Robert J. Smith joined the faculty as Professor of Medicine in 2000. He directed the Division of Endocrinology at Brown and Lifespan from 2000-2011 and was founding director of the Hallett Center for Diabetes and Endocrinology at Rhode Island Hospital. His education included a BA in biochemistry from the University of Pennsylvania, a BMS degree from Dartmouth Medical School, and an MD from Harvard Medical School. He completed internal medicine residency training at Duke University and subspecialty training in endocrinology, diabetes and metabolism at the National Institutes of Health (Bethesda, MD) and the Brigham and Women's Hospital (Boston, MA). Prior to coming to Brown, he was a member of the faculty of Harvard Medical School from 1978-2000, where he served as Director of the Metabolism Section and Associate Director of Research at the Joslin Diabetes Center, and was on the clinical staffs of the Brigham and Women's Hospital and the Beth Israel Deaconess Medical Center.
Dr. Smith has conducted a broad range of laboratory and clinical research on the mechanisms of cellular signaling by insulin, insulin-like growth factors and growth hormone, and the mechanisms through which changes in signaling lead to human disease. He currently has a primary focus on epidemiology and pharmacoepidemiology research relevant to diabetes and its complications.
| Hiatt WR, Smith RJ. "Assessing the clinical benefits of lipid-disorder drugs." New England Journal of Medicine, vol. 370, no. 5, 2014, pp. 396-9. |
| Engler PA, Ramsey SE, Smith RJ. "Alcohol use of diabetes patients: the need for assessment and intervention." Acta diabetologica, vol. 50, no. 2, 2013, pp. 93-9. |
| Smith RJ. "Nutrition and metabolism in hepatocellular carcinoma." Hepatobiliary surgery and nutrition, vol. 2, no. 2, 2013, pp. 89-96. |
| Hiatt WR, Kaul S, Smith RJ. "The cardiovascular safety of diabetes drugs--insights from the rosiglitazone experience." New England Journal of Medicine, vol. 369, no. 14, 2013, pp. 1285-7. |
| Smith RJ, Hiatt WR. "Two new drugs for homozygous familial hypercholesterolemia: managing benefits and risks in a rare disorder." JAMA Internal Medicine, vol. 173, no. 16, 2013, pp. 1491-2. |
| Morita M, Ler LW, Fabian MR, Siddiqui N, Mullin M, Henderson VC, Alain T, Fonseca BD, Karashchuk G, Bennett CF, Kabuta T, Higashi S, Larsson O, Topisirovic I, Smith RJ, Gingras AC, Sonenberg N. "A novel 4EHP-GIGYF2 translational repressor complex is essential for mammalian development." Molecular and Cellular Biology, vol. 32, no. 17, 2012, pp. 3585-93. |
| Malandrino N, Wu WC, Taveira TH, Whitlatch HB, Smith RJ. "Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes." Diabetologia, vol. 55, no. 1, 2012, pp. 226-35. |
| Akanji AO, Smith RJ. "The insulin-like growth factor system, metabolic syndrome, and cardiovascular disease risk." Metabolic syndrome and related disorders, vol. 10, no. 1, 2012, pp. 3-13. |
| Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, Smith RJ, Smith SR. "Obesity and type 2 diabetes: what can be unified and what needs to be individualized?." The Journal of Clinical Endocrinology & Metabolism, vol. 96, no. 6, 2011, pp. 1654-63. |
| Eckel RH, Kahn SE, Ferrannini E, Goldfine AB, Nathan DM, Schwartz MW, Smith RJ, Smith SR, Endocrine Society, American Diabetes Association, European Association for the Study of Diabetes. "Obesity and type 2 diabetes: what can be unified and what needs to be individualized?." Diabetes Care, vol. 34, no. 6, 2011, pp. 1424-30. |
| Malandrino N, Smith RJ. "Personalized medicine in diabetes." Clinical Chemistry, vol. 57, no. 2, 2011, pp. 231-40. |
| Smith RJ, Nathan DM, Arslanian SA, Groop L, Rizza RA, Rotter JI. "Individualizing therapies in type 2 diabetes mellitus based on patient characteristics: what we know and what we need to know." The Journal of Clinical Endocrinology & Metabolism, vol. 95, no. 4, 2010, pp. 1566-74. |
Robert Smith's current projects are investigating novel strategies for defining the effects of drugs used for the treatment of elevated blood glucose levels in diabetes mellitus on the long-term complications of diabetes. The primary goal is to develop methods for assessing the effects of specific drugs on macrovascular and microvascular disease outcomes, when used in variable combination with multiple other glucose-lowering drugs.
Diabetes mellitus currently affects approximately 10% of the U.S. population and has a generally similar prevalence throughout the world. Approximately 90% of these patients have type 2 diabetes. This form of diabetes has been increasing markedly in incidence over the past several decades as a consequence of increased obesity and lifestyle changes that include increased calorie intake and decreased physical exercise.
Many patients with type 2 diabetes experience substantial morbidity and shortened lifespan from gradually developing and progressive long-term complications, even with the use of currently available agents to manage blood glucose levels and other metabolic abnormalities. These include microvascular complications (vision loss secondary to retinal disease, kidney failure secondary to renal glomerular disease, and debilitating, often painful neuropathies). They also include macrovascular complications (myocardial infarction, peripheral vascular disease, and stroke). Approximately 70% of patients with type 2 diabetes ultimately die from cardiovascular disease.
The treatment of elevated blood glucose levels in type 2 diabetes typically involves multiple glucose-lowering agents used in combination. Patients often are managed with two or three different agents from a total of nine drug classes (including oral agents, insulin by injection, and non-insulin agents administered by injection). The primary goal in the clinical use of these drugs is to lower blood glucose levels as close to normal as possible without causing hypoglycemia. The various available drugs differ in their efficacy in lowering blood glucose, their propensity to cause hypoglycemia, and in their potential to increase or decrease diabetes long-term complications through mechanisms independent of effects on blood glucose levels.
Most of our knowledge of the benefits and risks of glucose-lowering drugs in type 2 diabetes is derived from studies designed to examine a single drug compared to placebo, or much less frequently two drugs compared to each other. These experimental approaches provide only limited insight into the potential beneficial or adverse effects of glucose-lowering drugs in the real world setting, where they typically are used in combinations.
In studies designed in collaboration with faculty members in epidemiology/biostatistics and pharmacoepidemiology, Dr. Smith is investigating methods for probing the effects of glucose-lowering drugs in type 2 diabetes. The goal is to develop novel methodologic strategies that will provide valid new insights into drug effects on diabetes outcomes from analysis of currently available large clinical databases.
Current Research Support
Agency: Patient-Centered Outsomes Research Institute (PCORI) (Roee Gutman PI)
Dates: 2/15-2/18
Title: Estimation of Multi-treatment effects from observational data with application to diabetes mellitus
Role: Co-Investigator
| Year | Degree | Institution |
|---|---|---|
| 1973 | MD | Harvard University |
| 1971 | BMS | Dartmouth College |
| 1969 | BA | University of Pennsylvania |
| Clinical Fellow | Peter Bent Brigham Hospital, endocrine | 1979-1979 | Boston, MA |
| Clinical Associate/Investigator | National Cancer Institute, National Institutes of Health, metabolism and endocrinology | 1975-1978 | Bethesda, MD, USA |
| Junior Assistant Resident | Duke University Medical Center, internal medicine | 1974-1975 | |
| Intern | Duke University Medical Center, medicine | 1973-1974 | |
| Research Fellow | nutrition | 1972-1972 | Republic of Zaire |
| Research Associate | Dartmouth Medical School, Endocrinology | 1971-1971 | Hanover, NH |
| Research Associate | Massachusetts Institute of Technology, biochemistry | 1969-1969 | Cambridge, MA |
1971 B.M.S. with Honors from Dartmouth Medical School
1972 AMA Goldberger Fellowship Research Award
1972-1978 National Institutes of Health (NIH) Costep Fellowship Award
1978-1986 Howard Hughes Medical Institute
1990 Elected to American Society for Clinical Investigation
1995 Harvard Division of Medical Ethics Responsible Conduct of Research Award
2007 Dean’s Teaching Excellence Award, The Warren Alpert Medical School of Brown University
2007 Taft Award of the Endocrine Society of Australia
2007 Honorary Professor, Luzhou Medical University, Luzhou, China
2007-2010 Honorary President of the Affiliated Hospital of Luzhou Medical University, Luzhou, China
2009 Certificate of Recognition for Exemplary Teaching, Endocrine Sciences, Alpert Medical School of Brown University
| Name | Title |
|---|---|
| Dore, David | Adjunct Assistant Professor of Health Services, Policy and Practice |
| Gutman, Roee | Professor of Biostatistics |
Affiliated Institution Appointments:
Research Staff, Ocean State Research Institute, Providence Veterans Administration Medical Center
Other Current Positions:
Chair, U.S. FDA Endocrinologic and Metabolic Drugs Advisory Committee
Chair, Diabetes Advisory Council, Rhode Island Department of Health
Chair, Medical Research Grant Review Committee, Rhode Island Foundation
Current Editorial Boards:
Acta Diabetologia
Journal of Growth Hormone and IGF Research (Associate Editor)
Journal of Hepatobiliary Surgery and Nutrition
UpToDate (Diabetes Section)
| Medical License | Rhode Island | 2001-Present | |
| Certification | American Board of Internal Medicine, Endocrinology, diabetes, and metabolism | 1983- | |
| Medical License | Massachusetts | 1978-2011 | |
| Medical License | Virginia | 1977-1978 | |
| Certification | American Board of Internal Medicine, Internal medicine | 1976- |
| Research Division Staff. Providence VA Medical Center, 2011-Present |
| Medical Staff. Providence VA Medical Center, 2001-Present |
| Director of the Division of Endocrinology. Brown Medical School & the Lifespan Rhode Island Academic Medical Center (Rhode Island Hospital and the Miriam Hospital), 2000-2011 |
| Founding Director. Brown Medical School & Rhode Island Hospital, 2000-2011 |
| Consultant. Joslin Diabetes Center, 2000-2006 |
| Consultant. Brigham and Women's Hospital, 1999-2006 |
| Associate Director of Research. Joslin Diabetes Center, 1999-2000 |
| Medical Staff. Beth Israel Deaconess Medical Center, 1995-2001 |
| Acting Director of Research. Joslin Diabetes Center, 1990-1991 |
| Assistant Director of Research. Joslin Diabetes Center, 1987-1999 |
| Active Provisional Staff. New England Deaconess Hospital, 1986-1997 |
| Associate Medical Staff. Joslin Clinic, 1985-2000 |
| Head of Metabolism Section. Joslin Research Laboratory, 1984-2000 |
| Associate Physician. Brigham and Women's Hospital, 1982-1999 |
| Senior Investigator. Joslin Research Laboratory, 1981-2000 |
| Junior Associate in Medicine. Brigham and Women's Hospital, 1978-1982 |
| Investigator. Joslin Research Laboratory, 1978-1981 |
