Contributions of Hypoglycemia and Hyperglycemia to Adverse Geriatric Outcomes in NH Residents with Diabetes and Alzheimer's Disease and Related Dementias (ADRD)

低血糖和高血糖对患有糖尿病、阿尔茨海默病和相关痴呆 (ADRD) 的新罕布什尔州居民老年不良结局的影响

• 批准号: 10477334
• 负责人: Alexandra Kathryn Lee
• 金额: $ 13.2万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10477334
• 关键词: Acute; Address; Adult; Affect; Aging; Alzheimer' s disease related dementia; Attention; Behavior; Blood Glucose; Caregivers; Caring; Clinical; Cognition; Complex; Crossover Design; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Doctor of Philosophy; Elderly; Electronic Health Record; Environment; Epidemiologist; Epidemiology; Expert Opinion; Foundations; Frail Elderly; Funding; Geriatric Assessment; Geriatrics; Glucose; Goals; Guidelines; Health; Health Services; Hyperglycemia; Hypoglycemia; Impaired cognition; Incidence; Incontinence; Insulin; Link; Measurement; Measures; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Neurology; Non-Insulin-Dependent Diabetes Mellitus; Nursing Homes; Outcome; Policies; Population; Psychiatry; Quality of Care; Quality of life; Recommendation; Research; Research Design; Research Personnel; Risk; Severities; Source; Structural Models; Symptoms; Syndrome; System; Testing; Time; Training; United States Department of Veterans Affairs; Universities; Urinary tract infection; Vulnerable Populations; base; career; career development; clinical care; cognitive function; comorbidity; diabetes management; evidence base; experience; falls; functional decline; high risk; human old age (65+); improved; mid-career faculty; multiple chronic conditions; professor; skills

Project Summary/Abstract Nursing home (NH) residents with type 2 diabetes have substantial multimorbidity that complicates diabetes management. Alzheimer's Disease and related dementias affects nearly 50% of NH residents and may increase risk of hypoglycemia. Current NH diabetes management guidelines do not address Alzheimer's Disease and related dementias and current recommendations for NH target blood glucose ranges are based on expert opinion rather than evidence of adverse geriatric outcomes at certain thresholds of glycemia. To address these weaknesses, we propose the following aims: 1) to compare the incidence rates of hypo- and hyper-glycemia in the NH by dementia status, 2) to examine the acute effects of hypo- and hyper-glycemia on geriatric syndromes and evaluate whether Alzheimer's Disease and related dementias modifies glycemic thresholds, and 3) to examine the cumulative effects of hypo- and hyper-glycemia on cognitive decline and functional decline, and to determine whether baseline severity of Alzheimer's Disease and related dementias modifies glycemic thresholds. The proposed research leverages existing Veterans Affairs electronic health record databases, a unique source of routine fingerstick glucose measurements. The long-term goal of this research is to establish NH-specific target blood glucose ranges with thresholds of hypoglycemia and hyperglycemia that account for the presence of Alzheimer's Disease and related dementias. Dr. Lee seeks a K01 Mentored Research Scientist Development Award to obtain essential skills and mentored research experience that will launch her career as an independent investigator in the field of aging, diabetes, and Alzheimer's Disease and related dementias. The five-year training plan will fill content gaps in geriatric syndromes and the assessment of Alzheimer's Disease and related dementias while building on her methodological strengths to include advanced causal inference methods and using electronic health records for research. Dr. Lee will complete the proposed research in the rich training environment of the UCSF Division of Geriatrics, with primary mentorship from geriatrics health services researcher Dr. Sei Lee, MD, MAS, Professor of Geriatrics at UCSF, co-mentorship by dementia expert Dr. Kristine Yaffe, MD, Professor of Psychiatry, Neurology and Epidemiology at UCSF, and aging epidemiologist Dr. Michelle Odden, PhD, Associate Professor of Epidemiology in the Division of Health Research and Policy at Stanford University. With the support of her mentors, co-mentors, and esteemed advisors, Dr. Lee will advance towards successfully competing for R01 funding and becoming a leader in geriatric diabetes.

项目摘要/摘要 2型糖尿病的疗养院（NH）居民具有很大的多种病，使糖尿病复杂化 管理。阿尔茨海默氏病和相关痴呆症影响近50％的NH居民，可能 增加低血糖症的风险。当前的NH糖尿病管理指南未解决阿尔茨海默氏症 疾病和相关痴呆症以及当前对NH目标血糖范围的建议是基于 出于专家的看法，而不是在血糖的某些阈值处表现出不良老年最终结果的证据。到 解决这些弱点，我们提出以下目的：1）比较低和 通过痴呆状态，NH中的高血糖，2）检查低血糖和高血糖的急性影响 老年综合征并评估阿尔茨海默氏病和相关痴呆症是否会改变血糖 阈值和3）检查低血糖和高血糖对认知能力下降和的累积影响 功能下降，并确定阿尔茨海默氏病和相关痴呆症的基线严重程度是否 修饰血糖阈值。拟议的研究利用现有的退伍军人事务电子健康 记录数据库，这是常规指法葡萄糖测量的独特来源。这个长期目标 研究是为了建立具有低血糖阈值和 高血糖解释了阿尔茨海默氏病和相关痴呆症的存在。李博士寻求 K01指导研究科学家发展奖，以获得基本技能和指导研究 将在衰老，糖尿病和 阿尔茨海默氏病和相关痴呆症。五年培训计划将填补老年病的内容空白 综合症以及对阿尔茨海默氏病和相关痴呆症的评估。 方法论上的优势包括高级因果推理方法并使用电子健康记录 进行研究。李博士将在UCSF部的丰富培训环境中完成拟议的研究 老年医学，由老年医学服务研究员Sei Lee博士，医学博士，MAS，MAS，MAS， UCSF老年医学教授，痴呆症专家Kristine Yaffe博士医学博士，教授 UCSF的精神病学，神经病学和流行病学，老龄化流行病学家米歇尔·奥登（Michelle Odden）博士，博士 斯坦福大学卫生研究与政策部流行病学副教授。和 李博士将在她的导师，联合顾问和受人尊敬的顾问的支持下迈向成功 争夺R01资金并成为老年糖尿病的领导者。