Dr. Caroline Kramer

• 2023–present; Associate Member, Institute of Medical Science, University of Toronto, Toronto
• 2021–present; Associate Professor, Division of Endocrinology and Metabolism, Medicine, University of Toronto, Toronto
• 2014–present; Clinician Scientist, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto
• 2014–present; Endocrinologist and Clinician Scientist, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Sinai Health, Toronto

• Postdoctoral research fellowship, Division of Endocrinology, Leadership Sinai Centre for Diabetes, University of Toronto, Toronto; 2012–2014 
• PhD (Partially undertaken at UCSD - scholarship from Brazil), Endocrinology, Epidemiology, Universidade Federal Do Rio Grande Do Sul and University of California San Diego (Partially), Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA; 2008–2009
• Endocrinology specialist, Department of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; 2006–2008  
• Internal medicine specialist, Department of Medicine, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; 2003–2006 
• MD, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; 1997–2002 

• 2023 – International visiting professor award, CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), Brazil
• 2016–2021 – Canadian Diabetes Association (Diabetes Canada) Clinician-Scientist Award
• 2015–2017 – Banting and Best Diabetes Centre New Investigator Award for Diabetes Research
• 2012–2017 – Clinician scientist merit award, Department of Medicine, University of Toronto, Toronto
• Recipient of a basket of eggs, homemade bread, and wild honey from a local underserved community in Brazil for my work as a clinician-scientist, because the work to support our communities and the recognition by them is as valuable or even more than an official award in our academic institutions. 

Impact of time-restricted eating (TRE) on metabolic health of individuals with T2DM

Previous studies have shown that achieving long-term weight loss and sustained blood sugar control through lifestyle interventions remains challenging for individuals living with obesity and type 2 diabetes. Our research focuses on evaluating practical lifestyle strategies that can improve metabolic health in this population, particularly time-restricted eating (TRE), a dietary approach that limits food intake to specific hours of the day.

We have completed a series of analyses demonstrating  that TRE may represent a simple, practical, and scalable lifestyle intervention for improving metabolic health, including a CIHR-funded randomized clinical trial evaluating the effects of TRE intervention in individuals with overweight and T2DM, (https://pubmed.ncbi.nlm.nih.gov/39193706/) (https://pubmed.ncbi.nlm.nih.gov/41814085/) (https://pubmed.ncbi.nlm.nih.gov/33319233/). 

Importantly, our previous work has also shown that currently available medications for T2DM cannot fully prevent the progressive decline in pancreatic beta-cell function over time. Building on these findings, we recently received a CIHR operating grant to evaluate the long-term effects of TRE over 52 weeks in individuals with T2DM and overweight/obesity. Our lab is working to address clinically important questions regarding this feasible and globally applicable lifestyle strategy to improve metabolic health and diabetes outcomes.

Epidemiology and social determinants of obesity

Dr. Kramer is a Brazilian physician with Indigenous background, and our lab has been working to address important factors related to lifestyle from an Indigenous Brazilian lens. In a publication in The Lancet, we evaluated the cardiometabolic health of Indigenous Brazilian peoples through a comprehensive analyses of the association of urbanisation with obesity, cardiovascular (CV) risk factors, and CV mortality. We demonstrated that macrosocial changes of Indigenous peoples traditional ways of living consequent to urbanization (i.e. adoption of unhealthy eating patterns) are associated with increased rates of obesity and adverse cardiometabolic outcomes. 

Another important contribution in the field of epidemiology of obesity was a meta-analysis demonstrating that metabolically healthy obesity is associated with an increased future risk of CV mortality and the evidence of discrepancies in representation of racialized and ethnically diverse populations in obesity trials as compared with multiethnic populations worldwide.

Effect of glucagon-like receptor agonists (GLP-1 RA) on metabolic health  

Our lab is interest in evaluation research questions on the impact of GLP-1 RA on metabolic health that are directly relevant to clinical practice. We have previously evaluated the use of GLP-1RA on weight regain in patients previously submitted to metabolic surgery and observed that liraglutide and semaglutide can promote significant weight reduction with an acceptable safety profile. 

These analyses have important implications for clinical care as it indicated that pharmacological treatment can still be safely offered post-bariatric surgery. Importantly, we are currently recruiting for a trial aiming to determine whether a gradual dose reduction of semaglutide prior to complete discontinuation is associated with differential changes in weight and cardiometabolic profile as compared to immediate treatment cessation.

Impact of lifestyle interventions and pharmacotherapies on cardiometabolic health  

My lab is interested in a broad range of lifestyle and drug interventions for metabolic health. We are interested in wholistic interventions that can improve well-being and metabolic health, and we welcome out-of-the box thinking for novel analytic approaches. 

A few of our previous publications on that: 
https://pubmed.ncbi.nlm.nih.gov/31592726/
https://pubmed.ncbi.nlm.nih.gov/37220157/  
https://pubmed.ncbi.nlm.nih.gov/41207257/  
https://pubmed.ncbi.nlm.nih.gov/36594235/ 

We are always looking for motivated researchers/trainees to join our team. If interested, please contact Dr. Caroline Kramer at [email protected]. If doing so, write concisely stating why you are interested along with your most recent CV.