GAFP Membership News

Georgia Academy of Family Physicians Awards Dolapo Babalola, MD, FAAFP, its 2019 Family Medicine Educator of the Year Award

The Georgia Academy of Family Physicians (GAFP) awarded Dolapo Babalola, MD, FAAFP its 2019 Family Medicine Educator of the Year, for her exceptional influence on medical students and residents as faculty at Morehouse School of Medicine.

Dr. Babalola is an Associate Professor of Family Medicine and the Director of Medical Education and Rural Health at Morehouse School of Medicine in Atlanta.

Dr. Babalola has led many innovative efforts, including the Family Medicine Sub-Internship Selective Curriculum both structurally and educationally for the fourth-year medical students to promote primary care. She volunteers in the free student run clinic where she supervises and teaches students as they provide medical care for underserved and uninsured populations. She continues to develop new curricula and initiatives for medical students which includes; mid-clerkship evaluation meetings, group clinical skill sessions and National Board of Medical Examiners Subject examination prep review.

Dr. Babalola received her Doctor of Medicine from the University of Guyana School of Medicine, in Guyana. She completed Postgraduate Training at Morehouse School of Medicine and a fellowship in the Department of Family Medicine Faculty Development and Family Medicine Residency. Dr. Babalola has received the following awards; Grady Community Teacher’s Award, Outstanding Family Medicine Educator by the Morehouse Student Government Association. She was the 2nd place recipient for the Morehouse Faculty Teaching Competition and she was the 2018 GAFP Research Poster Award winner in the Practicing physician category at Georgia Academy of Family Physicians Annual Meeting.

Dr. Babalola embodies the true definition of an effective educator in Family Medicine. She is an emerging leader and we look forward to supporting her in her pursuit of being a lifelong educator.

Dr. Babalola will be among a group of four individuals honored by GAFP at the Annual Fall CME meeting in November.

 

Georgia Academy of Family Physicians Awards Folashade Omole, MD, FAAFP its 2019 Community & Volunteer Services Awards

 

The Georgia Academy of Family Physicians (GAFP) selected Folashade Omole, MD, FAAFP as its 2019 Community & Volunteer Services Award recipient, for her outstanding commitment to the community and efforts in raising awareness about access to and affordability of medical care in underserved communities in Atlanta.

Dr. Omole holds the Sarah & William Hambrecht Endowed Chair of Family Medicine at Morehouse School of Medicine. She is the Professor of Family Medicine and the Medical Director of MSM H.E.A.L. (Health Equity for All Lives), a student-run clinic.

Dr. Omole exemplifies what it truly means to be a volunteer not only giving of her time, but her talents as well. At MSM, she’s a role model for students and residents and goes above and beyond to commit herself to the H.E.A.L. Clinic and the Good Samaritan Health Center in Atlanta. She leads other community initiatives at Morehouse School of Medicine including community health fairs and community engagement days to screen for chronic diseases and provide education.

Dr. Omole is a graduate of the Morehouse School of Medicine Family Medicine Residency Program. She received a BSc in Physics from the University of Lagos, Nigeria; and her medical degree from Obafemi Awolowo University, lle-lfe, Nigeria; two of the foremost prestigious universities in Nigeria. In 2000, Dr. Omole was appointed Clerkship Director in the Department of Family Medicine at MSM; and Residency Program Director in September 2004. She practices the full scope of family medicine including obstetrics; and is also a licensed medical acupuncturist.

Dr. Omole has served in various roles with the Georgia Academy of Family Physicians (GAFP) including Treasurer, District 11 Director for the GAFP Board and the GAFP Executive Committee. She was the recipient of the Georgia Academy Family Physician Educator of the Year Award in 2006 and the GAFP Family Physician of the Year in 2015. Dr. Omole will be among a group of four individuals honored by GAFP.

Dr. Omole will be among a group of four individuals honored by GAFP at the Annual Fall CME meeting in November.

Members in the News

Altelisha Taylor, MD, MPH appointed to the AAFP Commission on Continuing Professional Development (COCPD)

The American Academy of Family Physicians Board of Directors has appointed Altelisha Taylor, MD, MPH, to the AAFP Commission on Continuing Professional Development (COCPD) for 2019-2020. Dr. Taylor’s term begins December 15, 2019.

Dr. Taylor is a PGY-1 resident at Emory University Family Medicine Residency Program in Atlanta, GA.

Congratulations Dr. Taylor!

GLP-1 Receptor Agonists: Where do these non-insulin injectables, and newly approved oral option, fit in for the treatment of Type 2 Diabetes Mellitus?

GLP-1 Receptor Agonists:

Where do these non-insulin injectables, and newly approved oral option, fit in for the treatment of Type 2 Diabetes Mellitus?

By: Cedrice Davis, MD

Advances in treatment options for Diabetes have expanded over the last decade. While first-line therapy for the treatment of Diabetes has remained Metformin and comprehensive lifestyle modifications, several professional organizations, including the American Diabetes Association1, American College of Cardiology2, American Heart Association3, and American College of Clinical Endocrinologists4, have updated their guidelines to reflect a wider playing field for 2nd line options. Glucagon Like Peptide – 1 Receptor Agonists (GCP-1 RA) is one of those options.

Despite guideline updates, utilization of GLP-1 RA in the primary care setting remains relatively low.5 As an outpatient family physician with an office that participates in diabetes clinical research trials, I think it is important that we take a look at why this class of medicines should be part of the primary care physician’s armamentarium in the fight to control this disease.

GLP-1 is a member of the incretin family of glucoregulatory hormones.  It is secreted in response to food ingestion. GLP-1 RA therapies attempt to correct the dysregulation/dysfunction of normal physiology that contributes to the diabetes disease state.  GLP-1 RAs impact several core defects present in type 2 diabetes.6Background:

How do GLP-1 RA work?6

  1. Glucose-dependent increase in insulin secretion from pancreas. It does so by stimulating the beta cells of the pancreas in the setting of a glucose load.
  2. Glucose-dependent decrease of glucagon secretion from the liver. In Diabetes, the hormone glucagon is oversecreted causing an unwanted release of glucose from the liver. The suppression of the glucagon results in a welcomed decrease of glucose from the liver.
  3. Increased satiety resulting in a suppressed appetite. This occurs via receptors in the central nervous system.
  4. Delayed gastric emptying. This results in lower postprandial glucose levels.
  5. Protection of 𝛽-cell mass (demonstrated in animal models).

GLP-1 RA Products Available:

There is currently one newly approved oral GLP-1 RA and six injectable GLP-1 RAs available in the U.S. Dulaglutide (Trulicity), exenatide (Bydureon), exenatide (Byetta), liraglutide (Victoza), lixisenatide (Adlyxin), and semaglutide injectable (Ozempic) and now semaglutide oral (Rybelsus). (Click on brand name for link to product information)

Expected Clinical Outcomes:6,7,8

A1C reduction: 0.8-1.8%

Body weight reduction: 2-14 lbs

Efficacy and safety between GLP-1RAs vary. All have demonstrated cardiovascular safety, but liraglutide has an FDA approved indication to prevent CVD in high risk patients. Other GLP1 RAs are currently under FDA review for a CVD prevention indication (e.g., dulaglutide, semaglutide).

Cost:

Out of pocket expense for the patient will vary depending on insurance coverage.  Most manufacturers offer copay assistance for commercially insured patients and financial assistance for low income patients.

Tolerability: 6,7,9

GLP-1 RAs are generally well tolerated, with nausea and vomiting being the most common adverse event.  It is important to inform patients initiating GLP-1 RA therapy that this may occur initially, but it is usually transient and is typically mild to moderate in nature. If nausea is bothersome, the patient may be advised to eat smaller meals and avoid spicy or high-fat meals.  For patients already on the GLP-1 RA that experience nausea and vomiting with dose titration, consider decreasing back to the last tolerated dose for 1 week before repeating the incremental dosing steps.  The ADA standards of care note that renal dosing adjustments are required for exenatide and lixisenatide.1   Injection site reactions have also been reported.

What about GLP-1 RA and risk of pancreatitis? 9,10

Type 2 diabetes is a risk factor for development of acute pancreatitis, and studies of patients treated with GLP-1 RAs have reported that pancreatitis may occur more frequently with these medications, but results have been mixed. According to the PIs of all GLP-1 RAs, if pancreatitis is suspected, these drugs should be discontinued, and if acute pancreatitis is confirmed, they should not be restarted. The FDA and the European Medicines Agency (EMA) have agreed that assertions concerning a causal association between incretin-based drugs and pancreatitis or pancreatic cancer, as expressed in some scientific literature and in the media, are inconsistent with current data; however, the FDA and the EMA have not reached a final conclusion regarding such a causal relationship.

What about GLP-1 RA and risk of thyroid tumors? 6,7

In rodent models, GLP-1RAs have been linked to the release of calcitonin, and the potential formation of thyroid tumors, but there is no evidence of a causal relationship between GLP-1 RAs and thyroid tumors in humans. Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome is contraindicated according to the FDA PI for the long acting GLP-1 RAs dulaglutide, liraglutide, semaglutide and exenatide once weekly.

COMING SOON: 11

Different delivery systems for GLP-1 RAs are being investigated. Oral Semaglutide (Rybelsus) was approved by the FDA on September 20, 2019 and is now available in pharmacies. Other oral options are also being investigated as well as an implantable osmotic pump…. stay tuned!

References:

  1. American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42(Suppl. 1): S1-S193. https://doi.org/10.2337/dc19-S009
  2. Das SR, et al. 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on expert consensus decision pathways [published online November 26, 2018]. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2018.09.020
  3. Arnett DK, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2019 Mar 17; [e-pub]. https://doi.org/10.1016/j.jacc.2019.03.010
  4. Alan J. Garber, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2019 Executive Summary. Endocrine Practice: January 2019, Vol. 25, No. 1, pp. 69-100. https://doi.org/10.4158/EP151126.CS
  5. Raval, A. D., et al. National Trends in Diabetes Medication Use in the United States: 2008 to 2015. Journal of Pharmacy Practice.2018. https://doi.org/10.1177/0897190018815048
  6. Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metab.2018 Apr 3;27(4):740-756. https://doi.org/10.1016/j.cmet.2018.03.001
  7. Hinnen, D., et al. Glucagon-like peptide 1 receptor agonists for type 2 diabetes. Diabetes Spectr, 30 (3) 2017;202-210. https://doi.org/10.2337/ds16-0026
  8. Pratley RE, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol 2018;6:275–86. https://doi.org/10.1016/S2213-8587(18)30024-X
  9. Thomsen RW, et al. Incretin-based therapy and risk of acute pancreatitis: a nationwide population-based case-control study. Diabetes Care 2015;38:1089–1098. https://doi.org/10.2337/dc13-2983
  10. Egan AG, et al. Pancreatic safety of incretin-based drugs—FDA and EMA assessment.New England Journal of Medicine. 2014;370(9):794-797. https://doi.org/1056/NEJMp1314078
  11. Meier, J.J., et al. Incretin-based therapies: where will we be 50 years from now? Diabetologia. 2015;58: 1745. https://doi.org/10.1007/s00125-015-3608-6

In Memory of Our Colleagues

As this year draws to a close, the GAFP Board of Directors would like to acknowledge our members who passed away in 2019. These members were long-time, valued members of our organization, and embodied the attributes we outline in our mission – enhance the well-being of Georgians by promoting healthy practices consistent with the principles of family medicine.

Each of these members was an integral part of the communities in which they lived, and the patients they served throughout their careers.  The GAFP mourns their loss and will continue to serve as true advocates of family medicine in their memory.

Laurence T. Crimmins, MD ~ Albany

Chester R. Lapeza, MD ~ Cordele

Robert Mainor, MD ~ Smyrna

Bonnie P. Malvea, MD ~ Jonesboro

Beena S. Patel, MD ~ Sandy Springs

Allen L. Pelletier, MD ~ Augusta

Roslyn Donny Taylor, MD ~ Summerville, SC

Bradley L. Ward, MD ~ Taylorsville

 

“In the end, it’s not the years in your life that count. It’s the life in your years.

–Abraham Lincoln