VAMC Endocrinology Section

Louisville VAMCEDUCATION

As one of four statutory missions, the U.S. Department of Veterans Affairs (VA) conducts an education and training program for health professionals, medical students and residents to enhance the quality of care provided to veteran patients within the Veterans Health Administration (VHA) healthcare system.

In accordance with this mission, "To educate for VA and for the Nation," education and training efforts at the Robley Rex Veterans Affairs Medical Center are accomplished through coordinated programs and activities in partnership with the University of Louisville.

The Louisville VAMC is an integral part of our UofL Division of Endocrinology, Metabolism and Diabetes and Endocrinology Fellowship Training Program. We are very proud to serve our nation's veterans.

The VA is an important fellowship training resource, and each of our  fellow rotates through the Louisville VAMC, which provides a great learning opportunity through its multiple general endocrinology and specialized clinics and clinical research programs.

CLINICAL SERVICE

  • General Endocrinology Clinics - The Endocrinology Section has daily Clinics at the VAMC staffed by attending physicians and / or nurse practitioners. A wide range of endocrine disorders are seen in these clinics. The VA has efficient electronic medical record system and a number of clinical and ancillary facilities including radiology, clinical laboratory, nutrition counseling, comprehensive and individual diabetes education, and pharmacy teams.
  • Diabetes Technology Clinic - With advances in insulin delivery and glucose monitoring systems more Veterans have the opportunity to use insulin pumps, continuous glucose monitoring systems, and sensor-augmented pump therapy. In addition to offering routine care, veterans using these devices are seen in this specialized clinic to address technology related issues and optimize the use of these technologies. Fellows and residents participate in these clinics and have an opportunity to learn more about these cutting-edge technologies.
  • Ultrasound Guided FNA of Thyroid - Fellows have the opportunity to train in performance of US guided fine needle aspiration biopsy techniques. The Endocrinology Section has access to ultrasound equipment that is dedicated for this use.
  • Post-Bariatric Surgery Multi-disciplinary Clinic - Management of obesity is a lifelong process. Veterans who have had bariatric surgery are followed in this clinic to help them maintain or enhance weight loss, and prevent weight gain. In addition, they are monitored for long term adverse consequences of bariatric surgery and are counseled on ways to prevent complications. This clinic is held once a month and fellows rotate through this clinic.
  • Tele Medicine (VVIC) - The Veterans Administration has been a pioneer in providing telehealth services to veterans over last several years. With the ongoing COVID pandemic, the VA has taken the lead in setting a goal of increasing telemedicine use to approximately 30% of clinic visits. This will be a wonderful opportunity for residents and fellows to train in use of Tele Medicine.
  • Diabetes Self-Management Education and Support - The Louisville VA Medical Center offers comprehensive Diabetes Self Management Education program at the Robley Rex VA Medical Center. In addition, individual diet counseling and one-on-one education is also provided in both inpatient and outpatient settings.

Section of Endocrinology and Diabetes members:

RESEARCH COLLABORATIONS

The Endocrinology Section at the Robley Rex VA Medical Center has a long history of clinical and basic research. In addition to pioneering work on islet biology by Drs. Samols, Stagner, and Mokshagundam, the Section has participated in a number of landmark clinical trials such as the Diabetes Control and Complications Trial and ALLHAT. We have also been a clinical site for numerous pivotal industry sponsored clinical trials including inhaled insulin, rapid and long acting insulins, GLP-1 analogs, SGLT 2 inhibitors and others.

Fellows have participated in research projects utilizing data from the local electronic records. In addition, the VA data base (Vinci) has been used by our fellows, under the guidance of Dr. Krishnasamy, to analyze data on post-bariatric surgery patients.

Current and recently completed landmark clinical trials at our VA site:

  • 2010-2016 - LEADER: A long-term, multi-center, international, randomized double-blind, placebo-controlled trial to determine Liraglutide effects on cardiovascular events in diabetic subjects. Sponsoring Agency: Novo Nordisk. Multi-Center Clinical Trial.
  • 2011-2016 - Phase III, Multi-center Clinical Trial: An international, randomized, parallel group, double blind cardiovascular safety study of BI 10773 (10 mg and 25 mg administered orally once daily) compared to usual care in Type 2 diabetes mellitus patients with increased cardiovascular risks. Sponsoring Agency: Boehringer Ingelheim. Multi-Center Trial.
  • 2013-2016 - SUSTAIN 6: A long term randomized, double blind, placebo controlled multi-center trial to evaluate cardiovascular and other long term outcomes with semaglutide in subjects with Type 2 diabetes. Sponsoring Agency: Novo Nordisk. Multi-Center Trial.
  • 2014-2016 - DEVOTE: A long term, randomized, double –blind, placebo controlled, four-armed parallel group multi-national, multi-center safety and efficacy trial to evaluate cardiovascular and long term outcomes with insulin degludec in subjects with t2dm when compared to insulin glargine when added to standard of care treatment. Sponsoring Agency: Novo Nordisk. Multi-Center Trial.
  • 2017-present - PROMINENT Kowa K-877-302 study: Pemafibrate to Reduce cardiovascular Outcomes by reducing triglycerides in diabetic patients. Sponsoring Agency: KOWA Research Institute - VA NAVRAF

References:

  • Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB; LEADER Steering Committee; LEADER Trial Investigators. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016 Jul 28;375(4):311-22. doi: 10.1056/NEJMoa1603827. Epub 2016 Jun 13. PubMed PMID: 27295427; PubMed Central PMCID: PMC4985288.
  • Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, Tornøe K, Zinman B, Buse JB; LEADER Steering Committee and Investigators. Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med. 2017 Aug 31;377(9):839-848. doi: 10.1056/NEJMoa1616011. PubMed PMID: 28854085.
  • Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, Pieber TR, Pratley RE, Haahr PM, Lange M, Brown-Frandsen K, Moses A, Skibsted S, Kvist K, Buse JB; DEVOTE Study Group. Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes. N Engl J Med. 2017 Aug 24;377(8):723-732. doi: 10.1056/NEJMoa1615692. Epub 2017 Jun 12. PubMed PMID: 28605603; PubMed Central PMCID: PMC5731244.

 For more than 90 years, the VA Office of Research and Development has been improving the lives of Veterans and all Americans through health care discovery and innovation.

The mission of VA Research is fourfold:

  1. to improve Veterans' health and well-being via basic, translational, clinical, health services, and rehabilitative research;
  2. to apply scientific knowledge to develop effective individualized care solutions for Veterans;
  3. to attract, train, and retain the highest-caliber investigators, and nurture their development as leaders in their fields; and
  4. to assure a culture of professionalism, collaboration, accountability, and the highest regard for research volunteers' safety and privacy.

VA Research is unique because of its focus on health issues that affect Veterans. It is part of an integrated health care system with a state-of-the-art electronic health record and has come to be viewed as a model for superior bench-to-bedside research.

We are proud to serve those who served.

Clinical and Research team
Section of Diabetes and Endocrinology
Robley Rex VAMC at Louisville, KY