Cheng AKS, Pek SLT, Lim BK, Wong MDS, Lim SC. Alteration of the plasma amino acid profile predicts glucose tolerance after gastro-intestinal metabolic surgery in obese patients with type 2 diabetes. Singapore Health and Biomedical Congress 2015, Singapore.
4. Wong MDS, Moh MC, Cheng AKS, Tan LT, Lim BK, Pek SLT, Sum CF, Tavintharan S, Lim SC. Elevation of plasma long-chain acylcarnitines in obese patients with non-remission of type 2 diabetes after bariatric surgery. Singapore Health and Biomedical Congress 2015, Singapore.
5. Toy WC, Liu JJ, Cheng AKS, Wong MDS, Sylvia, Tan CSH, Sum CF, Lim SC. TNF-α induce fractalkine expression via activation of NF-kB in human adipocytes. Singapore Health and Biomedical Congress 2012, Singapore.
6. Toy WC, Cheng AKS, Tan TJ, Lau DP, Rajmohan L, Tan CSH, Wong MDS, Tavintharan S, Sum CF, Lim SC. The effect of PPARï?§ Rosiglitazone on the gene expression profile of subcutaneous vs visceral adipocytes. Alexandra Health Research Forum 2011, Singapore.
7. Lau DP, Toy WC, Cheng AKS, Tan CSH, Wong MDS, Narayanan R, Sum CF, Tavintharan S, Lim SC. Differential gene expression of inflammatory cytokines and receptors between human visceral and subcutaneous adipose tissue. Alexandra Health Research Forum 2011, Singapore.
8. Toy WC, Tan JJ, Lau DP, Tan CSH, Wong MDS, Tavintharan S, Sum CF, Lim SC, Cheng AKS. The miRNA profiling on the effect of Rosiglitazone on subcutaneous vs visceral adipocytes. Asia-Pacific Metabolic and Bariatric Surgery Society. 21st Oct 2010. Singapore.

Conference Papers

1. Lap adj Gastric Band for morbid Obesity Results at 5 years. Free paper. Aaron Poh, A Cheng. APMBSS Congress Singapore Oct 2010
2. Early improvement in Type 2 DM post RYGB in Asian patients. G Xu, A Cheng. APMBSS Congress Singapore Oct 2010
3. Laparoscopic Adjustable gastric Banding our 5 years experience in AH/KTPH. Ganesh R, A Cheng. ELSA Congress Singapore August 2011
4. Biliopanceatic diversion as a revision bariatric procedure our case series. Ganesh R, A Cheng. ELSA Congress Singapore August 2011
5. Single incision sleeve gastrectomy. Ganesh R, A Cheng. ELSA Congress Singapore August 2011
6. Single incision sleeve gastrectomy video presentation. HS Ho, WD Lau, Desmond Ooi, A Cheng. ELSA Congress Singapore August 2011
7. Laparoscopic Biliopancreatic Diversion, video presentation. Lau WD, Cheng A. ELSA Congress Singapore August 2011
8. Lengthening of BP limb post BPD due to severe malnutrition. Video presentation. Tan CC, Cheng A. ELSA Congress Singapore August 2011
9. Endoscopic stenting of GJ anastomotic leak after RYGB. Desmond Ooi, Ho HS, Lau WD, AKS Cheng. ELSA Congress Singapore August 2011
10. Reasons for loss to follow up in our Bariatric Surgical Center. Lucy Kong, Ganesh R, A Cheng. ELSA Congress Singapore August 2011
11. Laparoscopic Adjustable Gastric Banding 10 years experience, IFSO congress New Delhi, Oct 2012
12. Glycaemic Control after Gastric Bypass Surgery in Morbidly Obese Patients with Diabetes Mellitus: An Asian Experience, IFSO congress New Delhi, Oct 2012

Media Reports

1. Khoo Teck Puat Hospital studying effectiveness of bariatric surgery
2. More opt for drastic weight-loss surgery