Profile: Up close with Associate Professor Lim Su Chi

By Kimberley Wang, Manager, Media and Publications, Communications and Outreach

A clinician-scientist with close to two decades of experience in translational and clinical research, Associate Professor Lim Su Chi believes that the key to pursuing research is being young at heart and aspiring to make a difference. 

A/Prof Lim is the Co-Director of LKCMedicine’s Nutrition, Metabolism & Health research programme, Clinical Director of the Clinical Research Unit at Khoo Teck Puat Hospital, and Clinical Director of the Clinician Scientist Development Office at the National Healthcare Group (NHG) Group Research. In recognition of his excellent research performance, A/Prof Lim was recently conferred the Dean’s Awards for Research​.

In an interview with The LKCMedicine, A/Prof Lim talks about the major healthcare “tsunamis” that we are facing, what is being done to tackle diabetes in Singapore, and how medical students can get started in research.

Associate Professor Lim Su Chi (second from left) with his research team

Q: What inspired you to pursue a career in research?

Research is very much an extension of clinical practice. It is natural to be interested in research when practising medicine, especially when motivated by the aspiration to improve patient care. Research is one of the ways to better achieve better patient care.

Q: As Co-Director, how do you see LKCMedicine’s Nutrition, Metabolism & Health research programme contributing to realising the School’s vision of Redefining Medicine, Transforming Healthcare? 

In partnership with Programme Director Associate Professor Yusuf Ali, the programme provides a platform to bring together close collaboration between the scientist, clinical scientist, clinician-scientist, clinician and innovator in a whole continuum of research. This powerful consortium is pivotal to translating science to improve patient care and population health. Therefore, together, NHG, LKCMedicine and NTU can combine to conquer.

Q: How is the programme in line with the Healthier SG strategy, which takes an upstream approach in keeping people healthy by driving preventive care and early intervention? 

Metabolic burden is one of two major “tsunamis” hitting Singapore, the other one is ageing. We are going to face a convergence of these two “tsunamis”. While this is not unique to Singapore, we are facing accelerated problems because of urbanisation, better nutrition, less physical activities and an ageing society.

In collaboration with our partners at primary care and population health, we can help to better understand and describe metabolic problems such as obesity and diabetes among Asians and the different age groups.

We need to be able to understand metabolic disorders contextualised to our population and to describe them accurately. The impact of diabetes on our Asian and ageing population is different. For example, Asians are known to develop diabetes much younger, partly because they are more susceptible to diabetes with a lower burden of obesity. Another example is in an ageing population, the problem of obesity is compounded by sarcopenia, which is the gradual loss of muscle mass. This twin problem of obesity and sarcopenia (“sarcopenic obesity”) is especially challenging to manage well.

With a better understanding of metabolic problems in the context of Asians and an ageing population, we can improve the precision of intervention at the primary care and population level. 

Q: You are also Senior Consultant at the Diabetes Centre in Admiralty Medical Centre. In Singapore, one in three individuals in Singapore is at risk of developing diabetes in their lifetime. What is being done to address this health crisis?

It is important to recognise that not all diabetes are the same, in terms of causes and differential susceptibility to the spectrum of diabetic complications. It is not a single disease. There is no one-size-fits-all treatment strategy. For example, intensive weight management may be relevant for people who are obese but less so for those who are slim or frail.

Young people with diabetes tend to have a more aggressive disease trajectory, partly because the duration of having diabetes may be very long in their lifetime. Another point is that diabetes begets diabetes because a mother with diabetes is more likely to affect the susceptibility for diabetes in the next generation. The good news is that with good control, the aggressive course of the disease can be managed. With better diagnostics classification, the treatment choice can be better matched to the person.

Although our nation is on the right track in the war against diabetes, we can improve the precision of our intervention and prevention strategies to address the diabetes-spectrum.

Q: Your work has been published in top scientific journals such as Nature Communications. What are some of the key research projects that you are working on? 

The first is our group has contributed to understanding the mechanisms of diabetic kidney disease among Asians. We recognise that Asians are very susceptible to chronic kidney disease when they contract diabetes, much more than the other populations. This differential susceptibility is what we need to understand. 

In Singapore, more than 50 per cent of our dialysis population is due to diabetes. This is one of the highest in the world. The study not only allows us to better understand the reasons for getting kidney failure, but also who the high-risk group is and therefore, target the interventions to this group.

Through our prospective diabetes cohorts with a total size of close to 10,000 individuals over more than 10 years, it allows us to understand exposure, outcomes, and biomarkers. The biomarkers will better reveal the biology and relationship between the exposure.

The second is we have gained a better understanding of monogenic subgroups of complex traits like diabetes, hypertension and obesity. For any complex trait such as obesity, a sub-population of people who have this complex trait have a monogenic basis for their condition. This subset of individuals with a monogenic basis for their complex trait are the “poster boys” for precision genetic medicine. We can use genetics to make an accurate diagnosis and oftentimes, the treatment is very well guided by the genetic diagnosis. For example, for monogenic diabetes, some of the sub-types respond very well to a medicine called sulfonylureas.

Monogenic diseases are individually rare but collectively abundant. They are the low hanging fruits of genomic medicine, where precision medicine and intervention work best.

Q: What would you consider your biggest research breakthroughs to date? 

We have contributed to a better understanding of the biology and disease-trajectories of different subtypes of diabetes among Asians using both clinical and molecular tools. This highlights what clinician-scientists can contribute. We understand the clinical dimension, so we can use relevant and practical clinical parameters to classify our patients. 

While this is more applicable to the real world, it falls short of understanding the biology. This is where we combine the molecular tools – the “omics” (such as genomics) and biomarkers – to better describe the subtypes of diabetes. Our research lays the foundation to improve precision in diabetes care in the clinics. 

Clinician-scientists combine the understanding of the clinical world and the science world and put them together to improve our diagnostic classification of people with diabetes so that when we intervene, we are better guided by a deeper understanding of the disease biology.

Q: For our MBBS students who are interested in research, what advice would you give them on how to get started?

My suggestion is to take research training as seriously as clinical training. Like training in clinical medicine, research training is training of the mind. This will allow a clinician, eventually, to be able to evaluate a clinical problem using scientifically sound methodology. Without giving due emphasis on research training, when medical students become clinicians, they short-change themselves. Scientific training helps them to evaluate the scientific data without it becoming a black box. It is the key to unlocking the black box. 

The second advice is to forever be young at heart and be MAD – Make A Difference! Some of my best collaborators are in their seventies and they are more curious than the nineteen-year-old medical students. Even at their age, they remain very curious and open to inquisitive learning. 

Q: Your multiple roles must keep you busy! What do you enjoy doing in your free time?

I would love to have more free time. With whatever little I have, I enjoy spending time with my family and friends. I also go for long walks in my neighbourhood to reflect on things that I have read, listened to and learnt. The quiet time allows things to percolate and crystallise – to see how the dots are connected and bring meaning to the wide spectrum of ideas we are exposed to every day.