Daniela Geba, MD
Project: Comparative effectiveness of diabetes screening strategies: a pilot study
Mentor: Thomas Pearson, MD, MPH, PhD, Albert D. Kaiser Professor, Department of Public Health Sciences; Senior Associate Dean for Clinical Research, University of Rochester Medical Center; Director, Rochester Clinical and Translational Science Institute
Dr. Daniela Geba is a second-year PhD student in the Translational Biomedical Sciences (TBS) program at the University of Rochester Medical Center. Her journey to Rochester – like the innovative TBS program – is unique.
(Visit the CTSI Youtube page to watch Daniela speak about her work.)
After earning her medical degree at the University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania, Dr. Geba relocated to the United States, joining her husband, who was earning his PhD in mathematics at Princeton University. During her first several years in the U.S., Dr. Geba put her career on hold to raise the couple’s two daughters and help make the transition from Romania easier. When her daughters got older, she decided to resume her training and pursue her PhD. She then enrolled in an epidemiology program at the University at Buffalo, and later, in the TBS program at URMC.
Dr. Geba’s research interest is in the broad area of cardiovascular disease, with a focus on diabetes mellitus. She is currently developing a clinical trial which will compare screening strategies for type 2 diabetes.
Translational Biomedical Sciences Program
The Translational Biomedical Sciences program is one of the first of its kind in the nation. This non-traditional PhD program prepares students for careers in academic and clinical settings, emphasizing the adaption of basic biomedical science for clinical practices.
“Described often using the phrase, ‘from bench to bedside,’ translational research is meant to be the process which facilitates the collaboration between basic scientists and clinicians,” Dr. Geba said. “In one way, the great discoveries from basic science are translated into practical applications that are used in clinical and community-type research; in the other direction, the observations about human disease that are made by clinicians in their daily encounters with the patients stimulate new discoveries in basic science.”
The program’s formal curriculum includes skill-building workshops and seminars, research rotations, and a qualifying examination. Students are also encouraged to take advantage of opportunities aimed at developing skills in grant and manuscript writing, teaching, and in presenting their research. TBS students may pursue a course of study in either basic research or clinical research, but have exposure to both fields. Dr. Geba says the interdepartmental focus of the program is one of the primary reasons it is unique.
“This offers the students in the program a lot of flexibility when it comes to the project thesis they can choose,” she said. “The students in our program are allowed to have as advisors any faculty member from the University of Rochester Medical Center who is actively involved in research, and [they] can choose a project that’s placed anywhere along the entire spectrum of translational research.”
Students’ thesis committees consist of faculty members who have expertise in basic science research and those who specialize in clinical research.
“I think this is a great opportunity for the students to be in contact with experts who understand [the projects] from different perspectives,” Dr. Geba said. “In my case, I’m doing a clinical trial, so for me, it has been very helpful to have a member of my committee with a deeper understanding of the pathology of the disease.”
Mentoring and Collaboration
Dr. Geba says the greatest factor contributing to her success in the TBS program is the interaction she has with its faculty. With an emphasis on interdepartmental collaboration, the program encourages students to work with faculty members who will contribute in unique ways to their development as well-rounded scientists. Dr. Geba says she and her fellow students receive invaluable support from the leadership of the program, which includes the current program director, Dr. Patricia (P.J.) Simpson-Haidaris, and the founding program director, Dr. Nina Schor. Each student also chooses a mentor and research advisor to provide expertise and guidance throughout the research process. Dr. Thomas Pearson (Professor of Public Health Sciences; Senior Associate Dean for Clinical Research; and Director of the Clinical and Translational Science Institute) serves as both mentor and research advisor to Dr. Geba.
“The part that I enjoy the most in working with him is the balance between allowing me to work independently – to use my creative side to solve the issues that arise in [my] project – but also providing a lot of support. [He is] there as a mentor to guide me and to make sure that I move forward at a steady pace,” she said.
In addition to the support from faculty members in the TBS program, Dr. Geba says students receive assistance from individuals within the broader Medical Center community, including those affiliated with the Clinical and Translational Science Institute.
“I use extensively the Research Help Desk resources because the friendly and very knowledgeable team helped me get in contact with resources that help move the project along,” Dr. Geba said. “Another resource I find very helpful – especially for somebody in my position who is doing a clinical trial for the first time – is the Customized Action Plan, which is an online tool which assists researchers in planning and actually implementing their studies.”
Dr. Geba also reaches out to the Greater Rochester community to recruit patients for her clinical trial. She frequently interacts with clinicians associated with the Greater Rochester Practice-Based Research Network.
“I had the wonderful opportunity to present my project to the steering committee of this group twice, and I have to admit, it was an intimidating experience for a first-year student to do this,” she said. “Soon I learned that the feedback I received from the steering committee was so helpful to me.”
Falling in Love with a Terrible Disease: Type 2 Diabetes
Dr. Geba’s primary research interest is type 2 diabetes – a lifelong, chronic disease characterized by high blood glucose levels.
“Type 2 diabetes is, without a doubt, one of the important health issues of the 21st century,” Dr. Geba said. “The burden of the disease is tremendous, both in terms of human suffering because of the disease complications (type 2 diabetes is a risk [factor] for cardiovascular disease and it is the main cause for blindness and non-traumatic amputations among adults) and also due to the costs related to the disease (about one tenth of the total national healthcare costs are diabetes-related).”
The statistics pertaining to diabetes are staggering. According to the American Diabetes Association, more than 25 million children and adults in the United States have diabetes, and an estimated 90-95 percent of these individuals have type 2 diabetes. Nearly 19 million people have been diagnosed with diabetes, while seven million others who have the disease are undiagnosed. Finally, an astounding 79 million people are in the pre-diabetes stage.
“It is very easy to say one quarter of the diabetics are undiagnosed, but as an absolute number, that’s seven million people who are around us who have diabetes and are not aware, don’t start treatment, are not advised to have a lifestyle change that could have such a great impact on their life,” Dr. Geba said.
According to Dr. Geba, an even more disturbing fact is that more young people are being diagnosed with type 2 diabetes.
“We used to say [when I was in medical school] that type 2 diabetes is the disease diagnosed in people 40 or over and when it’s diagnosed before that age, it’s probably type 1. That’s not the case anymore. There are children, teenagers, who are diagnosed with type 2 diabetes and, developing the disease this early in life, they also will likely develop the complications early.”
The high prevalence of undiagnosed diabetes, as well as the high prevalence of pre-diabetes, are strong incentives to continue research focused on optimizing the screening process for the disease. Currently, the tests that are used include a fasting plasma glucose test, a hemoglobin A1c test, and an oral glucose tolerance test. Dr. Geba says a necessary, yet currently absent study, is one which compares the effectiveness of these different screening strategies in a clinical setting. Such a study, which she and Dr. Pearson are now designing, would examine the cost of the tests, their convenience, and their acceptability by the patients and clinicians. Dr. Geba’s project is entitled, “Comparative effectiveness of diabetes screening strategies: a pilot study.”
“My part of the project is actually related to developing a pilot in preparation for that comparative effectiveness study,” Dr. Geba said. “We want to examine the feasibility of the recruiting strategies we plan to use in the large scale study, the feasibility of working with the clinical practices where we want to recruit our participants, and the third objective of the pilot would be to get other data that would help us plan for the sample size for the large study.”
Dr. Geba has been involved with the comparative effectiveness study since its concept phase. She is assisting with the design of the study and will be involved with its implementation – the clinical trial. It is rare that a student has the opportunity to design a clinical trial.
“Learning about all these different aspects of planning and implementing is a great opportunity for me,” she said. “Finding solutions that work in our project is sometimes challenging, but is intellectually stimulating and I think I benefit a lot from this practical experience.”
Dr. Geba explains how her personal experience with diabetes has motivated her research
Dr. Geba’s interest in studying type 2 diabetes began when she was a medical school student, and has grown deeper for personal reasons. While earning her MD, Dr. Geba initially planned to pursue a career in surgery. She often interacted with patients in the surgery clinic; many of these individuals were diagnosed with diabetes and had undergone toe amputations.
“I was moved by their suffering and I wanted to learn more about type 2 diabetes. I studied more, I became more interested, and I could honestly say I was starting to fall in love with this terrible disease. Before I knew it, I was hooked.”
Dr. Geba has also experienced type 2 diabetes on a personal level: two years ago, her mother was diagnosed with the disease. Dr. Geba says because of this, she now has a better understanding of the burden of the disease on patients and their families, as well as how important it is to educate patients in how to manage the disease.
“This personal story has a silver lining because I’m very proud of how my mother handled this – how she really cared about the advice of her primary care provider, and how she allowed us to support her during this period,” Dr. Geba said. “She did a great job; she was slightly overweight and lost a couple of pounds, she’s more careful with her diet, and she exercises more.”
Without the use of glucose-lowering drugs, Dr. Geba’s mother was able to lower her blood glucose to a normal level. Dr. Geba says this is living proof that education and lifestyle changes can make a difference in managing type 2 diabetes.
“Being in the clinic and seeing the suffering of patients – that’s such a strong motivator because you know beyond statistics, which are just numbers. It’s important to see that each of those 25 million people [with diabetes] are people who suffer; they are somebody’s mother or somebody’s spouse or somebody’s teacher or neighbor, and there is a lot of suffering. That’s a strong motivator to keep going.”
It Takes a Village to Raise a Scientist
Dr. Geba explains how the TBS program has shaped her career goals
“Being involved in this program and receiving help and advice and support from so many people with expertise in so many areas really makes me think of that old African proverb, it takes a whole village to raise a child,” Dr. Geba said. “I see [how] the involvement of so many people will help me grow as a researcher, will help me have such a well-rounded experience.”
Dr. Geba says the TBS program has changed her life. She attributes her success to the dedicated and supportive faculty members – her role models – who she says have helped shape her career path and the individual she has become. After earning her PhD, she plans to continue doing research and to pursue a career in academia, with the hopes of working as a mentor.
“I would love to give to the next generation the wonderful things that I’ve received from those ahead of me.”
Greasing the wheels of managing overweight and obesity with omega-3 fatty acids.
Golub N, Geba D, Mousa SA, Williams G, Block RC.
Med Hypotheses. 2011 Dec;77(6):1114-20. Epub 2011 Oct 6.
Identification of those at risk for diabetes mellitus can comparative effectiveness research provide the answer?
Geba D, Pearson TA.
Am J Prev Med. 2011 Jan;40(1):101-3. No abstract available.